Are interventional radiology and allied specialities neglected in undergraduate medical education? A systematic review

Teaching Strategies in Interventional Radiology: A Narrative Review of the Literature

INTRODUCTION

Interventional radiology (IR) is a rapidly developing speciality where innovation-especially in teaching practices-is vital. With workforce and capacity shortages, synthesis of classical educational theories and novel strategies utilising virtual reality (VR) and artificial intelligence (AI) provide opportunities to make teaching as efficient and effective as possible. The aim of this review is to examine the literature on different approaches in IR teaching and learning in undergraduates and postgraduates.

METHODS

Literature was reviewed using a comprehensive search strategy with relevant keywords. Articles were limited to 2013-2023. Databases searched included MEDLINE, Embase, British Education Index and ERIC, in addition to a manual review of references.

RESULTS

Of the 2903 unique abstracts reviewed by the authors, 43 were relevant to the purpose of this study. The major pedagogical approaches identified were categorised into the following-traditional master-apprentice mentoring, virtual reality/simulation, physical models, and remote teaching. VR simulations enable practise free from the limits of time and risk to patients, as well as potential for standardised formal curricula. AI has the capability to enhance training simulations and assessment of trainees. With recent events necessitating innovation in online remote teaching, programs that are accessible whilst arguably imparting just as much clinical knowledge as in-person education have now been developed.

CONCLUSION

Mentoring has conventionally been the standard for radiology teaching, however there are now several alternative pedagogical approaches available to the IR community. A combination of the most effective ideas within each is the optimal method by which IR should be taught.

Endovascular Simulator Training and Shadowing in Interventional Radiology: A Comparison of Two Teaching Methods in the Curricular Training of Medical Students

PURPOSE

To identify the impact of endovascular simulator training and shadowing in interventional radiology on medical students' self-assessed IR knowledge. Moreover, the sequence of the teaching methods and its influence on the self-assessed IR knowledge is investigated.

MATERIALS AND METHODS

A total of 19 fourth-year medical students participated in this study. Eleven students completed shadowing live cases first and endovascular simulator training the following day. Eight students completed the teaching in reversed order. Questionnaires were completed before and after each teaching method. The students assessed their knowledge of instruments and materials, steps of the Seldinger technique, and aortography on a Likert scale (1 = "I do not agree at all," 5 = "I fully agree").

RESULTS

After simulator training, the students stated a significant increase in perceived knowledge compared with baseline (p < 0.001). Shadowing led to a significant improvement regarding the items "knowledge of instruments and materials" (3.2 vs. 3.8, p = 0.008) and "steps of the Seldinger technique" (3.7 vs. 3.9, p = 0.046). Self-assessed knowledge after simulator training increased significantly more regarding Seldinger technique compared with shadowing (+ 1.2 vs. + 0.2, p < 0.001). Simulator training before shadowing was significantly more effective regarding the increase in "knowledge of the steps of aortography" compared with the reverse sequence (+ 2.0 vs. + 0.9, p = 0.041).

CONCLUSION

Endovascular simulator training and shadowing are both feasible tools to improve medical students' perceived knowledge of interventional radiology. When organizing teaching, simulator training before shadowing can have a positive impact on self-assessed knowledge.

Level of Awareness Regarding Interventional Radiology Among Medical Students at Northern Border University in Arar, Saudi Arabia

Introduction Interventional radiology (IR) is a highly specialized field of radiology that employs advanced imaging techniques like MRIs, CT scans, X-rays, and ultrasounds to detect and treat a variety of medical disorders. By using minimally invasive procedures, interventional radiologists can access the body's internal organs and tissues with minimal discomfort and reduced risks compared to traditional surgical techniques. Some common IR procedures include angioplasty, embolization, biopsy, and stent placement, among others. Overall, IR is an innovative and effective approach to medical care that offers numerous benefits to patients. As this specialty expands, there is a huge demand for increasing staff. However, due to a lack of awareness, this increased demand could not be fulfilled. Objective The objective is to assess medical students' knowledge regarding IR and compare this knowledge between male and female students. Materials and methods This cross-sectional study was carried out at Northern Border University's College of Medicine in Arar, Saudi Arabia. The study aimed to assess the medical students' knowledge of IR. All students enrolled in the clinical years at Northern Border University were included in the study, and a self-administered online questionnaire was used to collect data. The minimum sample size required was 169. Appropriate statistical analysis was applied to the collected data, and a p-value of less than 0.05 was considered significant. Results One hundred and seventy-two participants in all who met the inclusion criteria answered the study's questionnaire. The fourth-year students represented the highest percentage of the sample, with 65 participants (37.8%), followed by 54 (31.4%) fifth-year students and 53 (30.8%) sixth-year students. The study found that 66 participants (38.4%) rated their knowledge of IR as adequate, while only 8 (4.7%) considered it excellent. The participants' self-rated knowledge of IR did not significantly differ across male and female groups. Conclusion The study's findings suggest that medical students have limited knowledge of IR and that there is no discernible difference in the knowledge and interest of males and females in this subject. Further research and targeted educational interventions may be necessary to improve the medical students' overall knowledge and interest in IR.

