Teaching IR to Medical Students: A Call to Action

Leadership in Interventional Radiology - Fostering a Culture of Excellence

This invited article reviews the current status of Interventional Radiology (IR), in terms of its status as a speciality, and outlines the conditions needed for IR to function optimally within healthcare settings. Guidance is offered in terms of developing an IR department, ensuring high-quality practice, dealing with administrative and political challenges, dealing with industry and creating a legacy.

A prospective cross-sectional study assessing teaching of interventional radiology across 20 Australian medical schools, endorsed by the Australian Medical Students Association

BACKGROUND

Existing literature from around the world has shown that teaching of Interventional Radiology (IR) to medical students remains suboptimal. Despite calls for improvement at a "grass-roots" level, most IRs find that junior doctors have limited or no knowledge of IR, and thus reduced awareness of potential IR treatments for their patients or contemplating IR as a future career. The aim of this study was to survey current medical students to assess perception of whether a wider variety of medical schools are integrating IR into their curriculum, from universities all across Australia. This was a prospective cross-sectional study of members of the Australian Medical Students Association (AMSA) from across Australia. Students were given a 14-question survey of current university teaching and students' knowledge of the discipline of IR. The primary outcome was perception of current teaching and knowledge of IR. Secondary outcomes include awareness of technical, clinical, and other duties of IRs.

RESULTS

Surveys were sent in a newsletter and posted on the AMSA Facebook page to their members. 82 responses were received via students from 20 out of 23 Australian medical schools. 61% of students described poor or no knowledge of IR. Teaching of IR was significantly worse than diagnostic radiology (p < 0.001), only 12% suggested that current IR teaching was adequate, and 99% suggested that IR teaching could be improved. Only 11% of students would consider a career in IR.

CONCLUSIONS

Medical student perception of exposure to IR is poor compared to diagnostic radiology. Better awareness may lead to improved referral patterns for patients and more career interest in IR.

Perception of Interventional Radiology among Jazan Medical Students: Assessment of Knowledge and Career Intentions

Context Lack of awareness among the students in the medical field is the greatest challenge to overcome in the emergence of contemporary interventional radiology (IR).

Objectives We aimed to conduct a survey among medical students of Jazan University to explore their knowledge about IR, interest in IR as a future career, and preferred methods of training in IR.

Materials and Methods This was a cross-sectional, self-directed questionnaire study. The target population was all medical students at Jazan University. Surveys were sent to 600 students. The questionnaire consisted of 11 closed and open-ended questions.

Statistical Analysis We calculated the size of the sample using the Raosoft Sample Size Calculator Web site. Data analysis was performed using SPSS statistics.

Results A total of 270 students responded (45%); more than half of the respondents (58.5%) were in the preclinical stage, while the rest were in the clinical stage. About 62.5% of clinical students and 66.4% preclinical students reported that their perception regarding the terminology of IR was good or excellent. Regarding the identification of interventional radiologists, 50.9% from the clinical students thought them to be radiologists and 50% from preclinical students also identified them as such.

About 29.5% from the clinical students and 27.8% from the preclinical students thought them special surgeons, and 31.3% clinical students compared with 30.4% preclinical students believed they are vascular surgeons working with X-rays. About 19.6% clinical students compared with 17.7% preclinical students said they are general surgeons working with X-rays, and 48.2% clinical students compared with 45.6% preclinical students said they are special radiologists who work with percutaneous techniques. There was a significant difference (p = 0.041) in the responses between preclinical and clinical students regarding knowledge about what this medical specialty does. About 60.8% of clinical students reported that their knowledge and information regarding IR are efficient in comparison to 39.2% of preclinical students.

Conclusion This study demonstrated that the basic knowledge among Jazan medical students is poor. About half of the respondents were clinical students who understood the radiology specialty, compared with one-third of preclinical students. This could impact the student’s decision toward IR as a future career.

