Dedicated core clerkship in radiology for medical students development, implementation, evaluation, and comparison with distributed clerkship

The integration of radiology curriculum in undergraduate medical education

Knowledge of basic radiology is an essential component of the undergraduate medical curriculum. Pre-clinical education introduces medical students to essential knowledge and skills. However, the current curriculum and radiology teaching are not without inherent limitations. This article explores the essential role of radiology education for medical students and discusses the current state of affairs. It also highlights the limitations and associated challenges and proposes solutions.

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Fulfilling the goal of integrating radiology into undergraduate medical curriculam is a real challenge due to the enduring faith assuming that traditional medical disciplines are worthy of consuming the available study time.

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Radiology is an essential division of medical science with a wide range of clinical applications in the diagnosis, prognosis, and treatment efficacy.

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Poor integration of the radiology curriculum in undergraduate medical education can lead to poor image interpretation skills and poor use of imaging algorithms in medical students and post-graduate doctors.

Acing the Fundamentals of Radiology: An Online Series for Medical Students and Interns

PURPOSE

The current undergraduate radiology education predominantly integrates radiology with other disciplines during preclerkship years and is often taught by nonradiologists. Early exposure to radiology and profound understanding of scientific fundamentals of imaging modalities and techniques are essential for a better understanding and interest in the specialty. Furthermore, the COVID-19 pandemic-related impact on in-person medical education aggravated the need for alternative virtual teaching initiatives to provide essential knowledge to medical students.

METHODS

The authors designed an online 7-session course on the principles of imaging modalities for medical students and fresh graduates in the United States and abroad. The course was delivered online and taught by radiologists from different US institutions. Pretests and posttests were delivered before and after each session, respectively, to assess change in knowledge. At the end of the course, a survey was distributed among students to collect their assessment and feedback.

RESULTS

A total of 162 students and interns initially enrolled in the program by completing a sign-up interest form. An average of 65 participants attended each live session, with the highest attendance being 93 live attendees. An average of 44 attendees completed both the pretest and posttest for each session. There was a statistically significant increase in posttest scores compared with pretest scores (P < 0.01) for each session; on average, the posttest scores were 48% higher than the pretest scores. A total of 84 participants answered the end-of-course survey. A total of 11% of the respondents described themselves as first year, 17% as second year, 18% as third year, 21% as fourth year, and 33% as "other." Attendees were enrolled in medical schools across 21 different countries with 35% of the respondents studying medicine in the United States. More than 76% of the respondents stated that they "strongly agree" that the program increased their understanding of radiology, increased their interest in radiology, and would be useful in their clinical practice in the future. Eighty-three percent of the respondents stated that they "strongly agree" that "this course was a worthwhile experience." Particularly, more than 84% of the respondents stated that among the most important components in enhancing their understanding of radiology were "the interpretation of normal imaging" and "interpretation of clinical cases." Ninety-two percent of the respondents stated that "the amount of effort to complete the requirements for this program was just right." Participants were also asked to rate each of the 8 sessions using the following scale: poor = 1 point, fair = 2, good = 3, and excellent = 4. The average rating for all 8 sessions was 3.61 points (SD = 0.55), which translates to 96% of the sessions being rated good or excellent. Eighty percent of the participants reported that the topics presented in the program were "excellent and clinically important to learn," and 20% of the participants reported that the topics presented were "good and somewhat important to learn." The participants were asked to evaluate their confidence regarding basic radiology skills before and after the program using the following scale: not confident at all = 1 point, somewhat confident = 2, moderately confident = 3, and very confident = 4. Figure 2 summarizes the responses of the participants.

CONCLUSIONS

An online course to teach the fundamentals of imaging modalities could be delivered through a webinar format to medical students and interns in several countries to address the potential gaps in radiology education, therefore increasing their understanding of the different imaging modalities and their proper use in medicine.

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.

A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship: Impact on Student Performance and Learning

RATIONALE AND OBJECTIVES

The principles of Collins' cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach.

MATERIALS AND METHODS

The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding.

RESULTS

Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R(2) from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students' radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice.

CONCLUSIONS

The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.

Radiology Undergraduate and Resident Curricula: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine the literature regarding radiology curricula for both undergraduates and residents.

METHODS

A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references.

RESULTS

Of the 4716 unique abstracts reviewed by the author, 142 were found to be relevant to the purpose of this study. Undergraduate radiology education, radiology curriculum, and radiology pedagogy vary widely between disciplines and between colleges within disciplines. Formal radiology education is not taught at all medical programs and little radiology training is incorporated into non-radiology residencies. This results in some medical graduates not being taught how to interpret basic radiology images and not learning contraindications and indications for ordering diagnostic imaging tests. There are no definitive studies examining how to incorporate radiology into the curriculum, how to teach radiology to either undergraduates or residents, or how to assess this clinical competency.

CONCLUSIONS

This review shows that radiology education is perceived to be important in undergraduate and residency programs. However, some programs do not include radiology training, thus graduates from those programs do not learn radiology essentials.

Needs Assessment for Standardized Medical Student Imaging Education: Review of the Literature and a Survey of Deans and Chairs

RATIONALE AND OBJECTIVES

Medical imaging education often has limited representation in formal medical student curricula. Although the need for greater inclusion of radiology material is generally agreed on, the exact skillset that should be taught is less clear. The purpose of our study was to perform a needs assessment for a national radiology curriculum for medical students.