Awareness of Interventional Radiology Among Medical Students at Majmaah University, Saudi Arabia

INTRODUCTION

Interventional radiology (IR) is a medical specialty that employs imaging techniques such as X-rays, ultrasound, CT scans, and MRI to guide minimally invasive procedures for diagnosing and treating a variety of medical disorders. The purpose of this investigation was to determine the level of IR awareness among medical students at Majmaah University.

METHODS

The cross-sectional investigation was carried out among the medical students at Majmaah University in Saudi Arabia. A self-administered questionnaire that had been pretested was used to gather the data. SPSS Statistics (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp) was used to analyze the data. The chi-square test was used to compare qualitative data, and a p-value <0.05 was considered significant.

RESULTS

There were 202 students who participated in this study, and among them, the majority were males, 126 (62.4%), and the majority of them were pre-clinical students, 105 (52.0%). Knowledge of routinely performed procedures by IR (only by a radiologist) was assessed; 116 (57.4%) of them responded with paracontinuous transluminal coronary angioplasty, 105 (52.0%) with central venous access, and 100 (49.5%) with lower arterial limp percutaneous transluminal angioplasty, which are routinely performed procedures by the radiologists. There was no significant difference in knowledge levels between genders.

CONCLUSION

Increasing awareness of IR among medical students is essential to improving patient outcomes and addressing healthcare challenges. Efforts to educate and expand access to IR services must be prioritized to ensure that medical students receive a comprehensive education and that patients receive the highest quality care possible.

A Multimedia Strategy to Integrate Introductory Broad-Based Radiation Science Education in US Medical Schools

US physicians in multiple specialties who order or conduct radiological procedures lack formal radiation science education and thus sometimes order procedures of limited benefit or fail to order what is necessary. To this end, a multidisciplinary expert group proposed an introductory broad-based radiation science educational program for US medical schools. Suggested preclinical elements of the curriculum include foundational education on ionizing and nonionizing radiation (eg, definitions, dose metrics, and risk measures) and short- and long-term radiation-related health effects as well as introduction to radiology, radiation therapy, and radiation protection concepts. Recommended clinical elements of the curriculum would impart knowledge and practical experience in radiology, fluoroscopically guided procedures, nuclear medicine, radiation oncology, and identification of patient subgroups requiring special considerations when selecting specific ionizing or nonionizing diagnostic or therapeutic radiation procedures. Critical components of the clinical program would also include educational material and direct experience with patient-centered communication on benefits of, risks of, and shared decision making about ionizing and nonionizing radiation procedures and on health effects and safety requirements for environmental and occupational exposure to ionizing and nonionizing radiation. Overarching is the introduction to evidence-based guidelines for procedures that maximize clinical benefit while limiting unnecessary risk. The content would be further developed, directed, and integrated within the curriculum by local faculties and would address multiple standard elements of the Liaison Committee on Medical Education and Core Entrustable Professional Activities for Entering Residency of the Association of American Medical Colleges.

Hidden Curriculum and the Demographic Stoicism That Keeps Women and Minorities Away From Radiology: A Mixed-Methods Study of Medical Students

OBJECTIVE

To understand how women and historically underrepresented minority medical students perceive radiology as a potential career choice.

METHODS

Medical students representing a broad spectrum of radiology exposure from a single institution were invited to participate in a mixed-methods study. Participants completed a 16-item survey about demographics and perceptions of radiology. Ten focus groups were administered to probe decision making regarding career selection. The themes influencing women and historically underrepresented minority students are presented.

