Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement

The Effects of Various Teaching Methods on Chest X-ray Interpretation Skills Among Medical Students and Interns: A Systematic Review

Chest X-ray (CXR) is a common tool used in medical practice. Medical students and interns should acquire knowledge of CXR interpretation, as it is an essential diagnostic tool for a large spectrum of diseases. This systematic review aimed to compare the effect of different intervention techniques on the competency of medical students and interns to demonstrate the level of confidence and competence in interpreting common presentations of CXRs. The population, intervention, comparison, and outcomes (PICO) framework was used to formulate the review question. All related articles in five databases (PubMed, Web of Science, Scopus, Medline, and Embase) were retrieved and the search was completed in March 2023 with no limiters on date and time. The number of relevant studies was 469. A multi-level approach through the Rayyan platform was used for the screening and exclusion processes. Eleven articles were included in the systematic review consisting of eight randomized controlled trials, one quasi-experimental study, one cross-sectional study, and one interventional cohort. Results showed significant effects of teaching methods utilizing deductive or inductive approach, clinical history, patient care comfort survey, and SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled). Contrarily, no significant effect was shown by flipped classroom models and mixed and blocked practice, peer-assisted learning vs. expert-assisted learning, and Chester, an artificial intelligence tool. This review identified beneficial approaches that may enhance the learning outcomes of interpreting CXRs for medical students and interns, highlighting the remarkable impact of SAFMEDS on medical students' ability to identify CXR findings as well as the availability and practicality of online and e-learning resources for students.

Videofluoroscopic swallow study training for radiologists-in-training: a survey of practice and training needs

BACKGROUND

There is a lack of formal, published videofluoroscopic swallow study (VFSS) training targeting radiologists, yet radiology senior medical officers and resident medical officers (i.e., radiologists-in-training, known in Australia as "registrars") are expected to be involved in VFSS interpretation of anatomical anomalies and reporting. This study investigated whether VFSS training is delivered to registrars during their specialist radiology training, whether it is a perceived need and, if so, to determine the desired content for inclusion in a targeted training package.

METHODS

A cross-sectional, mixed methods study design was used. An internet-based survey was circulated via convenience and snowball sampling to radiologists (both senior medical officers and registrars) and speech-language pathologists across Australia in October-November 2017. Surveys also were distributed to practitioners based in New Zealand and the United Kingdom, as they practised within similar health systems, and it was anticipated they may have similar VFSS training practices. The radiology survey contained 36 questions and the speech-language pathology survey contained 44 questions. Participants were asked the following: (1) Report their current VFSS radiology registrar training environment; (2) Advise whether radiology registrars need VFSS training; (3) Recommend the content, format, training intensity, and evaluation methods for an effective radiology registrar training package. Demographic data were analysed descriptively, and open-ended responses were analysed using qualitative content analysis.

RESULTS

21 radiology senior medical officers and registrars and 150 speech-language pathologists predominantly based at Australian tertiary hospital settings completed the survey. Most respondents (90.6%) identified that VFSS training is needed for radiology registrars. Only one speech-language pathologist respondent reported that they deliver VFSS training for radiology registrars. Specific content and teaching modalities for a VFSS training package, including diagnosing anatomical anomalies associated with dysphagia were recommended.

CONCLUSION

While most of the radiologists and speech-language pathologists surveyed did not deliver VFSS training to radiology registrars, they identified that targeted training is needed to improve radiology registrars' effectiveness and engagement in VFSS clinics. The training package content, format and evaluation methods recommended by participants will inform the development of a VFSS training package targeting radiology registrars to be piloted at an Australian tertiary hospital.

Expanding our concept of simulation in radiology: a "Radiology Requesting" session for undergraduate medical students

Objectives

Whilst radiology is central to the modern practice of medicine, graduating doctors often feel unprepared for radiology in practice. Traditional radiological education focuses on image interpretation. Key areas which are undertaught include communication skills relating to the radiology department. We sought to design teaching to fill this important gap.

Methods

We developed a small group session using in situ simulation to enable final and penultimate year medical students to develop radiology-related communication and reasoning skills. Students were given realistic cases, and then challenged to gather further information and decide on appropriate radiology before having the opportunity to call a consultant radiologist on a hospital phone and simulate requesting the appropriate imaging with high fidelity. We evaluated the impact of the teaching through before-and-after Likert scales asking students about their confidence with various aspects of requesting imaging, and qualitatively through open-ended short answer questionnaires.

Results

The session was delivered to 99 students over 24 sessions. Self-reported confidence in discussing imaging increased from an average of 1.7/5 to 3.4/5 as a result of the teaching (p < 0.001) and students perceived that they had developed key skills in identifying and communicating relevant information.

Conclusions

The success of this innovative session suggests that it could form a key part of future undergraduate radiology education, and that the method could be applied in other areas to broaden the application of simulation.

