Learning from the plain film competency assessment in the Singapore radiology residency programme.

Introduction: The national Plain Film Competency Assessment (PFCA) was held to allow passing Residents to report plain radiographs independently and thus perform on-call night duties. Our study aimed to investigate factors influencing performance in this exam.

Methods: This was a retrospective study of data from 2012- 20. Training data included previous experience in radiology as well as number of reported films (total and by body regions) whilst examination data comprised these scores as well as error analysis (classified as False Positives, False Negatives or Incorrect Abnormality) for the main and repeat sittings.

Results: Up to 222 residents were included for statistical analysis. Those with previous radiology exposure were more likely to pass, 85.1% compared to 68.9% (χ=0.03) and had higher scores, 85.1 versus 81.3 (p<0.01). The number of co-reported films did not affect passing even after excluding those with previous experience. Chest and limb radiographs made up at least three-quarters of the reported films, with residents passing these whilst failing those from the abdominal, skull and spine regions. There was no significant difference between their improved scores after undergoing remediation of either one or four months in duration. However, error analysis after remediation revealed a lower combined percentage of False Positives and Negatives.

Conclusions: Experience in a radiology posting after graduation facilitated passing. Although we could not establish an association between the number of reported films and passing, there was an imbalance in the variety of reported films, which should first be resolved.