RESULTS

Forty-nine medical students, including 29 (59%) women and 17 (35%) underrepresented minorities, participated. Most participants (28 of 48, 58%) reported men outnumbered women in radiology. Female participants reported a lack of mentorship and role models as major concerns. Outreach efforts focused on the family-friendly nature of radiology were viewed as patronizing. Demographic improvements in the field were viewed as very slow. Forty-six percent (22 of 48) of participants indicated that radiology had a less underrepresented racial or ethnic workforce than other medical specialties. Minority participants especially noted a lack of radiology presence in mainstream media, so students have few preconceived biases. A failure to organically connect with the mostly White male radiologists because of a lack of shared background was a major barrier. Finally, participants described a hidden curriculum that pushes minority medical students away from specialty fields like radiology and toward primary care fields to address underserved communities and health care disparities.

DISCUSSION

Women and historically underrepresented minority medical students perceive major barriers to choosing a career in radiology. Radiology departments must develop sophisticated multilevel approaches to improve diversity.

Knowing the ABCs: teaching the principles of radiology to medical students in Turkey

BACKGROUND

Radiology education in Turkey is mainly taught during clinical years of medical school and often lacks main principles. Exposure to the fundamentals of radiology at an early stage of medical education may drastically help students generate a better understanding of radiology and expand their interest in the specialty. With the Principles of Radiology Course that we provided, pre- and post-session tests, and assessment survey at the end of the course, we aimed to evaluate the effectiveness of such an online course among Turkish medical students.

METHODS

A total of nine online sessions on imaging modalities principles was developed by radiology professors. Each session was given through Zoom by radiologists from different U.S.-institutions to Turkish medical students from state (n = 33) and private (n = 8) universities. Pretests and post-tests were given to participants via Qualtrics before and after each session, respectively. Paired two-sample t-tests were conducted to detect the variance and p=-.05 was used as the significance level. An evaluation survey was distributed at the end of the course to collect their feedback through SurveyMonkey.

RESULTS

A total of 1,438 predominantly Turkish (99.32%) medical students engaged with this course. An average of 506 students completed both pre-test and post-test. There was a statistically significant (p < .001) increase in the scores in post-test (mean[range]:7.58[5.21-8.53]) relative to pre-test (mean[range]:5.10[3.52-8.53]). Four hundred and thirty-nine participants (F/M:63.33%/35.54%) completed the end-of-course survey. A total of 71% and 69.70% of the participants strongly agreed that the course would be useful in their clinical practice and had increased their understanding of radiology. They also reported that their level of confidence in the subjects had increased 68% and reached a weighted average of 3.09/4. The survey revealed that 396 (90.21%) of the participants strongly or somewhat agree that introductory principles and concepts should be presented in earlier years of medical education. Compared to in-person education, 358 (81.55%) found the course extremely or very convenient.

CONCLUSION

Online lecture series consisting of the principles of the radiological imaging modalities can be offered to Turkish medical students to enhance their grasp of the various imaging modalities and their correct clinical application.

Effectiveness of virtual teaching of diagnostic and interventional imaging fundamentals to Egyptian medical students: an analytical cross-sectional study

Background

There is a worldwide deficit in teaching and training in the field of radiology for undergraduate medical students. This educational gap is prominent in many medical schools as most radiology curricula are a part of other specialty trainings, usually provided by non-radiologists. After COVID-19 pandemic, there was an increased trend in online education. However, questions have been raised about the efficacy and acceptance of online education. We developed a course on the principles of radiology and medical imaging basics to target Egyptian medical students. We then assessed the impact of these educational videos through several online surveys. Our "The Principles of Radiology Online Course" was delivered to students at various Egyptian medical schools; it was a prerecorded series composed of nine sessions, and each session followed the sequence of a pre-test, video, and post-test. There was a final survey to assess the overall feedback. Finally, we analyzed the results to give insight onto how teaching radiology through online lectures can help build better physicians.

Results

Among various medical schools around Egypt, 1396 Egyptian medical students joined this cohort. Cohort population percentage was 56% female and 44% male. Ninety-eight percent of the students agreed that this program increased their understanding of radiology. Eighty-four percent of the students found the platform friendly and easy to use. Seventy-nine percent found these webinars were more convenient compared to in-person education. Statistical significance (p-value < 0.05) was achieved in all sessions after comparing students’ pre and post-test scores, and in students’ confidence and knowledge level before and after the course.