Advances in knowledge

This study highlights a gap in undergraduate medical education. It describes and demonstrates the effectiveness of an intervention to fill this gap.

IMPACT (Information Medically Pertinent in Acute Computed Tomography) requests: Delphi study to develop criteria standards for adequate clinical information in computed tomography requests in the Australian emergency department

INTRODUCTION

Inadequate clinical information in medical imaging requests negatively affects the clinical relevance of imaging performed and the quality of resultant radiology reports. Currently, there are no published Australian guidelines on what constitutes adequate clinical information in computed tomography (CT) requests. This study aimed to determine specific items of clinical information radiologists require in CT requests for acute chest, abdomen and blunt trauma examinations, to support optimal reporting.

METHODS

A panel of 24 CT-reporting consultant radiologists participated in this e-Delphi consensus study. Panellists undertook multiple online survey rounds of open-ended, dichotomous and Likert scale questions, receiving feedback following each. Round 1 responses formulated lists for each CT examination. Round 2 set a threshold of 80% agreement after dichotomous scoring. Round 3 accepted items which averaged 4 or more on a 5-point Likert scale. Round 4 required panellists to rank items within the aggregated, accepted lists, based on panellists' perceived level of usefulness.

RESULTS

The large numbers of round 1 items (chest: 101, abdomen: 76, blunt trauma: 80) were rationalised and grouped into categories to facilitate efficiency during subsequent rounds. Twenty-three chest, 24 abdomen and 17 blunt trauma items met the 80% agreement threshold in round 2. Items below threshold were included in round 3; numbering 44, 19 and 23 for chest, abdomen and blunt trauma, respectively. Through the e-Delphi process, we formulated clinical information criteria standards for three CT types.

CONCLUSIONS

The developed standards will guide Australian referrers in providing adequate clinical information in CT requests, to support optimal reporting, diagnosis and treatment.

Multimodal Three-Dimensional Visualization Enhances Novice Learner Interpretation of Basic Cross-Sectional Anatomy

While integrated delivery of anatomy and radiology can support undergraduate anatomical education, the interpretation of complex three-dimensional spatial relationships in cross-sectional and radiological images is likely to be demanding for novices. Due to the value of technology-enhanced and multimodal strategies, it was hypothesized that simultaneous digital and physical learning could enhance student understanding of cross-sectional anatomy. A novel learning approach introduced at a United Kingdom university medical school combined visualization table-based thoracic cross-sections and digital models with a three-dimensional printed heart. A mixed-method experimental and survey approach investigated student perceptions of challenging anatomical areas and compared the multimodal intervention to a two-dimensional cross-section control. Analysis of seven-point Likert-type responses of new medical students (n = 319) found that clinical imaging (mean 5.64 SD ± 1.20) was significantly more challenging (P < 0.001) than surface anatomy (4.19 ± 1.31) and gross anatomy (4.92 ± 1.22). Pre-post testing of students who used the intervention during their first anatomy class at medical school (n = 229), identified significant increases (P < 0.001) in thoracic cross-sectional anatomy interpretation performance (mean 31.4% ± 15.3) when compared to the subsequent abdominal control activity (24.1% ± 17.6). Student test scores were independent of mental-rotation ability. As depicted on a seven-point Likert-type scale, the intervention may have contributed to students considering cross-sectional interpretation of thoracic images (4.2 ± 1.23) as significantly less challenging (P < 0.001) than comparable abdominal images (5.59 ± 1.14). These findings could have implications for how multimodal cross-sectional anatomy learning approaches are implemented within medical curricula.

Medical imaging education opportunities for junior doctors and non-radiologist clinicians: A review

Medical imaging plays a critical role in clinical decision-making across disciplines, and as such, there is frequent need for non-radiologist clinicians to interact with medical imaging. This review examines the literature about the delivery of medical imaging education to non-radiologist clinicians, spanning junior doctors, advanced trainees and specialists. Knowledge of medical imaging among non-radiologist clinicians is paramount to the quality of patient care, with calls for formal implementation of radiology education into non-imaging specialty training programmes. Overall, there is a demand across non-imaging disciplines for greater formalised medical imaging education. Concerns are raised that too great a reliance on informal methods of teaching radiology, for example in ward settings, results in greater variation in the quality and volume of educational opportunities and risks the perpetuation of erroneous attitudes and practices. The evolution of the medical imaging workplace and increasing utilisation of remote reporting has distanced the collaborative relationship between radiologists and their non-imaging colleagues, diminishing opportunities for ad hoc learning and engagement in larger formalised educational collaborations. Ideally, radiologists should be directly involved in the development and delivery of medical imaging education to post-graduate doctors to not only benefit patient care but also foster inter-specialty relationships and respect. Evidence supports the value of structured radiological teaching opportunities, including tutorials, lectures and electronic resources, in improving medical imaging skills among non-radiologist clinicians. There is wide scope for growth in the e-learning arena to address this demand for quality and accessible imaging education for our non-radiology colleagues.