Future Interventional Radiologists and Where to Find Them-Insights from Five UK Interventional Radiology Symposia for Junior Doctors and Medical Students

Background

The interventional radiology (IR) trainee recruitment in the UK is lagging behind the pace of service expansion and is potentially hindered by underrepresented undergraduate curricula. Understanding the contributing factors that encourage junior doctors and medical students to consider an IR career will help the IR community to better focus the efforts on recruiting and nurturing the next generation.

Methods

Anonymised questionnaires on undergraduate and postgraduate IR exposure were distributed to attendees of five UK IR symposia between 2019 and 2020.

Results

220 responses were received from 103 (47%) junior doctors and 117 (53%) medical students. Prior IR exposure strongly correlates with individuals’ positive views towards an IR career (Pearson’s R = 0.40, p < 0.001), with involvement in clinical activities as the most important independent contributor (OR 3.6, 95%CI 1.21–10.50, p = 0.021). Longer time spent in IR (especially as elective modules) and IR-related portfolio-building experiences (such as participating in research, attending conferences and obtaining career guidance) demonstrate strong association with willingness to pursue an IR career for the more motivated (p values < 0.05). The symposia had overall positive effects on subjective likelihood to pursue an IR career, particularly among junior doctors who face near-term career choices (p < 0.001).

Conclusion

Our study, focusing on a self-selected cohort, identified contributing factors to individuals’ willingness to pursue an IR career. Symposia have additional recruitment effects in extra-curricular settings. Active engagement with junior doctors and medical students through clinical activities and non-clinical portfolio-related experiences are key to generate informed and motivated candidates for the future of IR.

Electronic supplementary material

The online version of this article (10.1007/s00270-020-02655-7) contains supplementary material, which is available to authorised users.

Endovascular simulation training: a tool to increase enthusiasm for interventional radiology among medical students

OBJECTIVES

Interventional radiology (IR) is a growing field but is underrepresented in most medical school curricula. We tested whether endovascular simulator training improves medical students' attitudes towards IR.

MATERIALS AND METHODS

We conducted this prospective study at two university medical centers; overall, 305 fourth-year medical students completed a 90-min IR course. The class consisted of theoretical and practical parts involving endovascular simulators. Students completed questionnaires before the course, after the theoretical and after the practical part. On a 7-point Likert scale, they rated their interest in IR, knowledge of IR, attractiveness of IR, and the likelihood to choose IR as subspecialty. We used a crossover design to prevent position-effect bias.

RESULTS

The seminar/simulator parts led to the improvement for all items compared with baseline: interest in IR (pre-course 5.2 vs. post-seminar/post-simulator 5.5/5.7), knowledge of IR (pre-course 2.7 vs. post-seminar/post-simulator 5.1/5.4), attractiveness of IR (pre-course 4.6 vs. post-seminar/post-simulator 4.8/5.0), and the likelihood of choosing IR as a subspecialty (pre-course 3.3 vs. post-seminar/post-simulator 3.8/4.1). Effect was significantly stronger for simulator training compared with that for seminar for all items (p < 0.05). For simulator training, subgroup analysis of students with pre-existing positive attitude showed considerable improvement regarding "interest in IR" (× 1.4), "knowledge of IR" (× 23), "attractiveness of IR" (× 2), and "likelihood to choose IR" (× 3.2) compared with pretest.

CONCLUSION

Endovascular simulator training significantly improves students' attitude towards IR regarding all items. Implementing such courses at a very early stage in the curriculum should be the first step to expose medical students to IR and push for IR.

KEY POINTS

• Dedicated IR-courses have a significant positive effect on students' attitudes towards IR. • Simulator training is superior to a theoretical seminar in positively influencing students' attitudes towards IR. • Implementing dedicated IR courses in medical school might ease recruitment problems in the field.

