The cadre of death education instructors in paramedic programs

OBJECTIVE

This study addresses the paucity of literature on death education offerings in emergency medical services schools. The study examines the cadre of death education instructors in paramedic training programs. Examining death education offerings in paramedic programs can provide insight into how well emergency medical services personnel are prepared when encountering bereaved persons on death-related responses.

METHODS

In an exploratory study, information was gathered from paramedic programs on the instructors who teach death-related education. A self-administered survey was sent to each (n = 537) paramedic programs in the USA. The survey solicited the number of instructors teaching death education, their backgrounds, and their formal training in death-related instruction.

RESULTS

The response rate was 45.4%. The majority of programs (78%) reported using a paramedic as the primary instructor to teach death-related content. Nurses (66%) and physicians (32%) also were utilized frequently. More than two-thirds (68%) of the responding programs utilize faculty members who have had no formal training in death and dying. Only one-third of the programs utilizes a multidisciplinary staff. Less than 40% of responding programs teach all of their death-related curricula with instructors who are trained in death education.

CONCLUSION

This study indicates that the majority of paramedic programs are not utilizing an instructor cadre that is formally trained in death education, nor are they using a multidisciplinary staff. Reasons for using these instructors to teach death education in paramedic programs are discussed.

Knowledge, attitude and practice of dental caries and periodontal disease prevention among primary school teachers in Udupi municipality

Primary school teachers of Udupi municipal corporation were surveyed to determine their knowledge, attitude and practice toward dental caries and periodontal disease prevention. Fourteen schools were selected by cluster sampling and the teachers working in these schools were included in the sample. The questionnaires were completed by one hundred teachers. The results showed that school dental health services must compulsorily hold demonstrations or lectures on prevention of oral diseases during school feasts and parent teacher meetings, in order to involve the teachers and parents in oral health promotion of the child.

Communication effectiveness training improves surgical resident teaching ability

BACKGROUND

An important educational objective of academic surgical programs is to train surgical teachers. Whether formal instruction of surgery residents in general principles of teaching has a role in the achievement of this objective is unproven.

STUDY DESIGN

We tested whether the teaching ability of surgery residents could be improved by two different interventions: (A) a lecture on communication effectiveness plus home study of their own videotaped lectures and (B) a critical review of their own videotaped lectures with a teaching consultant. Each resident taught four sessions. There was no intervention between sessions 1 and 2; intervention A occurred between sessions 2 and 3; and intervention B, between sessions 3 and 4. Each of the four videotaped sessions was graded for communication effectiveness using a standardized scoring form.

RESULTS

There were no significant differences between scores from lectures 1 and 2 (no intervention) or lectures 2 and 3 (intervention A). Intervention B (individualized feedback) resulted in significant improvement in all scores from session 4 compared with sessions 1 and 2: content 3.40 versus 2.98 (p = 0.01), language 3.43 versus 3.22 (p = 0.03), delivery 3.25 versus 2.87 (p = 0.002), and overall 3.43 versus 2.88 (p = 0.002).

CONCLUSIONS

Surgical resident teaching ability can be improved by communication effectiveness teaching. Individualized feedback is more effective than a lecture combined with self-study.

Teaching of all-ceramic restorations in central European dental schools: a survey

The teaching of all-ceramic restorations in Central European dental schools in the mid 1990s has been surveyed. Based on a 65% response, the findings indicate that the majority of undergraduate (pre-doctoral) students receive instruction in all-ceramic restorations with >75% gaining clinical experience in the use of such restorations prior to graduation. When clinical experience was not received, formal instruction, either in the regular curriculum or in elective studies was generally available. All the schools, with one exception, anticipated that the importance of teaching all-ceramic restorations would increase or at least stay the same. In general, the findings were similar to those reported in studies of the teaching of all-ceramic restorations in North America, Scandinavia, and the UK and Ireland, especially in relation to luting systems, contraindications and finishing instrumentation. However, clinical requirements for all-ceramic restorations in Central European dental schools were more common than in dental schools in North America, Scandinavia and the UK and Ireland.

