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BACKGROUND Interpretation of plain radiographs presents a challenging aspect of the management of basic trauma for junior doctors and is one of the main causes of diagnostic error. OBJECTIVE This study aimed to evaluate the accuracy and confidence in foundation doctors (n=42) interpreting fractures on plain radiographs. METHODS Foundation Year 2 doctors at the start of their A&E rotation were sent an online questionnaire three case studies with a clinically vignette and plain films of radiographs of the hand and wrist. Respondents were asked to state whether there was a fracture present, the location of the fracture, the management of the fracture and how confident out of 10 in their diagnoses. RESULTS Across all three case studies 62% of respondents were able to correctly identify whether there was a fracture present though could only correctly identify the location of the fracture in 48%. A fracture was missed in 12% of cases and the correct management option was selected in 65% of cases. Median and mean diagnostic certainty was low overall. Respondents were less confident in case study 3 where there was no fracture present than identifying one in Case Studies 1 and 2. CONCLUSIONS This cohort of Foundation Doctors starting A&E rotations have diagnostic uncertainty in interpreting plain radiographs and there is a tendency towards overdiagnoses of fractures. Close supervision and senior support are required to limit diagnostic errors. CLINICALTRIAL N/A

Background Accurate interpretation of radiographs is crucial for junior doctors in the accident and emergency (A&E) department (the emergency medicine department). However, it remains a significant challenge and a leading cause of diagnostic errors. Objective This study aimed to evaluate the accuracy and confidence of foundation doctors (doctors within their first 2 years of qualifying) in correctly interpreting and managing forearm and hand fractures on plain radiographs. Methods A total of 42 foundation doctors with less than 2 years of experience and no prior emergency medicine training who worked in a large district general hospital participated in a web-based questionnaire. The questionnaire consisted of 3 case studies: distal radius fracture, scaphoid fracture, and a normal radiograph. Respondents were required to identify the presence or absence of a fracture, determine the fracture location, suggest appropriate management, and rate their confidence on a Likert scale. Results Overall, 48% (61/126) of respondents accurately identified the presence and location of fractures. The correct management option was chosen by 64% (81/126) of respondents. The median diagnostic confidence score was 4 of 10, with a mean diagnostic certainty of 4.4 of 10. Notably, respondents exhibited a significantly lower confidence score for the normal radiograph compared to the distal radius fracture radiograph (P=.01). Conclusions This study reveals diagnostic uncertainty among foundation doctors in interpreting plain radiographs, with a notable inclination toward overdiagnosing fractures. The findings emphasize the need for close supervision and senior support to mitigate diagnostic errors. Further training and educational interventions are warranted to improve the accuracy and confidence of junior doctors in radiographic interpretation. This study has several limitations, including a small sample size and reliance on self-reported data. The findings may not be generalizable to other health care settings or specialties. Future research should aim for larger, more diverse samples and explore the impact of specific educational interventions on diagnostic accuracy and confidence.