Teaching Systematic Viewing to Final-Year Medical Students Improves Systematicity but Not Coverage or Detection of Radiologic Abnormalities

Koos van Geel*, Ellen M. Kok, Joost Dijkstra, Simon G. F. Robben, Jeroen J. G. van Merrienboer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Purpose: Systematic viewing of images is widely advocated in radiology; it is expected to lead to complete coverage of images and consequently more detection of abnormalities. Evidence on the efficacy of teaching systematic viewing to students is conflicting. The aim of this study was to investigate the effects of teaching systematic viewing to final-year medical students on systematicity of viewing behavior, coverage of the image, and detection.

Methods: Final-year medical students (n = 60) viewed 10 chest radiographs in a first series before training and another 10 radiographs in a second series after training. Between series, students were taught basic chest radiographic viewing, in either a systematic or a nonsystematic manner. With eye tracking, systematicity (Levenshtein distances), coverage (percentage of image viewed), and detection (sensitivity and specificity) were measured.

Results: In a mixed two-by-two design, significantly higher sensitivity was found after training compared with before training (F-1,F-55 P =.012, eta(2)(p)=.11) but no significant effect for type of training (F-1,F-55 = 1.24, P = .30) and no significant interaction effect (F-1,F-55 = 0.12, P = .73). Thus, training in systematic viewing was not superior to training in nonsystematic viewing. A significant interaction of training type and time of viewing was found on systematicity (F-1,F-49 = 20.0, P <.01, eta(2)(p) = .29) in favor of the systematic viewing group. No significant interaction was found for coverage (F-1,F-49 = 0.43, P = .51) or specificity (F-1,F-55 = .124, P = .73).

Conclusions: Both training types showed similar increases in sensitivity. Therefore, it might be advisable to pay less attention to systematic viewing and more attention to content, such as the radiologic appearances of diseases.

Original languageEnglish
Pages (from-to)235-241
Number of pages7
JournalJournal of the American College of Radiology
Issue number2
Publication statusPublished - Feb 2017


  • Education
  • perception
  • systematic viewing
  • eye movements

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