EDITORIALS Does Practice Make Perfect When Interpreting

“The art of the practice of medicine is to be learned only by experience; ‘tis not an inheritance; it cannot be re-vealed. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.” Sir William Osler (1) The accuracy of screening mammography relies on a human interpreter. It seems intuitive that high levels of accuracy would occur for radiologists who routinely interpret high volumes, have many years of experience, and who audit the results of women undergoing breast biopsies at their recommendation. This statement, although based on common sense, is not sup-ported by the analyses presented by Beam et al. (2) in this issue of the Journal. Beam et al. studied the association between self-reported an-nual interpretation volume and radiologist accuracy in screening mammography. The authors asked 110 U.S. radiologists to in-terpret a test set of 148 mammograms (64 of the women had breast cancer) in a controlled and timed environment. “Recent reading volume ” and other radiologist-specific information such as “years of practice ” were collected via surveys. Surprisingly, Beam et al. found no statistically significant association between volume and accuracy. Just 1 year ago, Esserman et al. (3) reported that both sensi-tivity and specificity are better among high-volume readers (>5000 mammograms per year) than among low-volume read-ers. In the accompanying editorial “Does Practice Make Perfect When Interpreting Mammography? ” (4), we commented that practice probably does improve accuracy, but it may not make us perfect. Efforts to optimize the human interpretation of screen-ing mammography examinations should consider the entire con-text of clinical medicine, including levels of ambiguity in clini-cal decision making, fear of medical malpractice, financial rewards, and characteristics of the population screened and of overall health care systems. The study by Beam et al. and similar studies identify impor-tant issues that warrant further discussion, including how to define and measure the experience of a radiologist, whether performance using a test set of films reflects what occurs in clinical practice, and how to appropriately model the relation-ships between accuracy and volume