Resident conferences that focus on mistakes result in higher quality of care

Residents who attend conferences that focus on missed or misinterpreted cases are 67% less likely to miss important findings when reading on-call musculoskeletal x-ray images, a new study shows.

"Residents had 55 major discrepancies out of 5,326 x-ray studies of the shoulder, elbow, hand, wrist, ankle, foot, pelvis and knee before we began holding regular focused missed case conferences," said Dr. Jason Itri, of the Hospital of the University of Pennsylvania, and one of the authors of the study. That number dropped to 18 major discrepancies out of 5,272 x-rays studies after the focus missed-case conferences became part of the resident education program, he said.

The value of the conferences was emphasized by the fact that the major discrepancy rates for residents who attended the conferences was lower than that for board certified fellows who did not attend the conferences, Dr. Itri said. "During the time of the study, fellows had an overall major discrepancy rate of 1.5% diagnosing musculoskeletal injuries related to topics discussed during the missed-case conferences, while the residents overall major discrepancy rate was only 0.8%, nearly one-half the miss rate for fellows," he said.

The results of the study have encouraged Dr. Itri's department to include 10 focused missed cased conferences as part of a three week course residents take before they can take independent call. In addition, Dr. Itri and his colleagues are developing fellow-specific missed case conferences in each specialty.

The study is published in the October, 2011 American Journal of Roentgenology.