Conclusions

Radiology is an underrepresented subject for a lot of medical students. Online radiology webinars have proven to be a promising method of teaching medical students key medical imaging concepts. An online course of radiology basics and principles can help improve a medical student’s knowledge and enhance overall future patient care.

Impact of COVID-19 pandemic on radiology education, training, and practice: A narrative review

Radiology education and training is of paramount clinical importance given the prominence of medical imaging utilization in effective clinical practice. The incorporation of basic radiology in the medical curriculum has continued to evolve, focusing on teaching image interpretation skills, the appropriate ordering of radiological investigations, judicious use of ionizing radiation, and providing exposure to interventional radiology. Advancements in radiology have been driven by the digital revolution, which has, in turn, had a positive impact on radiology education and training. Upon the advent of the corona virus disease 2019 (COVID-19) pandemic, many training institutions and hospitals adhered to directives which advised rescheduling of non-urgent outpatient appointments. This inevitably impacted the workflow of the radiology department, which resulted in the reduction of clinical in-person case reviews and consultations, as well as in-person teaching sessions. Several medical schools and research centers completely suspended face-to-face academic activity. This led to challenges for medical teachers to complete the radiology syllabus while ensuring that teaching activities continued safely and effectively. As a result, online teaching platforms have virtually replaced didactic face-to-face lectures. Radiology educators also sought other strategies to incorporate interactive teaching sessions while adopting the e-learning approach, as they were cognizant of the limitations that this may have on students' clinical expertise. Migration to online methods to review live cases, journal clubs, simulation-based training, clinical interaction, and radiology examination protocolling are a few examples of successfully addressing the limitations in reduced clinical exposure. In this review paper, we discuss (1) The impact of the COVID-19 pandemic on radiology education, training, and practice; (2) Challenges and strategies involved in delivering online radiology education for undergraduates and postgraduates during the COVID-19 pandemic; and (3) Difference between the implementation of radiology education during the COVID-19 pandemic and pre-COVID-19 era.

In vivo Simulation-Based Learning for Undergraduate Medical Students: Teaching and Assessment

An increasing emphasis on simulation has become evident in the last three decades following fundamental shifts in the medical profession. Simulation-based learning (SBL) is a wide term that encompasses several means for imitating a skill, attitude, or procedure to train personnel in a safe and adaptive environment. A classic example has been the use of live animal tissue, named in vivo SBL. We aimed to review all published evidence on in vivo SBL for undergraduate medical students; this includes both teaching concepts as well as focused assessment of students on those concepts. We performed a systematic review of published evidence on MEDLINE. We also incorporated evidence from a series of systematic reviews (eviCORE) focused on undergraduate education which have been outputs from our dedicated research network (eMERG). In vivo SBL has been shown to be valuable at undergraduate level and should be considered as a potential educational tool. Strict adherence to 3R (Reduce, Refine, Replace) principles in order to reduce animal tissue usage, should always be the basis of any curriculum. In vivo SBL could potentially grant an extra mile towards medical students' inspiration and aspiration to become safe surgeons; however, it should be optimised and supported by a well-designed curriculum which enhances learning via multi-level fidelity SBL.

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.

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.

What does radiation biology tell us about potential health effects at low dose and low dose rates?

The health risks to humans exposed to low dose and low dose rate ionising radiation remain ambiguous and are the subject of debate. The need to establish risk assessment standards based on the mechanisms underlying low dose/low fluence radiation exposures has been recognised by scholarly and regulatory bodies as critical for reducing the uncertainty in predicting adverse health risks of human exposure to low doses of radiation. Here, a brief review of laboratory-based evidence of molecular and biochemical changes induced by low doses and low dose rates of radiation is presented. In particular, two phenomena, namely bystander effects and adaptive responses that may impact low-level radiation health risks, are discussed together with the need for further studies. The expansion of this knowledge by considering the important variables that affect the radiation response (e.g. genetic susceptibility, time after exposure), and using the latest advances in experimental models and bioinformatics tools, may guide epidemiological studies towards reducing the uncertainty in predicting the potential health hazards of exposure to low-dose radiation.