Virtual reality and annotated radiological data as effective and motivating tools to help Social Sciences students learn neuroanatomy

Neuroanatomy as a subject is important to learn, because a good understanding of neuroanatomy supports the establishment of a correct diagnosis in neurological patients. However, rapid changes in curricula reduced time assigned to study (neuro)anatomy. Therefore, it is important to find alternative teaching methods to study the complex three-dimensional structure of the brain. The aim of this manuscript was to explore the effectiveness of Virtual Reality (VR) in comparison with Radiological Data (RaD) as suitable learning methods to build knowledge and increase motivation for learning neuroanatomy. Forty-seven students (mean age of 19.47 ± 0.54 years; 43 females; 4 males) were included; 23 students comprised the VR group. Both methods showed to improve knowledge significantly, the improvement between groups was not different. The RaD group showed to have a significantly higher score on expectancy than students in the VR group. Task value scores regarding finding a task interesting, useful and fun were found to be significantly different in favor of the VR group. Consequently, significant higher Motivation scores were found in the VR group. Motivation and expectancy, however, did not moderate learning results, whereas task value impacted the results in favour of the VR group. This study concludes that VR and RaD are effective and diverting methods to learn neuroanatomy, with VR being more motivating than RaD. Future research should investigate motivation and task value when using VR over a longer period of time.

The "Look Ahead" Technique: A Novel Way to Engage Medical Students in the Radiology Reading Room

RATIONALE AND OBJECTIVES

Engaging medical students during a radiology course can be challenging. We sought a way to actively engage students with live cases, allow them to interact with the picture archiving and communication system workstation, and experience what it is like to be a radiologist.

MATERIALS AND METHODS

Medical students enrolled in one of three radiology courses between May 2016 and June 2017 were eligible. The "Look Ahead" technique is as follows: a preceptor identifies several nonurgent imaging studies and allows the students to view the images first and make independent observations and conclusions. When ready, the students present their findings, receive feedback, and observe the preceptor generate a final report. Students completed the postcourse survey comparing the "Look Ahead" technique with the current standard (observing a preceptor interpret imaging studies with accompanying teaching points).

RESULTS

Thirty-four (56.7%) of 60 potential respondents completed the postcourse survey. Of these 34, 24 (70.6%) reported at least one reading room case (mean 4.6) in which the technique was employed, with a mean of 2.4 unique preceptors. When compared to the current standard (0 = not to 100 = very interested/engaged/valuable/memorable), the "Look Ahead" technique was associated with increased student-reported interest (92.5 vs 75.1, p < 0.01), engagement (94.0 vs 70.3, p < 0.01), educational value (92.5 vs 73.2, p < 0.01), memorability of the case (88.5 vs 73.2, p < 0.01) and of accompanying teaching points (90.1 vs 76.7, p < 0.01).

CONCLUSION

The "Look Ahead" technique is a meaningful and engaging teaching method, which students find "interesting," "valuable," and "memorable."

Evaluating the integration of pre-mortem body donor imaging into a dissection-based medical anatomy course

BACKGROUND

Medical faculties are currently embracing a modernistic approach to anatomical education that integrates diagnostic imaging largely through post-mortem computed tomography scanning of body donors. Post-mortem imaging, however, poses a multitude of challenges. The purpose of this study was to assess the implementation of pre-mortem donor-specific diagnostic imaging on student learning and dissection experience in addition to understanding the potential impact on students' preparation for clinical practice.

METHODS

Students in a fourth-year medicine elective course were divided into groups; group 1 received pre-mortem donor-specific diagnostic imaging, while group 2 received pathology-specific diagnostic imaging, a collection of images relating to the type(s) of pathologies the donors exhibited, though not specific to the donors themselves. Both groups also received a donor-specific case vignette. A convergent, parallel mixed methods design was employed. This included integrating data from group responses to a study participant survey and students' academic assessment scores analyzed quantitatively through statistical analyses with data from focus group sessions investigating the psychosocial aspects of the student dissection experience and perceptions of the imaging use in the course analyzed qualitatively.

RESULTS

As compared to students receiving pathology-specific diagnostic imaging, the quantitative results demonstrated that students receiving pre-mortem donor-specific diagnostic imaging more positively supported the relevancy of diagnostic imaging to their understanding of anatomy, valued the integration for future practice, and suggested an earlier integration within their medical curriculum. Qualitatively, two main themes were observed: the influence of diagnostic imaging integration on dissection experience and on professional mindset. Although both student groups received imaging corresponding to their body donor, consideration towards the humanistic nature of the body donor as a patient with a history was limited to student feedback from the donor- specific diagnostic imaging group.