Experience of undergraduates from three London dental schools and trainers from the south east of England on interviews for vocational training in 1996

OBJECTIVE

To assess the current perceptions, motivations and expectations of trainers and vocational dental practitioners (VDPs) of vocational training (VT) interviews.

DESIGN

Questionnaire based study.

SETTING

General practice study carried out in 1996.

SUBJECTS

Undergraduates from three London dental schools and vocational trainers from south-east England.

MAIN OUTCOME MEASURES

Perceptions, motivation and experiences were assessed by a questionnaire.

RESULTS

111 questionnaires were posted to trainers with 72 (65%) returned. 108 (70%) were returned from the dental schools after 155 were posted. Graduates employed in hospital training posts, armed forces and community dentistry were eliminated from the results. Most trainers (74%) had previous experience of VT and 89% of trainers thought that a CV was important for their choice of VDPs. However, only 11% of trainers sought references before interviewing. 34% of VDPs preferred jobs close to their dental school but 75% considered location to be vital to their choice. 67% of VDPs made 10 or more applications and 57% visited 10 or more practices for interviews. 78% of VDPs considered that either genderism or racism was likely to or possibly influenced the trainers choice. However, the converse was not true, 62% of trainers considered it unlikely that the VDPs were influenced by their gender or race.

CONCLUSIONS

Trainers and VDPs have different perceptions concerning the protocol of interviews for VT.

Teaching physiology to predoctoral dental students

A survey was sent to the physiology course directors of the fifty-three dental schools in the continental United States. Information was collected regarding the type of instructional arrangements, course content and emphasis, and amount and type of nondidactic instruction. Responses were obtained for forty-eight courses, all of which covered the core topics of physiology, although twelve schools taught neurophysiology as part of a neuroscience course. Combined medical and dental student (MS+DS) courses used six to fourteen hours of nondidactic instruction per core topic, whereas the courses taught by dental school-(DS-B) or medical school-based instructors used 0.5 to 2.6 hours per topic. Courses combining dental students with other nonmedical professional students used mainly didactic instruction. While most dental school physiology courses continue to rely on traditional didactic instruction, a few schools integrate physiology with other basic science and clinical courses, include problem-solving exercises, and offer advanced physiological topics during the clinical years. Consequently, there is considerable potential for change in predoctoral physiology instruction.

Suicides among physicians, engineers and teachers: the prevalence of reported depression, admissions to hospital and contributory causes of death

The number of admissions to hospital, reported diagnoses, prevalence of reported depression and contributory causes of death among Finnish physicians, engineers and teachers who committed completed suicide between 1986 and 1993 were studied. The data for hospital admissions with diagnoses were obtained from the Finnish Hospital Discharge Register. Thin-layer chromatography was used to detect drugs in the liver, a dual-column gas chromatographic method was used for screening and quantification of drugs in the blood sample, and a head-space chromatographic method was used to measure blood alcohol levels. Physicians had more somatic diagnoses than the reference groups, and the prevalence of reported depression was higher among females than males. A minority of the depressed subjects had been admitted to hospital, although depression was observed to be the most prevalent contributory cause of death in all of the groups studied. The physicians used solid or liquid substances, especially barbiturates, as the main method of suicide. It is possible that depression in physicians, especially in male subjects, is undertreated in psychiatric hospitals.

[Reasons for anxiety in primary care professionals. A resident-tutor comparison]

OBJECTIVES

1) To find the reasons for PC professionals' anxiety when going about their normal work. 2) To check whether training and experience affect the assessment of the reasons of Family Doctors for anxiety.

DESIGN

A descriptive study using a questionnaire.

SETTING

PC health centres with second-year family and community medicine (FCM) residents from the Murcia Teaching Unit.

PARTICIPANTS

All second-year FCM residents from the Teaching Unit (28) in December 1995 and their tutors.

MEASUREMENTS

Open questionnaire based on three points: Causes of anxiety in on-demand consultations; causes of anxiety in scheduled consultations; other reasons for anxiety connected with the Health Centre.