A prospective study integrating a curriculum of interventional radiology in undergraduate education: a tetra-core simulation model

Background

Interventional radiology (IR) is underrepresented in undergraduate medical curricula across Europe. By continuing to challenge the boundaries of IR, a rise in the demand for radiologists has been inevitable – a trend not met by a corresponding rise in the supply of radiologists. On tracing the roots of this shortage, lack of awareness of the specialty within medical trainees coupled with a global lack of IR teaching in undergraduate education seem to constitute major exacerbating factors. The purpose of this study was to identify gaps in the field of IR education and address these by implementing an international IR simulation-based course for undergraduates.

Results

Implementation of a multi-modality simulation-based course consisted of seven modules incorporating technical and non-technical skills, basic science and applied clinical science modules. Of all participants, 90.7% (N = 68) never had previous IR teaching experience and only 28% (N = 21) had a previous placement in an IR department. Following the course, confidence improvement was statistically significant both in IR skills (1/5, p < 0.01) and knowledge (1/5, p < 0.01)]. The majority (90.7%) said they would benefit with more exposure to IR. In terms of the students’ motivation for a career in IR, 32% (N = 24) reported that they would more likely consider a career in IR after completing the course.

Conclusion

Delivery of a tetra-core simulation course with the aim to address the gaps in undergraduate IR education has had a positive impact on students’ skills, confidence levels as well as motivation. We propose reviewing the curricula across medical schools in Europe to identify gaps and address any inadequacies; for this, we consider our simulation course an excellent starting point.

Awareness and knowledge of interventional radiology among medical students at an Indian institution

Purpose

Interventional radiology (IR) is a novel and evolving sub-specialty that encompasses image guided diagnostic and therapeutic procedures. With the advent of new imaging techniques and an increasing demand of minimally invasive procedures, IR continues to grow as a core component in medical and surgical therapeutics. Radiology teaching is a part of medical undergraduate curriculum; however, the medical undergraduate cohort lacks exposure to IR principles, methods and techniques. The purpose of this study is to determine the knowledge and awareness of IR among medical students in a single university in India.

Materials and methods

Electronic anonymous surveys were sent to 350 medical students of Pt. JNM Medical College, Raipur, India. Each survey comprised of questions assessing knowledge and exposure to IR. A total of 70 students (20%) responded.

Results

85.7% of respondents positively reported that radiologists have a role in diagnostic as well as therapeutic interventions, however, 60% of students cited a very poor/poor knowledge of IR. A larger part, 91.5%, stated that they would be interested in IR based teaching delivered as a part of their undergraduate teaching program. Those who knew at least one interventional radiology technique were 1.51 (95% CI: 1.02–2.22; p < 0.05) times more likely to be considering it as a career.

Conclusion

Medical Students demonstrate a poor knowledge of IR. This corresponds to a limited and inconsistent exposure to IR in medical schools. The study suggests that there is a need to deliver an IR based curriculum in medical undergraduate teaching in India. Our proposition includes introducing a regulated IR teaching in undergraduate medical education using new module designs and presenting medical students an opportunity to attend IR education days, symposiums and conferences to incite early participation.

Awareness of interventional radiology before professional training and outcome measurement of an interventional radiology curriculum: a survey of third-year undergraduates in a Chinese medical college

PURPOSE

We aimed to assess the awareness of interventional radiology (IR) among medical students, and to evaluate an IR curriculum in China.

METHODS

Between the academic years of 2008 and 2016, 517 third-year medical undergraduates, who successfully applied for an IR curriculum, received a survey related to IR before taking the course. Final exams were conducted after the IR course.

RESULTS

A total of 355 of the 517 medical students (68.67%) answered the survey; 81.97% of the respondents had heard of IR, 40.28% believed they understood what IR is, but no one was familiar with IR. The four most common pathways for medical students to acquire IR knowledge were via new media (e.g., internet, apps) (42.82%), a teacher/textbook (36.90%), a friend (32.68%), and traditional media (26.48%). The most familiar interventional procedures to respondents were percutaneous transluminal coronary angioplasty (PTCA, 78.59%) and transcatheter arterial chemoembolization (TACE, 44.51%). The results of the survey also indicated that 68.45% of the respondents wanted to learn about IR, but that only 47 male students (13.24%) considered a career in IR. The pass rate of the IR course final exam was 87.04%, i.e., 87.04% of the students successfully completed the course and final exam.