CONCLUSION

Overall the integration of pre-mortem donor-specific diagnostic imaging into anatomical dissection provided students with practical skill development, an enhanced dissection experience, and reinforced personal qualities critical for future practice.

Blended learning of radiology improves medical students' performance, satisfaction, and engagement

Purpose

To evaluate the impact of blended learning using a combination of educational resources (flipped classroom and short videos) on medical students’ (MSs) for radiology learning.

Material and methods

A cohort of 353 MSs from 2015 to 2018 was prospectively evaluated. MSs were assigned to four groups (high, high-intermediate, low-intermediate, and low achievers) based on their results to a 20-MCQs performance evaluation referred to as the pretest. MSs had then free access to a self-paced course totalizing 61 videos based on abdominal imaging over a period of 3 months. Performance was evaluated using the change between posttest (the same 20 MCQs as pretest) and pretest results. Satisfaction was measured using a satisfaction survey with directed and spontaneous feedbacks. Engagement was graded according to audience retention and attendance on a web content management system.

Results

Performance change between pre and posttest was significantly different between the four categories (ANOVA, P = 10⁻⁹): low pretest achievers demonstrated the highest improvement (mean ± SD, + 11.3 ± 22.8 points) while high pretest achievers showed a decrease in their posttest score (mean ± SD, − 3.6 ± 19 points). Directed feedback collected from 73.3% of participants showed a 99% of overall satisfaction. Spontaneous feedback showed that the concept of “pleasure in learning” was the most cited advantage, followed by “flexibility.” Engagement increased over years and the number of views increased of 2.47-fold in 2 years.

Conclusion

Learning formats including new pedagogical concepts as blended learning, and current technologies allow improvement in medical student’s performance, satisfaction, and engagement.

Interdimensional Travel: Visualisation of 3D-2D Transitions in Anatomy Learning

Clinical image interpretation is one of the most challenging activities for students when they first arrive at medical school. Interpretation of clinical images concerns the identification of three-dimensional anatomical features in two-dimensional cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) images in axial, sagittal and coronal planes, and the recognition of structures in ultrasound and plain radiographs. We propose that a cognitive transition occurs when initially attempting to interpret clinical images, which requires reconciling known 3D structures with previously unknown 2D visual information. Additionally, we propose that this 3D-2D transition is required when integrating an understanding of superficial 2D surface landmarks with an appreciation of underlying 3D anatomical structures during clinical examinations.Based on educational theory and research findings, we recommend that 3D and 2D approaches should be simultaneously combined within radiological and surface anatomy education. With a view to this, we have developed and utilised digital and art-based methods to support the 3D-2D transition. We outline our observations and evaluations, and describe our practical implementation of these approaches within medical curricula to serve as a guide for anatomy educators. Furthermore, we define the theoretical underpinnings and evidence supporting the integration of 3D-2D approaches and the value of our specific activities for enhancing the clinical image interpretation and surface anatomy learning of medical students.

ESR statement on new approaches to undergraduate teaching in Radiology

Medical education is evolving and electronic learning (e-Learning) strategies have now become an essential asset in radiology education. Radiology education is a significant part of the undergraduate medical curriculum and the use of e-Learning in radiology teaching in medical schools is on the rise. If coupled with clinical decision support systems, e-Learning can be a practical way of teaching students clinical decision making, such as selecting the diagnostic imaging tests that are best suited in certain clinical scenarios.The innovative concept of flipped classroom learning encourages students to work independently and maximises the application of learnt contents in interactive classroom sessions.For integrated curricula with their student-centred, problem-based, and community-based design, an approach to systematically integrate radiology may be to define diagnostic reasoning as one of the core goals. Radiologists as teachers and scholars may understand themselves as experts in diagnostic reasoning and in mentoring how to make medical decisions.Computer programs simulating the routine work are available and can be used to teach the recognition of anatomical structures and pathological patterns, and also to teach ultrasonography and interventional radiology, maximising patient safety.

How scientific mobility can help current and future radiology research: a radiology trainee's perspective

One of the ways in which modern radiology is manifesting itself in higher education and research is through the increasing importance of scientific mobility. This article seeks to provide an overview and a prospective of radiology fellows in their last year of training about the current trends and policy tools for promoting mobility among young radiologists, especially inside the European Union. Nowadays, the need to promote international cooperation is even greater to ensure that the best evidence-based medical practices become a common background of a next cross-border generation of radiologists. Organisations such as the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA) are called upon to play as guarantors of the training of young radiologists building know-how and world-class excellence. Today, it is not just being certified radiologist that matters, the place where the training was done plays an important role in enhancing chances when applying for a high-level job or fellowship. The article argues that the mobility of radiology trainees is an indispensable prerequisite to face new challenges, including the application of artificial intelligence to medical imaging, which will require a large multicentre collaboration.

