Journal of Pediatric Orthopaedics - 2026-08-19 - Journal Article
Pediatric Musculoskeletal Radiograph Interpretation Among Orthopaedic Surgery Postgraduate Trainees: A Competency-Based Education Intervention.
Starvaggi CA, Bouchard M, Camp M, Carsen S, Mortimer AJ, Katchky R, El-Hawary R, Archer LA, Saran N, Stimec J, Ziebarth K, Keitel K, Boutis K
Topics
Key Takeaway
A web-based, mastery-learning intervention improved pediatric MSK radiograph risk stratification accuracy by 20.5% among orthopaedic trainees, with 78% reaching a 90% performance standard in a median of 141 cases per body region.
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Summary
This multicenter prospective cohort study evaluated whether a structured web-based mastery-learning platform using 1,609 pMSK radiograph cases could improve fracture detection, localization, and risk stratification among orthopaedic surgery postgraduate trainees. Diagnostic accuracy improved 10.5%, localization accuracy 11.9%, and risk stratification accuracy 20.5% from first to final 25-case assessment, with ankle/foot showing the greatest gains. Of 246 attempts to reach the 90% performance standard, 192 (78%) succeeded, requiring a median of 141 cases per body region completed in approximately 35 minutes.
Key Limitation
Only 39.1% of participants completed the post-intervention survey, and the study lacks a control arm or pre-intervention baseline assessment independent of the platform, making it impossible to isolate the intervention's effect from natural learning over time.
Original Abstract
BACKGROUND
Pediatric musculoskeletal radiographs (pMSK) are the primary imaging modality for evaluating injured children, yet there is no widely adopted, standardized approach to teach and assess this specific skill among orthopaedic surgery postgraduate trainees (OS-PGT). We evaluated an online educational and assessment intervention using pMSK radiographs to improve fracture/dislocation detection and risk stratification among OS-PGT.
METHODS
We conducted a multicenter prospective cohort study using a web-based educational intervention, recruiting a convenience sample of OS-PGT. The intervention included 1609 pMSK radiograph cases organized into 6 body regions. OS-PGT judged whether a fracture/dislocation was present or absent, and when present, localized the abnormality and assigned a risk category. Participants received immediate feedback after every case, continuing until reaching a predefined 90% performance standard. Following the intervention period, participants were invited to complete a post-intervention survey.
RESULTS
A total of 64,489 unique case interpretations were generated by 115 OS-PGT. From initial to final, 25 cases were completed, and diagnostic accuracy increased by 10.5% (95% CI: 9.4%, 11.6%), localization accuracy by 11.9% (95% CI: 10.7%, 13.0%), and risk stratification accuracy by 20.5% (95% CI: 18.9%, 22.1%), with the greatest gains observed for ankle/foot radiographs. Across 246 attempts to reach the performance standard, 192 (78.0%) were successful. The median number of cases required per body region was 141 (IQR: 96, 313), completed in a median of 34.9 minutes (IQR: 23.8, 77.6). Error rates were lower when participants were certain of their answers (7.8% incorrect "definite" interpretations vs. 23.7% "probable"). Forty-five (39.1%) participants completed the post-intervention survey, and 38 (84.6%) supported integrating the intervention into orthopaedic residency training.
CONCLUSION
This study shows that a structured, web-based intervention combining performance-based assessment with case-based practice led to substantial and efficient learning gains in pMSK radiograph interpretation among OS-PGT and helped identify diagnostic challenges. These findings support the use of such educational interventions as a practical strategy to supplement orthopaedic residency training in targeted diagnostic skills.
LEVELS OF EVIDENCE
Level II-prospective cohort study.