CONCLUSION

The IR knowledge of medical students in China is worse than that of European medical students. We suggest that providing medical students with general information about IR in the media, as well as via teaching and textbooks in medical school, requires prompt and significant attention. An IR curriculum is beneficial for increasing the IR knowledge of undergraduates.

SURVEY OF KEY RADIATION SAFETY PRACTICES IN INTERVENTIONAL RADIOLOGY: AN IRISH AND ENGLISH STUDY

Interventional radiology is a rapidly evolving speciality with potential to deliver high patient radiation doses, as a result high standards of radiation safety practice are imperative. IR radiation safety practice must be considered before during and after procedures through appropriate patient consent, dose monitoring and patient follow-up. This questionnaire-based study surveyed fixed IR departments across Ireland and England to establish clinical practice in relation to radiation safety. Pre-procedure IR patient consent includes all radiation effects in 11% of cases. The patient skin dose surrogate parameter of Kerma to air at a reference point (Kar) is under-reported. Only 39% of respondents use a substantial radiation dose level and inform patients after these have been reached. Poor compliance with unambiguous, readily available best practice guidance was observed throughout highlighting patient communication, patient dose quantification and subsequent patient dose management concerns.

Understanding the Awareness, Knowledge and Perceptions of Interventional Radiology Amongst Undergraduates in the UK

INTRODUCTION

The role of interventional radiology (IR) in health care is rapidly expanding in the United Kingdom (UK). However, the presence of IR in the current undergraduate curriculum is lacking.

PURPOSE

This study investigates the awareness, knowledge and perceptions of IR in undergraduates through the clinical years of medical school to suggest future interventions.

METHODS

A total of 360 questionnaires, designed to test undergraduates' knowledge of, and exposure to, IR were distributed over a 14-day period in a UK medical institution.

RESULTS

Of the 312 respondents (86.7%), the majority had never formally shadowed a radiologist (65.4%) or encountered teaching from an interventional radiologist (54.5%). Most students (88.5%) felt their knowledge of IR was lower than other specialties. Students' knowledge of IR procedures did not statistically increase through the clinical years. Students were most cognisant of vascular procedures and least aware of IR's role in oncology. Only 10.9% would consider a career in IR, with 39.7% citing the lack of knowledge and 18.6% citing patient contact as the top reasons for this.

CONCLUSION

Current students have poor exposure to IR through the undergraduate curriculum. Consequently, there is no increase in knowledge of IR clinical practice through the clinical years. Multi-level interventions, incorporating universities and radiological societies are required to increase undergraduate awareness and promote IR as a career.

LEVEL OF EVIDENCE

Level 3, Local non-random sample.

Establishing a Platform for Interest and Education in Interventional Radiology Amongst Radiology Trainees

PURPOSE

Over recent times, procedural Radiologists have begun to establish themselves as the distinct subspecialty of Interventional Radiology (IR). The Interventional Radiology Society of Australasia (IRSA) was established in 1982 to share collaborative ideas, encourage research, and promote education. IRSA developed a weekend registrar workshop attended by Radiology Registrars from Australia and New Zealand. In the 2018 event, we surveyed the Registrars to identify their interest in IR training before and after the workshop.

MATERIALS AND METHODS

The event was held over a weekend and consisted of both lectures and hands-on workshops. A survey was handed to all 67 registrants of the workshop and there was a 55% response rate including 78% of females in attendance.