Musculoskeletal Radiology Teaching at a UK Medical School: Do We Need to Improve?

The United Kingdom is currently facing crisis due to a shortage of radiology consultants despite ever-increasing demand for medical imaging. The specifics of how best to teach radiology has generated increasing interest. This study aims to determine whether musculoskeletal (MSK) radiology teaching at the University of Nottingham (UoN) Medical School is perceived to be satisfactory by medical students, Foundation-Year doctors, and senior medical professionals in preparing students for the demands working as Foundation-Year doctors. Questionnaires were distributed to all medical students and Foundation-Year doctors that graduated from UoN (n = 307). Semi-structured interviews were conducted with consultants and teaching staff (n = 13). Forty-nine percent of preclinical medical students, 43% of clinical students and 27% of Foundation-Year doctors thought MSK radiology teaching was not sufficient in preparing them for the radiology challenges Foundation-Year doctors' face. This difference was statistically significant (P < 0.001). The consensus from senior medical professionals was that MSK Radiology teaching is currently adequate and producing competent students. Interestingly, only 5% of students were considering a career in radiology compared to 34% of Foundation-Year doctors. Overall, there seems to be concern among students regarding MSK radiology teaching and students have a lack of confidence with MSK radiology. Foundation-Year doctors and senior medical professionals do not share this view. This may be due to medical students' lack of clarity on what is required of them. Formal documentation of set learning objectives for MSK radiology throughout the curriculum may address this.

Integrating 3D Visualisation Technologies in Undergraduate Anatomy Education

Anatomy forms the basis of clinical examination, surgery and radiology and it is therefore essential that a fundamental understanding of the key concepts, structures and their relationships is gained by medical and healthcare students during their undergraduate training. Anatomy involves the study of three dimensional entities relating to the human body itself and its constituent structures. In our experience, the appreciation of 3D concepts is one of the most demanding areas for medical student learning of anatomy (ben Awadh et al. 2018, unpublished observations). The ability to interpret 3D anatomical features in 2D cross-sectional clinical images can be troublesome, while the dynamic nature of embryological development is a further challenge.The aim of introducing technology enhanced-learning (TEL) approaches into our practice is with a view to enhancing undergraduate medical student learning of clinically relevant anatomy. Here we will explore the importance of visualisation and visual learning in anatomy as a scholarly basis for the integration for TEL approaches. We will then describe examples of visualisation technologies that are currently being implemented within the School of Medical Education at Newcastle University based on a research informed understanding of how students learn anatomy. We will consider the available evidence that supports best practice, identify limitations where they arise, and discuss how these visual 3D learning technologies can be effectively utilised as adjuncts and self-directed resources to supplement more established approaches to undergraduate anatomy education.

Knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students, foundation doctors, specialist radiology registrars and radiographers at a UK university teaching hospital

Objective:

Junior doctors routinely request radiological investigations for patients. Prior studies have noted that among this group there is a lack of knowledge on radiation legislation and radiation exposure in common radiological investigations. However, no studies have compared this against radiology trainees and radiographers. We compared knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students (FYMS), foundation year doctors (FY1, FY2) against specialist radiology trainees (SRT) and radiographers (RG).

Methods:

A 12-question multiple choice questionnaire (MCQ) was distributed to FYMS, FY1, FY2, SRT and RG at a UK teaching hospital. Questions assessed knowledge of radiation legislation and radiation-dose estimates of common radiological investigations. Mean MCQ scores were compared using one-way ANOVA and Tukey post-test to determine statistical significance (p-value < 0.05).

Results:

127 participants were included in the study. Mean scores (%) for FYMS (49.3%), FY1 (52.6%) and FY2 (51.1%) were significantly lower compared to SRT (64.4%) and RG (66.3%) (p-value < 0.05). Mean test scores between FYMS, FY1 and FY2 did not significantly differ (p-value > 0.05).

Conclusion:

FYMS, FY1 and FY2 knowledge of radiation legislation and radiation exposure in common radiological investigations was poor compared to SRT and RG. Patients require knowledge of radiation risk to provide informed consent as per IRMER regulations, thus we propose formal teaching on the subject matter to promote radiation safety culture among medical undergraduates and postgraduates.

Advances in knowledge:

First study to compare knowledge of radiation legislation and radiation exposure in common radiological investigations between medical students and junior doctors to radiology trainees and radiographers.

The impact on internship of a tailored intern preparation package

INTRODUCTION

On commencing internship, new medical graduates (new interns) are often required to perform core procedural skills under differing levels of supervision. This variability of knowledge and experience with procedural skills can place patient safety at risk. Consequently, in 2012, we developed a targeted, intensive, 3-day training course for our pre-intern (PrInt) students. The aim of this study was to evaluate the intern preparation package by exploring interns' self-reported knowledge, confidence, and experience in key procedural skills during the early months of internship.

