Educational interventions to improve screening mammography interpretation: A randomized controlled trial

Berta M. Geller, Andy Bogart, Patricia A. Carney, Edward A. Sickles, Robert Smith, Barbara Monsees, Lawrence W. Bassett, Diana M. Buist, Karla Kerlikowske, Tracy Onega, Bonnie C. Yankaskas, Sebastien Haneuse, Deirdre Hill, Matthew G. Wallis, Diana L Miglioretti

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to conduct a randomized controlled trial of educational interventions that were created to improve performance of screening mammography interpretation. MATERIALS AND METHODS. We randomly assigned physicians who interpret mammography to one of three groups: self-paced DVD, live expert-led educational seminar, or control. The DVD and seminar interventions used mammography cases of varying difficulty and provided associated teaching points. Interpretive performance was compared using a pretest-posttest design. Sensitivity, specificity, and positive predictive value (PPV) were calculated relative to two outcomes: cancer status and consensus of three experts about recall. The performance measures for each group were compared using logistic regression adjusting for pretest performance. RESULTS. One hundred two radiologists completed all aspects of the trial. After adjustment for preintervention performance, the odds of improved sensitivity for correctly identifying a lesion relative to expert recall were 1.34 times higher for DVD participants than for control subjects (95% CI, 1.00-1.81; p = 0.050). The odds of an improved PPV for correctly identifying a lesion relative to both expert recall (odds ratio [OR] = 1.94; 95% CI, 1.24-3.05; p = 0.004) and cancer status (OR = 1.81; 95% CI, 1.01-3.23; p = 0.045) were significantly improved for DVD participants compared with control subjects, with no significant change in specificity. For the seminar group, specificity was significantly lower than the control group (OR relative to expert recall = 0.80; 95% CI, 0.64-1.00; p = 0.048; OR relative to cancer status = 0.79; 95% CI, 0.65-0.95; p = 0.015). CONCLUSION. In this randomized controlled trial, the DVD educational intervention resulted in a significant improvement in screening mammography interpretive performance on a test set, which could translate into improved interpretative performance in clinical practice.

Original languageEnglish (US)
JournalAmerican Journal of Roentgenology
Volume202
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Mammography
Randomized Controlled Trials
Odds Ratio
Neoplasms
Teaching
Logistic Models
Physicians
Sensitivity and Specificity
Control Groups

Keywords

  • Interpretive performance
  • Intervention
  • Mammography
  • Screening

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Educational interventions to improve screening mammography interpretation : A randomized controlled trial. / Geller, Berta M.; Bogart, Andy; Carney, Patricia A.; Sickles, Edward A.; Smith, Robert; Monsees, Barbara; Bassett, Lawrence W.; Buist, Diana M.; Kerlikowske, Karla; Onega, Tracy; Yankaskas, Bonnie C.; Haneuse, Sebastien; Hill, Deirdre; Wallis, Matthew G.; Miglioretti, Diana L.

In: American Journal of Roentgenology, Vol. 202, No. 6, 2014.

Research output: Contribution to journalArticle

Geller, BM, Bogart, A, Carney, PA, Sickles, EA, Smith, R, Monsees, B, Bassett, LW, Buist, DM, Kerlikowske, K, Onega, T, Yankaskas, BC, Haneuse, S, Hill, D, Wallis, MG & Miglioretti, DL 2014, 'Educational interventions to improve screening mammography interpretation: A randomized controlled trial', American Journal of Roentgenology, vol. 202, no. 6. https://doi.org/10.2214/AJR.13.11147
Geller, Berta M. ; Bogart, Andy ; Carney, Patricia A. ; Sickles, Edward A. ; Smith, Robert ; Monsees, Barbara ; Bassett, Lawrence W. ; Buist, Diana M. ; Kerlikowske, Karla ; Onega, Tracy ; Yankaskas, Bonnie C. ; Haneuse, Sebastien ; Hill, Deirdre ; Wallis, Matthew G. ; Miglioretti, Diana L. / Educational interventions to improve screening mammography interpretation : A randomized controlled trial. In: American Journal of Roentgenology. 2014 ; Vol. 202, No. 6.
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abstract = "OBJECTIVE. The objective of our study was to conduct a randomized controlled trial of educational interventions that were created to improve performance of screening mammography interpretation. MATERIALS AND METHODS. We randomly assigned physicians who interpret mammography to one of three groups: self-paced DVD, live expert-led educational seminar, or control. The DVD and seminar interventions used mammography cases of varying difficulty and provided associated teaching points. Interpretive performance was compared using a pretest-posttest design. Sensitivity, specificity, and positive predictive value (PPV) were calculated relative to two outcomes: cancer status and consensus of three experts about recall. The performance measures for each group were compared using logistic regression adjusting for pretest performance. RESULTS. One hundred two radiologists completed all aspects of the trial. After adjustment for preintervention performance, the odds of improved sensitivity for correctly identifying a lesion relative to expert recall were 1.34 times higher for DVD participants than for control subjects (95{\%} CI, 1.00-1.81; p = 0.050). The odds of an improved PPV for correctly identifying a lesion relative to both expert recall (odds ratio [OR] = 1.94; 95{\%} CI, 1.24-3.05; p = 0.004) and cancer status (OR = 1.81; 95{\%} CI, 1.01-3.23; p = 0.045) were significantly improved for DVD participants compared with control subjects, with no significant change in specificity. For the seminar group, specificity was significantly lower than the control group (OR relative to expert recall = 0.80; 95{\%} CI, 0.64-1.00; p = 0.048; OR relative to cancer status = 0.79; 95{\%} CI, 0.65-0.95; p = 0.015). CONCLUSION. In this randomized controlled trial, the DVD educational intervention resulted in a significant improvement in screening mammography interpretive performance on a test set, which could translate into improved interpretative performance in clinical practice.",
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AU - Carney, Patricia A.

AU - Sickles, Edward A.

AU - Smith, Robert

AU - Monsees, Barbara

AU - Bassett, Lawrence W.

AU - Buist, Diana M.

AU - Kerlikowske, Karla

AU - Onega, Tracy

AU - Yankaskas, Bonnie C.

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KW - Intervention

KW - Mammography

KW - Screening

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