## 4 Discussion
### Competency Assessment Evaluation
#### 4.2.1 Speed  
Nine out of seventeen articles (53%) present statistics referencing the overall examination time of radiographic images. The overarching suggestion indicated a strong relationship between greater experience and faster interpretation times, with some literature suggesting alternative statistics.  
The main articles which supported a decreased interpretation time with increased experience were namely [PERSON] et al. [25] [PERSON] et al. [26] [PERSON] et al. [27] [PERSON] and [PERSON], [21] [PERSON] and [PERSON], [28] and [PERSON] et al. [22]. Whilst comparing different professional disciplines (e.g., \"advanced and novice surgeons\" versus \"oral and maxillacial radiologists and dental students\") there was commonality that the participant group at a higher level of experience interpreted the radiographs at an overall faster rate. Thequality of all articles was adequate, with appropriate sample sizes, participant recruitment techniques and demographics. Additionally, all articles utilised some form of statistical analysis to provide significance. There are some issues presented with error, such as for [PERSON] and [PERSON] [28] who compared different university dental students (2 nd and 5 th semesters), however also \"re-tested\" the 2 nd semester students after structured interpretation training to provide greater participant comparisons. This could pose limitations in giving irregular exposure to students at such an early stage in education and failing to provide the same opportunities to the 5 th semester students. Variation in results can also be found in the article by [PERSON] et al. [27] in which significance was found across participant groups, however stronger time statistics were found between registrars and senior house officers, and between senior house officers and interns specifically. These six articles present adequate arguments for the relationship between higher experience level and a decreased interpretation speed.  
However, two studies by [PERSON] et al. [29] and [PERSON] et al. [23] reported that participants with \"greater expertise\" interpreted radiographic images at a slower rate than compared to inexperienced counterparts. One of these articles, [PERSON] et al. [23] would be considered high quality with a significant study design and suggests that reporting radiographers spent longer interpreting than both students and radiographers (which is statistically significant). Interestingly, it was noted that radiographers (diagnostic) were faster than both students and reporting radiographers, therefore not aligning to a linear pattern of experience. Such statistics were also statistically significant. [PERSON] et al. [29] also conducted a study with sound quality, however, did not document data sets as thoroughly as [PERSON] et al. [23]. [PERSON] et al. suggested that expert observers had a longer examination time of the panoramic radiographs and did provide significance, alongside a considerable sample size of 136 participants, a strong study design and statistical analysis via the Chi-square test and the Fisher's exact test. These results may be considered important in final conclusions.  
[PERSON] et al. [24] additionally commented on interpretation speed of undergraduate dental students analysing panoramic radiographs, however this does not provide a comparison to another experienced demographic. The average speed statistics were provided at 245.58 \(\pm\) 106.7 s, however no further significant results were determined.  
Whilst articles with alternative themes are important to consider when drawing overall conclusions (i.e., [PERSON] et al. [23] and [PERSON] et al. [29]), the volume and strength of the literature (i.e., [21; 22; 25; 26; 27; 28]) provide adequate evidence to generalise that there is a relationship between a \"greater experience level\" and a shorter interpretation time for health professionals when interpreting radiographic images.