METHODS

Between 2012 and 2016, 5 cohorts of PrInt students (n=223) participated in our course. In the following years 2013-2017, the same 5 cohorts, at 4-5 months into their internship, were surveyed anonymously and invited to attend focus groups. Descriptive statistics and thematic analysis were used to analyze data.

RESULTS

Of the 223 interns, 91 (41%) responded. Of the 91, 82 (93%) agreed that the intern preparation package provided during PrInt had been beneficial to their practice as an intern. Awareness of potential risks to patient safety was high, ranging from infection control at 89/89 (100%) to 87/90 (97%) for patient identification. Confidence in performing procedural skills varied from moderate in identifying nasogastric tube placement on X-ray (66/89; 85%), to equal least confidence in managing cardiac-related emergencies (53/90; 59%) and identifying the correct placement of peripherally inserted central catheter lines on X-ray (52/89; 58%).

MAJOR QUALITATIVE FINDINGS

The preparation package had refreshed interns' procedural skills ability and awareness of risks to patient safety. Integration into the clinical team was positive, but requests to perform procedural skills on day 1 was unexpected.

CONCLUSION

Interns reported that they had gained substantial benefit from their preparation package, and they performed practical procedures from day 1, further highlighting the need for an intensive preparation course immediately prior to entering internship.

Radiology trainees forum survey report on workplace satisfaction, ESR education, mobility and stress level

Objectives

The Radiology Trainees Forum (RTF) of the European Society of Radiology (ESR) conducted a survey among radiologists in training to gather and evaluate data on workplace satisfaction, ESR educational initiatives, mobility of professionals and stress levels.

Methods

A questionnaire was forwarded to radiologists in training across Europe. The subject of the questionnaire was related to: (1) the working place, (2) safety of the working environment, (3) satisfaction at the working place, (4) familiarity with educational initiatives within the ESR and (5) reasons and motivation for mobility. Results were obtained and analysed.

Results

Invitations to participate were sent by the ESR office to radiologists in training across Europe. A total of 1045 radiologists responded to the questionnaire; 77.8% were trainees and 22.2% were certified radiologists. Of the responders 65.3% considered the working place safe. Only 25.7% considered themselves involved in management, 43.9% would consider working in another country, and 52.3% were moderately satisfied with their working place. Of the responders 46.8% did not have any teaching responsibilities; 59.7% knew the European Diploma in Radiology (EDiR) and 69.7% were not aware of the content of the ESR European Training Curriculum (ETC).

Conclusion

The level of training in aspects related to management safety and quality is low among trainees. The level of satisfaction at work is adequate but not sufficient. The degree of responsibility in training tasks is scarce. A small percentage is familiar with the ESR educational initiatives. As for the mobility the main reservation is lack of confidence in the training acquired.

Main Messages

• For satisfaction levels to improve, it is vital to include more creative aspects of the profession, such as research and teaching, in balance with the routine aspects of radiology.

• Furthermore, a greater involvement of radiologists in patient care is also essential in radiology training.

• To facilitate mobility, it is important to standardise training across European countries through universal programmes and training controls such as the EDiR and the ETC.

Matching medical student achievement to learning objectives and outcomes: a paradigm shift for an implemented teaching module

INTRODUCTION

Low student achievement in a basic imaging module was the impetus for an assessment of the module.

METHODS

A valid, reliable, and structured Likert scale was designed to measure the degree of student satisfaction with the domains of the module, including learning objectives (LO), teaching strategy and tools (TT), assessment tools (AT), and allotted credit hours (CH). Further analysis was conducted of student dissatisfaction to determine the subdomain in which module improvement was to be implemented. Statistical analysis of data among Likert scale domains was conducted.

RESULTS

Likert scale data showed the TT domain to be the major reason for low student achievement. Statistical studies revealed 57/117 students (48.6%) were dissatisfied with TT, compared with LO 16/117 (13.6%), AT 54/117 (46.1%), and CH 12/117 (10.2%). Significant P-values were obtained for LO vs TT (P<0.0001), LO vs AT (P<0.0001), LO vs CH (P<0.03), TT vs CH (P<0.0001), and AT vs CH (P<0.0001). No significant difference was observed between TT and AT (P<0.29). Regarding TT, 41/117 (34.9%) students were dissatisfied with lectures (L) compared to hospital-based teaching (HPT) 24/117 (20%), problem-based learning (PBL) 8/117 (6.8%), self-directed learning (SDL) 3/117 (2.5%), and seminars (S) 4/117 (3.4%). Significant P-values were obtained for L vs HPT (P<0.0001), L vs PBL (P<0.0001), L vs SDL (P<0.0001), L vs S (P<0.0001), HPT vs PBL (P<0.002), HPT vs SDL (P<0.0001), and HPT vs S (P<0.0001). Regarding lecture modifications, student satisfaction was 78.3% compared to 52% before modification. A significant P-value (P<0.0001) was obtained between Likert scale domains before and after modification. Lecture modification resulted in a good student response and satisfaction.

