The Exposure Dilemma: Qualitative Study of Medical Student Opinions and Perceptions of Radiology

Revamping Undergraduate Radiology Education in a Problem-Based Learning Driven Institution: Successes, Challenges, and Lessons Learned

Radiology teaching for undergraduate medical students is often limited in amount and lacking a longitudinal approach spanning multiple years. At our institution, we had a goal to develop a formal and sustainable radiology curriculum. There were sequential changes made to the curriculum over several years and here, the successes, challenges, and lessons learned are outlined. Alongside these elements, student radiology quiz results and survey data over several years are also summarized. Curricular development included integrated anatomy and radiology sessions, revamped lectures focusing on interactivity and eliminating unnecessary redundancies across the multi-year curriculum, radiology media files to supplement problem-based learning, clinical skills videos, and a pre-clerkship radiology bootcamp elective.

Medical student perspectives on radiology subspecialties prior to core clerkship

RATIONALE AND OBJECTIVES

Radiology remains underrepresented in U.S. medical school clinical curricula, and preconceived opinions about the field may impact whether students pursue elective exposure. A core radiology clerkship at one academic institution presents an opportunity to evaluate students' early preferences for different radiology subspecialties, thus informing curricular design and inspiring student recruitment.

MATERIALS AND METHODS

At a single allopathic medical school, a required, four-week, clinical-year radiology clerkship that occurs in the second year includes immersive one-week experiences in two subspecialties. Prior to their clerkship, students rank their immersion preferences by distributing 100 points across eight fields, the values of which were analyzed as a proxy for interest. A secondary survey was distributed to active first- and second-year medical students to further investigate the factors drawing them to radiology.

RESULTS

Immersive experiences in musculoskeletal, body, and breast imaging were most preferred, earning ≥20 points from 41.6 %, 34.3 %, and 31.9 % of students, respectively. Women were significantly more likely than men to express interest in breast imaging (35.8 % vs. 24.8 %, p = 0.037) and pediatric radiology (28.8 % vs. 12.8 %, p = 0.001). Men were significantly more likely than women to prefer body imaging (41.9 % vs. 30.2 %, p = 0.034), neuroradiology (29.1 % vs. 19.5 %, p = 0.048), and nuclear medicine (11.1 % vs. 5.1 %, p = 0.044).

CONCLUSION

Early in their clinical education, medical students prefer certain subspecialties, especially musculoskeletal, body, and breast imaging. Women expressed significantly stronger interest in breast imaging and pediatric radiology, while men indicated significantly stronger interest in body imaging, neuroradiology, and nuclear medicine.

Exploring Medical Students' Perceptions of Peer-to-Peer Interactions Related to Applying to a Surgical Residency

OBJECTIVE

The objectives were to (1) identify themes related to competitive peer-to-peer interactions elicited from the lived experiences of undergraduate medical students, and (2) understand how these experiences influenced medical students' choices related to surgical residency programs.

DESIGN

A qualitative descriptive methodology, with purposive and maximal variation sampling (e.g., selection based on medical school location; gender), was adopted for this study.

SETTING

Temerty Faculty of Medicine, University of Toronto.

PARTICIPANTS

Participants were 15 undergraduate medical students from 4 medical schools in Ontario, Canada, who agreed to an individual semi-structured interview by Zoom or telephone.

RESULTS

Peer-to-peer interactions influence students' perception of self and identity formation related to surgical specialty decision-making and interest. These interactions were shown to hold greater value, specifically for information gathering. Identity formation, related to pursuing a surgical residency, was influenced by the attitudes and perceptions of competition with peers throughout medical school. Cultures of competition were seen to dictate peer-to-peer interactions and their associated value, with their perception and experience differing between medical schools.

CONCLUSIONS

Peer-to-peer interactions and a culture of competition have inherent roles in the residency decision-making process. We observed that student background and pre-formed relationships influenced how students perceived and responded to competition. Addressing the culture of competitiveness associated with peer-to-peer interactions along with considering student background and pre-existing relationships may provide insight into how medical educators can tailor learning experiences that limit the detrimental effects of hidden curriculum influences.