RESULTS

The three most anxiety-producing causes in relation to each question were: a) on-demand consultation: residents (R)--unfinishable consultations, lack of time, clinical problems; tutors (T)--unfinishable consultations, a lot of patients waiting outside, manipulative patients. b) Scheduled consultation: R--clinical problems, consultation too long, difficulties in reaching a solution; T--consultation too long, patients without an appointment and interruptions in the middle of the consultation. c) Other reasons for anxiety: R--not being off the day after being on call, having to do research work, and emergency calls; T--emergency calls, research work and temperature problems.

CONCLUSIONS

Clinical problems are the causes of anxiety with the greatest difference between tutors and residents. Regulated training in the health centre and professional experience seem to act positively on some of the causes of anxiety.

Undergraduate endodontic teaching in the United Kingdom: an update

Anecdotal evidence and scientific surveys suggest that the quality of root canal treatment within the General Dental Services is often less than ideal. Six years ago, it was reported that endodontic teaching in the United Kingdom was given a low priority and that the time devoted to the laboratory practice of root canal treatment should be increased. In the following year, the European Endodontic Society (ESE) published guidelines for the teaching of Endodontology and made recommendations as to what should be included in the undergraduate curriculum. Shortly afterwards, the ESE published quality guidelines for endodontic treatment. The aim of this project was to determine the current pattern of undergraduate endodontic teaching within the dental schools of the UK. Data were gathered by questionnaire from all 14 undergraduate dental schools and supplemented with further detailed enquiries where necessary. The results were compared with that reported following an identical survey carried out previously. Although the ESE curriculum guidelines for endodontic teaching provide an overall framework for teaching, the results of this study confirmed that a number of topics were either not included or were covered only briefly. However, the average time devoted to the preclinical instruction of root canal treatment in the first clinical year had increased from 14 to 24 h, with additional time provided in subsequent years by the majority of schools. In most instances, staff teaching endodontology in the UK have no specialist training.

Fifteen years on: evolving ideas in researching sex differences in depression

BACKGROUND

A cohort study of a socially homogeneous group of teachers was commenced in 1978 to pursue possible risk factors contributing to the recognized female preponderance of depression.

METHODS

Multiple measures of depressive experience included: (i) lifetime rates, duration and number of depressive episodes using two caseness definitions, DSM-III-R major depression and 'all depression' (which included a category of minor depression); (ii) self-report measures of state and trait depression, neuroticism, and self-esteem. DSM-III-R anxiety disorder rates are also reported and co-morbidity with major depression examined.

RESULTS

At the 15-year review in 1993, the sample had a mean age of 39 years, there was a trend for a female preponderance in lifetime rates of major depression and 'all depression' (and which was more pronounced with the inclusion of data for anxiety disorders), with statistically significant differences in rates of social and simple phobias and combined anxiety disorders. Mean neuroticism scores were consistently higher for women.

CONCLUSIONS

The strong association between anxiety and depressive disorders suggests that greater reporting of anxiety and higher neuroticism scores in women may be a key determinant that contributes to any female preponderance in depression rates.

Career preferences of pediatric dentistry advanced education students

A questionnaire addressing career preferences of pediatric dentistry advanced education students was mailed to 52 training programs. Two hundred and thirty-two completed surveys from 45 responding programs were returned. Men were in combined specialty programs significantly more than women (P < 0.05, chi-square) and U.S. citizen students were significantly older than non-citizens (P < 0.05, t-test). The collected data reflected differences in career preferences between men and women, and citizens and noncitizens. Women reported a significant preference for private practice, part-time associate and public health practice than did men. Although not significant, men declared equal preference for full-time private practice either solo or as an associate. Noncitizens were found to have a significant preference when compared to citizens for academic full- and part-time, hospital/institutional full- and part-time, research, full- and part-time positions, and for additional training.

