From image to clinical judgment: a randomized near-peer teaching trial on systematic chest radiograph interpretation

BACKGROUND: Chest radiograph (CXR) interpretation remains a fundamental yet challenging skill for undergraduate medical students, requiring both perceptual and integrative reasoning. Near-peer instruction and structured checklists have been proposed to enhance learning, but evidence from randomized designs is limited. METHODS: We conducted a randomized educational trial among final-year medical students (n = 50). All participants attended a two-hour lecture on CXR interpretation delivered by intensive care medicine residents. The intervention group received additional training using a systematic checklist for image analysis. Performance was assessed through a 16-item test (interpretation and diagnosis domains). Nonparametric tests and Spearman correlations were applied; internal consistency and item discrimination were analyzed. RESULTS: Compared with controls, the intervention group achieved higher median scores in interpretation (6 vs. 3), diagnosis (4 vs. 3), and total score (10 vs. 6) (all p < 0.05). Interpretation and diagnosis scores were not correlated (Spearman ρ = 0.12, p = 0.40). Cronbach’s alpha was 0.592, with 56% of items showing excellent discrimination. CONCLUSIONS: A brief, resident-led, checklist-guided session significantly improved CXR interpretation and overall performance. Structuring perceptual search through systematic frameworks can rapidly strengthen diagnostic foundations and represents a feasible, low-cost addition to medical curricula.