How do medical students, residents and graduated physicians really perceive radiologists? A cross-national study

BACKGROUND

Radiology has always been an attractive specialty for residents, but its attractiveness has recently decreased in France regarding the median choice rank after at the National Residency Board.

AIM

To study Radiologists' perceptions and social representations (SRs) among a group of medical students, residents and graduated physicians in France, to better understand the view of Radiologists to debunk stereotypes.

METHODS

The nationwide web-based survey was based on valid hierarchical evocation methods. We determined the corpus's central core and SRs' principal themes with prototypical and correspondence factor analysis (CFA), respectively.

RESULTS

Overall, 419 answers were analyzed. Radiologists' SRs were divided into 3 classes: negative stereotypes of Radiologists, negative stereotypes of the Radiologists' daily practice and Radiologists' skills. After multivariate analysis, variables that seemed to have a positive influence on Radiologists' SRs were considering radiology as a potential choice of specialty (p < 0.001) and the existence of practical experience in Radiology (p = 0.008). Women seemed to have a more negative SR of Radiologists than men (p = 0.035).

DISCUSSION

This was the largest qualitative study on the subject and the only one among medical students, residents and graduated physicians, allowing a global picture. SRs of Radiologists seemed to be negative, potentially caused by poor knowledge of the Radiologists' profession.

CONCLUSION

SRs of Radiologists among medical students and graduated physicians appears to be negative. Promoting the specialty among medical students and encouraging their immersion in a Radiology department could help to debunk many stereotypes about the daily life and missions of Radiologists.

Evaluation of learning and exposure in the undergraduate interventional radiology curriculum (ELIXIR)

AIM

To gauge current final year medical students' exposure to interventional radiology (IR)and assess their perceptions of IR as a prospective career option.

MATERIALS AND METHODS

An online questionnaire comprising of questions that gauge final-year medical students' understanding of and exposure to IR based on the recommendations set out by the British Society of Interventional Radiology (BSIR), was sent out to final-year students across 34 UK medical schools.

RESULTS

Five hundred and ten responses were collected from 33 out of 34 eligible medical schools. Sixty-four per cent of respondents rated their own IR knowledge as inadequate. On average, only 50% of all subtopics proposed in the BSIR undergraduate curriculum was covered during medical school and 32.7% of respondents were not exposed to any fundamental IR principles and techniques recommended by the BSIR during medical school. Regarding careers, 2.7% of respondents reported a definite interest in pursuing a career in IR. Most respondents (89.8%) felt that there was insufficient undergraduate teaching on IR and that they lacked information to consider pursuing a career in IR (87.5%).

CONCLUSION

Insufficient exposure and teaching on IR throughout medical schools have led to a lack of awareness and consideration of IR as a future career choice amongst UK medical students. The re-evaluation of IR teaching in the medical school curricula is needed. In the long-term, such recommendations could provide the much-needed solution to the workforce shortages seen in IR.

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.

The Radiology Scholars Certificate Program: A Medical Education Learning Tool

RATIONALE AND OBJECTIVES

The Radiology Scholars Certificate Program (RSCP) is an extracurricular program created for preclinical medical students to address disparities in radiology education and exposure during medical school.

MATERIALS AND METHODS

The RSCP was designed as a year-long program for first- and second-year medical students. The 4 key components of the RSCP are: Exposure to radiology through shadowing, knowledge acquisition through self-paced case-based learning modules, knowledge application in interactive workshops, and completion of a scholarly project. Students are required to complete at least 3 hours of shadowing, attend at least 3 workshops, complete self-paced online modules, and complete a capstone project on a topic of their choosing. Pre- and post-program surveys were administered to assess trends in participants' perception of the field and imaging-related clinical knowledge.

RESULTS

In the first year of the RSCP, 55% of the matriculating class enrolled and of those, 84% completed the program. Approximately half of participants were female. Participants demonstrated significant improvement in radiology knowledge, with average scores improving from 52.8% to 68.6% (p < .001) on the knowledge-related survey questions. Significant improvements were also observed in student-reported confidence with ordering and interpreting imaging studies and in their perceptions of the field.

