This study assessed the ability of junior doctors in accident and emergency to detect radiographic abnormalities. Their assessments of 505 radiographs taken at nights and weekends over a period of 8 months and showing abnormalities were examined. Each assessment by a senior house officer (SHO) was compared with the subsequent diagnosis of a radiologist of senior registrar or consultant status. An error rate of 35% was found. For abnormalities with clinically significant consequences the error rate was 39%. Although this error rate appears high the results are consistent with those of earlier studies in that missed positive radiographs constitute 2.8% of the total number of radiographs taken in the period. It is considered that the proportion of missed abnormalities gives a truer index of SHOs' abilities. No improvement in performance was evident over the 6-month period of the SHOs tenure of post. It is argued that it is unrealistic to expect accident and emergency SHOs to acquire this complex skill simply through experience and that more formal training and guidance is needed.
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