Appropriate use of radiological studies is of utmost importance in medical practice, guiding care and reimbursement. The American College of Radiology Appropriateness Criteria (ACR-AC) is a free, online evidence-based resource dedicated to supporting practitioners with radiology decision-making. However, this resource has historically been underutilized by physicians and medical students, with those groups often opting to use alternative resources such as UpToDate (UTD). Increasing awareness and user-friendliness of the ACR-AC within medical education is necessary to integrate regular use of this resource in practice. This study seeks to investigate medical student performance with and perception of the ACR-AC and UpToDate when presented with radiology decision-making cases.

Methods First-year osteopathic medical students were presented with a clinical case and utilized either UpToDate or ACR to assist in determining the most appropriate imaging modality for the case. Following the case, students were surveyed to assess their familiarity with each resource, its effectiveness in establishing a differential diagnosis, ease of selecting the appropriate imaging, perceived usefulness, impact on confidence in imaging selection, and likelihood of future utilization. The accuracy of their decisions was also evaluated based on which resource they used. 

Results Our survey had 82 respondents for the UTD group, and 83 respondents for the ACR group. The results showed that more students have used UTD over ACR coming into the study (20% vs 8%, p=0.01). The students also more strongly agreed that UTD was more helpful in establishing a differential diagnosis for the cases (56.1% vs 49.4%, p= 0.04). However, students found that ACR was easier to use as a resource for determining the appropriate imaging modality (3.9 vs 4.2, p=0.02). The accuracy of the tests showed a trent towards significance with case one showing 92.1% correct vs 82.6% with UTD (p=0.06) and 84.9% vs 75.6% on case two (p=0.13). 

Conclusion The awareness of imagining resources among first year medical students is generally low. Following a case presentation, students more strongly agreed that UTD is a more helpful resource in establishing a differential diagnosis. However, students found that ACR was easier to use to determine the appropriate imaging modality. The results also showed a trend towards significance with students making more accurate decisions utilizing ACR over UTD.