Recent Advances: Teaching in accident and emergency medicine: 10 commandments of accident and emergency radiology

One of the many attractions of accident and emergency medicine is the wide and varied opportunities it provides for education. This is because of the acute nature of the work, which necessitates prompt and accurate decision making. However, in many instances the decisions have to be made by inexperienced senior house officers. Departments therefore need a safe system of practice that can be remembered and adhered to under stress. The 10 commandments is one such system for analysing emergency radiographs of all the regions of the body. This system lays down guidelines to protect both staff and hospitals from the inevitable mistakes that inexperienced doctors will make.

More than half the patients attending accident and emergency departments in the United Kingdom have a radiograph taken. But radiological interpretation can be poor—for example, in one study 39% of clinically important abnormalities were missed by accident and emergency senior house officers.1 In addition points dealing with radiology are involved in over half of all cases of litigation concerning the standards of care in accident and emergency departments (Brian Capstick, personal communication). It is therefore essential to improve the training of senior house officers in interpreting emergency radiographs.

Many accident and emergency departments now run induction courses for junior doctors.2 When teaching emergency radiology, however, it is easy to go over several “radiological pitfalls” and end up simply showing mistakes that have been made by previous incumbents. This only increases anxiety as the doctors realise the multitude of possible errors. It is better to formulate a system that will enable senior house officers to detect abnormalities, to use a book constructively for reference,3 and to know when to ask for help.4 5

This article provides a system that is applicable to doctors of all specialties who request and review …