CONCLUSION

The major reason for low student achievement was the teaching tools, particularly the lectures. Major modifications to lectures improved student achievement. The students and most of the teaching staff were highly satisfied with the modifications, which provided for reciprocal discussion and interaction. These results should encourage and guide other medical schools to investigate the points of weakness in their curriculum.

Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students

"I am not young enough to know everything."Oscar Wilde.

BACKGROUND

There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students' training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics.

MATERIALS AND METHODS

The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance.

RESULTS

A total of 301 students were enrolled in the study. There was 58% (P < .01) and 85% (P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase (P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline (P = .03).

CONCLUSIONS

A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.

A review of peer-assisted learning to deliver interprofessional supplementary image interpretation skills

BACKGROUND

Peer-assisted learning provides a means through which individuals can learn from one another through a reciprocal process. Radiographic image interpretation skills are fundamental to both diagnostic radiography students and medical students due to their shared role in preliminary evaluation of conventional radiographic images. Medical students on graduation, may not be well prepared to carry out image interpretation, since evidence suggests that they perform less well than radiographers in e.g. Accident and Emergency situations.

METHOD

A review of literature was conducted exploring the application of peer-assisted learning within diagnostic radiography and health education more widely as well as the practice of initial image interpretation. An extensive and systematic search strategy was developed which provided a range of material related to the areas.

FINDINGS

An overview was obtained of the effectiveness of peer-assisted learning and the issues associated with development of image interpretation skills and a degree of discrepancy was identified between the two cohorts regarding their interpretative competence and confidence. This inconsistency may create an opportunity to apply peer-assisted learning, better preparing both disciplines for the practical application of image interpretation skills.

CONCLUSION

The review identified the lack of a substantial evidence base relating to peer-assisted learning in radiography. Peer-assisted learning is not widely embraced in an interprofessional context. Multiple positive factors of such an intervention are identified which outweigh perceived negative issues. Student teacher and learner may benefit as should the clinical service from enhanced practitioner performance. The findings justify further research to develop the evidence base.

Teaching Radiology to Medical Students-There Is a Need for Change to Better Prepare Students for Clinical Practice

RATIONALE AND OBJECTIVES

Deriving maximum benefit from radiology rotations in medical schools is challenging. Lack of education on appropriate imaging renders students feeling unprepared. This study compares the ability of undergraduate medical students to identify appropriate radiological investigations, both at the beginning and end of their final year of education, to those of residents in their first year of clinical practice.

MATERIALS AND METHODS

Twelve scenarios were extracted from the American College of Radiology's Appropriateness Criteria (ACR-AC) and a questionnaire was generated. One topic was selected from each of the 10 sections in the diagnostic section and two from the interventional section. The questionnaire was distributed to three groups. Group A was composed of medical students at the beginning of final year. Group B was composed of medical students at the end of final year. Group C was composed of residents at the end of their first year of clinical practice. Radiology residents were surveyed to assess familiarity with the ACR-AC among trainees in Ireland.

RESULTS

The total cohort included 160 participants. Group C (n = 35) performed significantly better than group A (n = 72) and group B (n = 53). There was no statistical difference in the mean scores achieved by group A and group B. Sixteen (73%) of 22 radiology trainees were familiar with the ACR-AC.

CONCLUSIONS

A minimal improvement in the knowledge of medical students in requesting radiological investigations over the course of the final medical year, yet a significant impact of a relatively short period of "on-the-job" learning in the clinical setting, was indicated. Emphasis on education on appropriateness may offer an improvement in the utilization of radiology services and improve patient care.

Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective: A Comparison of MS-IIs, MS-IIIs, and MS-IVs

RATIONALE AND OBJECTIVES

Correct selection of imaging tests is essential f or clinicians but until recently has been largely neglected in medical education. How and when students acquire such non-interpretive skills are unknown. This study will assess student knowledge of imaging test selection before and after a general radiology elective.

MATERIALS AND METHODS

Between 2008 and 2015, an unannounced 13-item test was administered to second, third, and fourth-year students on the first and last days of the Johns Hopkins School of Medicine radiology elective. Scores (0–13) were based on the American College of Radiology Appropriateness Criteria. Pre- and posttest means were compared using paired samples t tests. Whether performance on the pretest and posttest differed by class year was assessed using analysis of variance and Kruskal-Wallis, respectively, and whether year was associated with posttest score after controlling for pretest score was assessed using analysis of covariance.