RESULTS

Before the workshop, trainees rated their interest in IR training at a mean of 3.7 out of 5. After the workshop, trainees rated their interest in IR training as an average of 4.4 out of 5 (p < 0.001). The difference in interest between males and females before the workshop (4.0 vs. 3.1) was significant (p = 0.003), however after the workshop (4.5 vs. 4.1) was not significant (p = 0.07). The change in interest from attending the workshop was significant between genders, p = 0.03 (male interest increased mean 0.5, female increased mean 1.0).

CONCLUSION

We show that a program of lectures and workshops designed to generate interest in IR leads to a significant increase in training interest, particularly amongst females. Other subspecialty groups should consider this type of intervention and promote ongoing education and inspiration.

LEVEL OF EVIDENCE

Cross-sectional study, Level IV.

Australian students' perspective on interventional radiology education: A prospective cross-institutional study

INTRODUCTION

As interventional radiology (IR) adopts an increasingly pivotal role within therapeutic medicine, it is essential that medical students gain exposure to IR so as future doctors, they can fulfil the growing demand for interventional radiologists (IRs) and make appropriate referrals to IRs. Nonetheless, several international studies have reported no or little representation of IR in medical schools. Our study aims to assess the current awareness, exposure, knowledge and attitudes about IR among Australian medical students, so as to provide preliminary data on whether IR teaching in Australian medical schools needs improvement.

METHODS

A prospective cross-sectional study was conducted via web-based and in-person distribution of a voluntary, anonymous questionnaire.

RESULTS

A total of 237 complete responses were received from approximately 1400 clinical-based students (17% response rate); 38% of respondents had never witnessed an IR procedure, 39% witnessed 1-2 and the remainder, 3-5. Few students reported adequate teaching or knowledge in IR (7% and 5% respectively). Of the 32% of the students considering a career in IR, males predominated (25% of females vs. 59% of males, OR = 0.48, 95%, CI = 0.27-0.83, P = 0.008). Most students agree that IR should be in the university curriculum (59%) and is key to improving healthcare (74%). Senior students were more likely to report adequate teaching (P < 0.001) and believe that IR teaching is important (P = 0.001).

CONCLUSIONS

Australian medical students have a strong appreciation for IR despite having suboptimal teaching, exposure and knowledge in IR. In order to complement and sustain the rapid uptake of IR techniques in modern medicine, university curricula require a greater focus on IR.

Interventional Radiology and Spanish Medical Students: A Survey of Knowledge and Interests in Preclinical and Clinical Courses

INTRODUCTION

Interventional Radiology (IR) is a medical activity that has experienced an extraordinary growth in the medical field in Spain in recent years. However, there is a lack of visibility in the Spanish Health Administration and the University community, especially among medical students.

PURPOSE

The purpose of this study is to determine IR knowledge among medical students, preclinical and clinical, in a single University in Spain.

MATERIAL AND METHODS

An electronic survey was uploaded (November-December 2017) to an online learning platform (Moodle) and sent to 414 students from second (183 PCs) and fourth (231 Cs) year of medical school. A total of 313 students of 414 (75.6%) answered the survey 142/45.4% PCs and 171/54.6% Cs.

RESULTS

Students quantified their knowledge between adequate (41% PCs/80.7% Cs) and poor levels (50.7% PCs/14% Cs). Most of the students suggested that interventional radiologists (IRs) should have a mixed training, surgical and radiological (95% PCs/88.8% Cs). Majority of students indicated that the professionals in charge of carrying out angioplasty were the IRs (95% PCs/83.6% Cs) and only 20.4% PCs/12.8% Cs (P = 0.165) of students chose cardiologists. Almost all of the medical students in both groups said they wanted to know more about IR (99.3% PCs/100.0% Cs), and the majority of students (100.0% PCs/98.8% Cs) said they agree or strongly agree that IR should be taught as an undergraduate medical subject.

CONCLUSION

This study demonstrates that medical students in our University have poor knowledge of IR; however, they are overwhelmingly positive in their desire to have this subject taught as distinct curriculum in medical school.