Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Pediatrics, Johns Hopkins Global Program in Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, 200 North Wolfe St., Baltimore, MD, 21287, USA.
Pediatr Radiol. 2021 Jul;51(8):1322-1331. doi: 10.1007/s00247-021-04992-2. Epub 2021 Mar 11.
Chest radiography is the standard for diagnosing pediatric lower respiratory infections in low-income and middle-income countries. A method for interpreting pediatric chest radiographs for research endpoints was recently updated by the World Health Organization (WHO) Chest Radiography in Epidemiological Studies project. Research in India required training local physicians to interpret chest radiographs following the WHO method.
To describe the methodology for training Indian physicians and evaluate the training's effectiveness.
Twenty-nine physicians (15 radiologists and 14 pediatricians) from India were trained by two WHO Chest Radiography in Epidemiological Studies members over 3 days in May 2019. Training materials were adapted from WHO Chest Radiography in Epidemiological Studies resources. Participants followed WHO methodology to interpret 60 unique chest radiographs before and after the training. Participants needed to correctly classify ≥80% of radiographs for primary endpoint pneumonia on the post-training test to be certified to interpret research images. We analyzed participant performance on both examinations.
Twenty-six of 29 participants (89.7%) completed both examinations. The average score increased by 9.6% (95% confidence interval [CI] 5.0-14.1%) between examinations (P<0.001). Participants correctly classifying ≥80% of images for primary endpoint pneumonia increased from 69.2% (18/26) on the pretraining to 92.3% (24/26) on the post-training examination (P=0.003). The mean scores of radiologists and pediatricians on the post-training examination were not statistically different (P=0.43).
Our results demonstrate this training approach using revised WHO definitions and tools was successful, and that non-radiologists can learn to apply these methods as effectively as radiologists. Such capacity strengthening is important for enabling research to support national policy decision-making in these settings. We recommend future research incorporating WHO chest radiograph methodology to consider modelling trainings after this approach.
胸部 X 光检查是中低收入国家诊断小儿下呼吸道感染的标准方法。世界卫生组织（WHO）最近更新了一项用于研究终点的小儿胸部 X 光片解读方法，名为《流行病学研究中的胸部 X 射线摄影》项目。印度的研究需要培训当地医生按照世卫组织的方法解读胸部 X 光片。
描述培训印度医生的方法并评估培训效果。
2019 年 5 月，29 名来自印度的医生（15 名放射科医生和 14 名儿科医生）参加了为期 3 天的培训，培训由两名《流行病学研究中的胸部 X 射线摄影》项目成员进行。培训材料改编自世卫组织《流行病学研究中的胸部 X 射线摄影》资源。参与者在培训前后按照世卫组织的方法解读了 60 张不同的胸部 X 光片。参与者需要在培训后的测试中正确分类≥80%的放射片才能获得解读研究图像的认证。我们分析了两次考试中参与者的表现。
29 名参与者中有 26 名（89.7%）完成了两次考试。两次考试的平均分数提高了 9.6%（95%置信区间 [CI]：5.0-14.1%）（P<0.001）。参与者正确分类≥80%的主要终点肺炎图像的比例从培训前的 69.2%（18/26）提高到培训后的 92.3%（24/26）（P=0.003）。培训后，放射科医生和儿科医生的平均分数没有统计学差异（P=0.43）。
我们的结果表明，使用修订后的世卫组织定义和工具的这种培训方法是成功的，非放射科医生也可以学习应用这些方法，与放射科医生一样有效。这种能力的加强对于支持这些环境中的国家政策决策研究非常重要。我们建议未来的研究采用世卫组织胸部 X 光片方法，借鉴这种方法进行培训模拟。