The clinical role of nurse teachers within a Project 2000 course framework

This paper reports on part of a national study that was conducted over a 3-year period (1991-1994). The overall aim of the study was to explore the changing role of the nurse teacher. Multiple methods of data collection were used, including a modified Delphi survey, a case study and telephone interviews. The sample included a wide variety of respondents (nurse teachers, midwife teachers, clinical nurses, health service managers and higher education lecturers). Findings in relation to the clinical role of the nurse teacher within a Project 2000 course framework are presented. This includes the nature of the clinical role, views on linking theory and practice, and potential barriers to the nurse teacher's clinical role. The future role of nurse teachers within the clinical area is discussed and this includes suggestions for the ways in which a nurse teacher's clinical commitment could be facilitated. Issues relating to the role of lecturer/practitioner are also highlighted.

Screening school personnel for cardiovascular disease risk factors: short-term impact on behavior and perceived role as promoters of heart health

BACKGROUND

Few controlled studies have evaluated the impact of community-based screening to detect risk factors for cardiovascular disease (CVD) on behavior change. This study examined the short-term impact of school-based screening on smoking, leisure time exercise, and fat consumption of personnel working in schools offered CVD risk factor screening. Also, the impact of screening on the perceptions that teachers have of their role in promoting heart health at school and the frequency of discussing heart health issues with students was investigated.

METHODS

The impact of screening was investigated in a before-after study design comparing behaviors of staff working in eight inner-city elementary schools offered the screening with those of staff working in eight matched comparison schools. Data were collected in self-administered questionnaires 2 weeks before and 4 months after screening.

RESULTS

A total of 209 subjects in the intervention schools completed the baseline questionnaire. Of these, 125 (59.8%) participated in the screening and completed the 4-month follow-up questionnaire. In the comparison schools, 135 of 177 subjects who completed the baseline questionnaire (76.3%) also completed the follow-up questionnaire. Multivariate analysis of covariance detected no changes in cigarette or fat consumption, but subjects exposed to the screening significantly increased their level of physical activity. Also, teachers exposed to screening increasingly supported the notion that teachers have a role in promoting heart-healthy behaviors among their students.

CONCLUSIONS

Although several methodological limitations might have influenced the results, these data suggest that screening and counseling for CVD risk factors is an effective strategy to positively influence level of physical activity. If screening does increase motivation and interest among teachers to become heart-health role models or educators, the benefits of school-based screening could extend well beyond those who actually participate.

Sex differences in academic advancement. Results of a national study of pediatricians

BACKGROUND

Although the numbers of women in training and in entry-level academic positions in medicine have increased substantially in recent years, the proportion of women in senior faculty positions has not changed. We conducted a study to determine the contributions of background and training, academic productivity, distribution of work time, institutional support, career attitudes, and family responsibilities to sex differences in academic rank and salary among faculty members of academic pediatric departments.

METHODS

We conducted a cross-sectional survey of all salaried physicians in 126 academic departments of pediatrics in the United States in January 1992. Of the 6441 questionnaires distributed, 4285 (67 percent) were returned. The sample was representative of U.S. pediatric faculty members. Multivariate models were used to relate academic rank and salary to 16 independent variables.

RESULTS

Significantly fewer women than men achieved the rank of associate professor or higher. For both men and women, higher salaries and ranks were related to greater academic productivity (more publications and grants), more hours worked, more institutional support of research, greater overall career satisfaction, and fewer career problems. Less time spent in teaching and patient care was related to greater academic productivity for both sexes. Women in the low ranks were less academically productive and spent significantly more time in teaching and patient care than men in those ranks. Adjustment for all independent variables eliminated sex differences in academic rank but not in salary.

CONCLUSIONS

Lower rates of academic productivity, more time spent in teaching and patient care and less time spent in research, less institutional support for research, and lower rates of specialization in highly paid subspecialties contributed to the lower ranks and salaries of female faculty members.

Teaching critical care in Europe: analysis of a survey

OBJECTIVE

To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe.

DATA SOURCES

Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals in each western country of the European Region of the World Health Organization and to the people responsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionnaires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article.

RESULTS

Postgraduate and undergraduate training differ widely in terms of the content of, and disciplines in charge of, the teaching of critical care. Even countries of the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic discipline of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been established in many countries. The topics in medical schools that correspond to critical care medicine do not encompass a distinct body of knowledge and are distributed among more traditional disciplines, most frequently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely between and within countries. The repetition of critical care conditions for which patients receive critical care in several disciplines, as described by the responses, leads us to wonder whether these conditions are really included in the curriculum.