RESULTS

Posttest means were significantly higher than pretest means for students in all years (P values <.0001). Pretest scores differed by year (F(2, 360) = 66.85, P <.0001): fourth-year students scored highest (mean = 9.96 of 13) and second-year students scored lowest (mean = 7.01 of 13). Posttest scores did not differ (χ2(2, 270) = 0.348, P = .841). Year in school had no independent effect on posttest score (F(2, 239) = 0.45, P = .637).

CONCLUSION

Knowledge of modality selection increases with clinical training, but room for improvement remains. A general radiology elective increases this knowledge. Second-year students improve most, suggesting that taking radiology early is efficient, but further research to evaluate retention of this knowledge is needed. Medical student education in radiology must increasingly recognize and address non-interpretive skills and intelligent imaging utilization.

A new e-learning platform for radiology education (RadEd)

One of the key elements of e-learning platforms is the content provided to the students. Content creation is a time demanding task that requires teachers to prepare material taking into account that it will be accessed on-line. Moreover, the teacher is restricted by the functionalities provided by the e-learning platforms. In contexts such as radiology where images have a key role, the required functionalities are still more specific and difficult to be provided by these platforms. Our purpose is to create a framework to make teacher's tasks easier, specially when he has to deal with contents where images have a main role. In this paper, we present RadEd, a new web-based teaching framework that integrates a smart editor to create case-based exercises that support image interaction such as changing the window width and the grey scale used to render the image, taking measurements on the image, attaching labels to images and selecting parts of the images, amongst others. It also provides functionalities to prepare courses with different topics, exercises and theory material, and also functionalities to control students' work. Different experts have used RadEd and all of them have considered it a very useful and valuable tool to prepare courses where radiological images are the main component. RadEd provides teachers functionalities to prepare more realistic cases and students the ability to make a more specific diagnosis.

Evaluation of use of e-Learning in undergraduate radiology education: a review

PURPOSE

The aim of this review is to investigate the evaluative outcomes present in the literature according to Kirkpatrick's learning model and to examine the nature and characteristics of the e-Learning interventions in radiology education at undergraduate level.

MATERIALS AND METHODS

Four databases (PubMed, MEDLINE, Embase, Eric) are searched for publications related to the application of e-Learning in undergraduate radiology education. The search strategy is a combination of e-Learning and Mesh and non Mesh radiology and undergraduate related terms. These search strategies are established in relation to experts of respective domains. The full text of thirty pertinent articles is reviewed. Author's country and study location data is extracted to identify the most active regions and year's are extracted to know the existing trend. Data regarding radiology subfields and undergraduate year of radiology education is extracted along with e-Learning technologies to identify the most prevalent or suitable technologies or tools with respect to radiology contents. Kirkpatricks learning evaluation model is used to categorize the evaluative outcomes reported in the identified studies.

RESULTS

The results of this analysis reveal emergence of highly interactive games, audience response systems and designing of wide range of customized tools according to learner needs assessment in radiology education at undergraduate level. All these initiatives are leading toward highly interactive self directed learning environments to support the idea of life-long independent learners. Moreover, majority of the studies in literature regarding e-Learning in radiology at undergraduate level are based on participant satisfaction followed by participant results or outcomes either before or after an intervention or both. There was no research particularly demonstrating performance change in clinical practice or patient outcome as they may be difficult to measure in medical education. Thus clinical competences and performances are highly affected by pretentious learning environments.

Undergraduate radiology teaching from the student's perspective

Objectives

To obtain medical students’ evaluation of the quality of undergraduate radiology teaching received, preferred teaching methods and resources. This is a follow-up project to an earlier study of junior doctors who felt that radiology teaching left them ill prepared for medical practice.

Methods

A questionnaire to third and fifth year medical students undertaking clinical rotations at Newcastle University, UK.

Results

The questionnaire was completed by 57/60 (95 %) of third and 37/40 (93 %) of final year medical students. Students received minimal radiology teaching in pre-clinical years, feeling this was insufficient. The majority of students rated interactive case-based teaching as effective. Self-directed learning resources such as textbooks, journals and even online learning modules were perceived as less effective. Other types of web resources rated higher. Motivation for most students when studying radiology was to achieve learning objectives needed to pass their next exams and/or to improve as a doctor.

Conclusions

Medical students criticise the lack of radiology teaching in pre-clinical undergraduate years. Radiology teaching should be represented in all undergraduate years, preferably delivered via interactive teaching sessions. Currently available e-learning modules do not meet the students’ learning needs and there is a call for reliable, up-to-date open access electronic resources.

Main Messages

• Radiology teaching should be represented in all pre-clinical and clinical undergraduate years.

• Medical students rate interactive case-based teaching sessions as very effective.

• There is a call for reliable, up-to-date open access electronic resources for medical students.