MATERIALS AND METHODS

We analyzed data from previous unpublished portions of the American College of Radiology/Alliance of Medical Student Educators in Radiology survey of Deans and Radiology Chairs regarding prevalence of radiology curricular revisions, assessment tools, use of the American College of Radiology Appropriateness Criteria, and resources used in curriculum revision. We also performed a literature search through both PubMED and a general search engine (Google) to identify available resources for designing and implementing imaging curricula and curricular revisions.

RESULTS

Medical school deans and chairs reported a need for more overall radiology content; one of every six programs (15%) reported they had no recognized imaging curriculum. Of schools currently with imaging curricula, 82% have undergone revision in the last 10 years using a variety of different resources, but there is no universally agreed on guide or standard curriculum. The PubMED and Google searches identified only 23 and eight resources, respectively, suggesting a sizable deficit in available guidance; however, a single published medical student radiology curriculum is available through the Alliance of Medical Student Educators in Radiology.

CONCLUSIONS

There is a need, but few available resources, to guide educators in adding imaging content to medical school curricula. We postulate that a standardized national curriculum directed by a focused skillset may be useful to educators and could result in greater uniformity of imaging skills among graduating US medical students. A proposed skillset to guide a national curriculum in radiology is described.

Redesign and implementation of the radiology clerkship: from traditional to longitudinal and integrative

PURPOSE

The authors discuss the evolution and application of 3 radiology teaching methods-a fundamentals-of-imaging course, a combined clinical-radiology case conference, and a radiology objective structured clinical examination-to medical education at the Brigham and Women's Hospital site of Harvard Medical School.

METHODS

The evolution of the medical student radiology teaching program from content needs assessment to blueprint creation, through implementation, is outlined.

RESULTS

The 3 components of the teaching program are described. The changes in format in response to feedback and challenges faced in deploying this new curriculum are detailed. Results from student surveys and the radiology objective structured clinical examination scores from recent years are also presented.

CONCLUSIONS

As radiology assumes an increasingly central role in patient care and diagnosis, the need for effective integration of radiology teaching into medical education becomes more critical. The concepts presented here have been deemed to be successful by students and faculty members and may be applicable to other institutions.

Fourth-year medical student opinions and basic knowledge regarding the field of radiology

RATIONALE AND OBJECTIVES

This study evaluates the opinions and knowledge of fourth-year US medical students regarding radiology and analyzes the influence of a required or nonrequired radiology rotation as a reflection of the effectiveness of radiology medical student education.

METHODS AND MATERIALS

Our institutional review board granted exempt status. An invitation e-mail was sent to 137 US medical schools. Upon receiving approval a second email was sent containing our voluntary anonymous online survey hyperlink to forward to their fourth-year class. Survey topics included demographics, radiology educational experiences, attitudes toward the field, and basic radiology knowledge. Responses were collected between August 4 and September 26, 2011.

RESULTS

A total of 444 fourth-year medical students from 37 medical schools participated: 89% planned to enter a nonradiology specialty, 10.8% were required to take a dedicated radiology rotation, 34.9% completed one, 77% planned to complete one by graduation, 88.4% thought radiology often changes patient care or is at least as important as physical exam, 91.4% underestimated the cancer risk of an abdomen and pelvis computed tomography by at least one order of magnitude, and 72.9% by at least two orders. Seventy-seven percent had never heard of the American College of Radiology (ACR) Appropriateness Criteria. Respondents underestimated the potential risks of magnetic resonance imaging (MRI); with 58.3% aware intravenous gadolinium can cause nephrogenic systemic fibrosis and 79.4% aware of potential injury from metallic projectiles. 40.4% indicated that non-radiologist clinicians in specific medical specialties interpret their respective imaging studies at least as accurately as corresponding subspecialty radiologists. Other results include student opinions regarding teleradiology, radiologist lifestyle, and compensation.

CONCLUSIONS

Fourth-year medical students recognize the importance of radiology but are poorly informed regarding radiation safety, MRI safety, and ACR Appropriateness Criteria, despite 34.9% having a dedicated rotation. This highlights the need for adoption of the Alliance of Medical Student Educators in Radiology curriculum.

Results of a survey by the European Society of Radiology (ESR): undergraduate radiology education in Europe-influences of a modern teaching approach

Objectives

The purpose of the present study is to determine in what way a conventional versus a modern medical curriculum influences teaching delivery in formal radiology education.

Methods

A web-based questionnaire was distributed by the ESR to radiology teaching staff from 93 European teaching institutions.

Results

Early exposure to radiology in pre-clinical years is typically reported in institutions with a modern curriculum. The average number of teaching hours related to radiology is similar in both curriculum types (60 h). Radiology in modern curricula is mainly taught by radiologists, radiology trainees (50%), radiographers (20%) or clinicians (17%). Mandatory clerkships are pertinent to modern curricula (55% vs. 41% conventional curriculum), which start in the first (13% vs. 4% conventional curriculum) or second year of the training (9% vs. 2% conventional curriculum). The common core in both curricula consists of radiology examinations, to work with radiology teaching files, to attend radiology conferences, and to participate in multidisciplinary meetings.

Conclusion

The influence of a modern curriculum on the formal radiology teaching is visible in terms of earlier exposure to radiology, involvement of a wider range of staff grades and range of profession involved in teaching, and radiology clerkships with more active and integrated tasks.

Main Message

• This study looks at differences in the nature of formal radiology teaching.