CONCLUSIONS

The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.

Compensation to a department of medicine and its faculty members for the teaching of medical students and house staff

BACKGROUND

Changes in the organization and financing of health care threaten to alter the prevailing system of financing the teaching of medical students and residents. Little information is available from private medical schools and teaching hospitals about the extent of teaching by faculty members or the mechanisms and levels of reimbursement for teaching.

METHODS

We surveyed faculty members in the Department of Medicine at Columbia-Presbyterian Medical Center to ascertain the extent of their teaching activities. A standard number of hours was assigned to each activity, and the total number of teaching hours was calculated for each faculty member. Teaching of fellows and in continuing medical education programs was excluded. We also determined how much money the Department of Medicine received in payment for faculty members' teaching activities, and the sources of this compensation.

RESULTS

In the 1992-1993 academic year, the 188 full-time faculty members spent a total of 46,086 hours teaching (mean [+/- SD], 245 +/- 178 hours per faculty member); 10,780 hours (23.4 percent) were spent teaching medical students, and 35,306 hours (76.6 percent) teaching house staff. Eighty percent of faculty members taught for 137 or more hours each. In a multivariate analysis including faculty rank, subspecialty division, years since graduation from medical school, sex, and tenure or clinical track, senior faculty members (P = 0.02), members of certain subspecialty divisions (P < 0.001), and women (P = 0.05) contributed more than the average number of teaching hours. An additional 56 non-full-time faculty members contributed a total of 5684 hours. The net reimbursement to the department for teaching totaled $965,808, or about $16 per hour of teaching by full-time faculty members, after the cost of fringe benefits was excluded.

CONCLUSIONS

Faculty members of the department of medicine at a major medical center contribute a large number of hours teaching medical students and house staff. This effort is poorly compensated. Cost-containment efforts have the potential to jeopardize fragile social contracts at academic health centers whereby the faculty participates in teaching by contributing unreimbursed or underreimbursed time.

The source, accuracy, and impact of initial sexuality information on lifetime wellness

Seven hundred male and female respondents ranging in age from 9 to 73 years, were surveyed. Data were provided for examining the age, source, accuracy, and impact of initial sexuality information on lifetime wellness. Subjects were placed in five chronological age groups for data analysis. Responses from the youngest group, comprised exclusively of students enrolled in schools offering comprehensive school health education, were also utilized to examine program influence. While the age for obtaining sexual knowledge was similar, parents were never reported as the primary information source. Young participants, citing teachers and siblings as their primary information source, achieved the highest accuracy scores. This suggests the value of health education. Accurate sexuality information was reported as extremely important to lifetime wellness, and ignorance was found to have produced guilt and illness in the majority of respondents.

Risk factors of psychosis: identifying vulnerable populations premorbidly

This article reviews premorbid indicators of psychosis that may be relevant to primary intervention. These risk markers are divided into two categories: (1) precursors related to early etiological factors (family psychiatric history, perinatal and obstetric complications, neurobehavior deficits, early parental separation, institutionalization, and poor family function) and (2) precursors signaling latent mental illness (personality measurements indicating proneness to psychosis, and teacher ratings indicating emotional lability, social anxiety, social withdrawal, passivity, poor peer relations, and disruptive and aggressive behavior). Because teacher ratings have been shown to be powerful predictors of adult mental breakdown, part of this article focuses on a specific study that assesses such ratings as predictors of psychosis in a high-risk population. Risk indicators may also provide clues about protective factors relevant for primary prevention.

Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up to the NHANES I and the California Occupational Mortality Study

What jobs are associated with the highest and lowest levels of cigarette use and of lung cancer? Are there gender differences in these jobs? Two data sets-the Epidemiological Follow-up to the National Health and Nutrition Examination Survey (NHEFS) and the California Occupational Mortality Study (COMS) were analyzed to answer these questions. For females, the broad occupations ranking from highest to lowest cigarette use in the NHEFS was: transportation operators, managers, craft workers, service workers, operatives, laborers, technicians, administrative workers, farm owners and workers, sales workers, no occupation, and professionals. The corresponding ranking for males was: transportation operators, no occupation, laborers, craft workers, service workers, technicians, and professionals. The highest-ranking jobs in the COMS were waitresses, telephone operators, and cosmetologists for women, and water-transportation workers, roofers, foresters and loggers for men. Teachers were especially low on all four lists. This study could not determine whether employment within any occupation encouraged smoking or if smokers selected certain occupations.

Can we be both women and analysts?

The authors, candidates at a psychoanalytic institute that has not had a woman training analyst for more than 20 years, have a unique vantage point from which to examine the woman's development as an adult female and as a psychoanalyst. Our group has engaged in a series of discussions asking: Can we be both women and analysts? Comparing and contrasting our experiences with feedback from colleagues across the United States and abroad, we had to accept that our unique situation could not be a foil for the training dilemmas facing women. Our insights into the challenges involved with training, expression of sexuality, family ties, formation of an analytic identity, creative contributions to the field, and career progression have caused us to arrive at some sobering observations and hard-hitting questions which we present here. We hope that as we describe our discussions about the woman analyst's experience an active dialogue will arise within the reader's mind, and subsequently with colleagues.

Strategies for teaching research: a survey of baccalaureate programs

The purpose of this study was to survey educators in National League for Nursing-accredited baccalaureate programs regarding placement and teaching strategies for nursing research and assignments used to integrate research throughout the curriculum. The 25-item survey instrument was sent to 100 randomly selected deans and directors of schools, 67 of whom responded. Demographic and descriptive data are reported. Assignments specific for theory and clinical courses are tabulated. Although a number of variables, such as size of school, region, education of faculty, and presence of a graduate program were analyzed, no significant correlations were found.

Assessing the quality of the working life of nurse educators in Finland: perceptions of nurse educators and their spouses

As part of a broader descriptive study of nurse educators' well-being at work in Finland, the quality of working life was assessed by the nurse educators themselves and by their spouses (or another adult living with them). Data were analysed from 477 (68% of 706) educators from 25 institutes throughout Finland and from 409 (58% of 706) spouses. Nurse educators evaluated their working life as being good. Background factors that improved one or several features of working life were: young age, being married, permanent employment in a small institute in the countryside, and highschool education. Lack of freedom to choose the teaching field and tasks at work reduced the quality of working life. Nurse educators estimated that they did an average of 9.6 hours overtime a week; according to their spouses the figure was 12.7 hours. More than moderate amounts of negative stress, derived mainly from work, were reported. Interactions with people at work and the support obtained for their work were generally judged to be good. Participants reported that they were not very satisfied with relationships with college directors, while they were, generally, satisfied with relationships with students. The spouses estimated nurse educators' working life more negatively than did the educators themselves, with the exception of the balance between work and leisure time, which both groups estimated similarly.

Patient involvement in clinical teaching

This paper presents findings from a longitudinal study of patient refusals (as reported by graduating medical students) to take part in the teaching function of public hospitals. Results from a smaller study of non-patients' attitudes are also reported. Findings are discussed in terms of patients' rights, issues of personal privacy, medical education, and the public good.

Longitudinal comparison of multimedia textbook instruction with a lecture in radiology education

RATIONALE AND OBJECTIVES

The purpose of this prospective randomized study was to compare the long-term instructional effectiveness of a computer-based radiology multimedia textbook (MMTB) with that of a traditional lecture.

METHODS

Volunteer faculty/fellows and residents were randomly assigned to either a computer-based MMTB group or to a lecture group. The course content for each instructional group was the same. Pretests, posttests, and 1-year long-term retention tests were administered to both groups. The same 10 questions were on all tests. The resulting data were analyzed using analysis of variance procedures available on the Statistical Analysis System.

RESULTS

A comparison of the long-term instructional effectiveness of an MMTB versus a lecture showed that the MMTB computer instructional method was at least comparable in spite of the initial short-term appearance of lecture superiority.

CONCLUSION

These results suggest a promising future for MMTB and other forms of computer-based education in radiologic instruction for medical students and radiologists.