CONCLUSION

The RSCP is an effective tool for addressing deficits in radiology education and exposure during medical school. It is designed to be run by senior medical students under radiology resident and attending supervision. With motivated student and radiologist investment, the RSCP should be easily replicable in medical training programs worldwide.

Radiology Stereotypes, Application Barriers, and Hospital Integration: A Mixed-methods Study of Medical Student Perceptions of Radiology

RATIONALE AND OBJECTIVES

Limited exposure to radiology by medical students can perpetuate negative stereotypes and hamper recruitment efforts. The purpose of this study is to understand medical students' perceptions of radiology and how they change based on medical education and exposure.

MATERIALS AND METHODS

A single-institution mixed-methods study included four groups of medical students with different levels of radiology exposure. All participants completed a 16-item survey regarding demographics, opinions of radiology, and perception of radiology stereotypes. Ten focus groups were administered to probe perceptions of radiology. Focus groups were coded to identify specific themes in conjunction with the survey results.

RESULTS

Forty-nine participants were included. Forty-two percent of participants had positive opinions of radiology. Multiple radiology stereotypes were identified, and false stereotypes were diminished with increased radiology exposure. Opinions of the impact of artificial intelligence on radiology closely aligned with positive or negative views of the field overall. Multiple barriers to applying for a radiology residency position were identified including board scores and lack of mentorship. COVID-19 did not affect perceptions of radiology. There was broad agreement that students do not enter medical school with many preconceived notions of radiology, but that subsequent exposure was generally positive. Exposure both solidified and eliminated various stereotypes. Finally, there was general agreement that radiology is integral to the health system with broad exposure on all services.

CONCLUSION

Medical student perceptions of radiology are notably influenced by exposure and radiology programs should take active steps to engage in medical student education.

Professional stereotypes among specialties and fields of work within the veterinary community

BACKGROUND

Medical specialties hold varying degrees of prestige, stemming from the existence of stereotypes among them. These have been shown to lead to prejudice against specific specialists, which not only influences career choices but also affects the perception of equality among specialties.

METHOD

The aim of the research was to determine the presence of stereotypes in the UK veterinary community. Using an online questionnaire, participants were asked to provide an adjective that best characterises 15 specialties, in addition to their perceptions on prestige and gender association. Word cloud analysis coupled with sentiment analysis in Python using the language processing software Natural Language Toolkit (NLTK) was used to assess sentiments with respect to the adjectives.

RESULTS

There were 665 questionnaire respondents, and there was evidence of their construction of specialty-specific stereotypes. Some specialties were perceived more negatively than others, including equine general practitioners, surgeons, pathologists, dermatologists and public health veterinarians/epidemiologists. Gender bias was identified within this study, most prominently within production animal and behavioural medicine veterinarians. The most prestigious specialties were neurology, surgery and cardiology.

CONCLUSION

Specialty-specific stereotypes exist within the veterinary community. Acknowledging their existence is a first step to recognising the influence they have on career choices.

Factors Influencing Trainees' Interest in Breast Imaging

Purpose: To gauge the level of interest in breast imaging (BI) and determine factors impacting trainees' decision to pursue this subspecialty. Methods: Canadian radiology residents and medical students were surveyed from November 2020 to February 2021. Training level, actual vs preferred timing of breast rotations, fellowship choices, perceptions of BI, and how artificial intelligence (AI) will impact BI were collected. Chi-square, Fisher's exact tests and univariate logistic regression were performed to determine the impact of trainees' perceptions on interest in pursuing BI/women's imaging (WI) fellowships. Results: 157 responses from 80 radiology residents and 77 medical students were collected. The top 3 fellowship subspecialties desired by residents were BI/WI (36%), abdominal imaging (35%), and interventional radiology (25%). Twenty-five percent of the medical students were unsure due to lack of exposure. The most common reason that trainees found BI unappealing was repetitiveness (20%), which was associated with lack of interest in BI/WI fellowships (OR = 3.9, 95% CI: 1.6-9.5, P = .002). The most common reason residents found BI appealing was procedures (59%), which was associated with interest in BI/WI fellowships (OR, 3.2, 95% CI, 1.2-8.6, P = .02). Forty percent of residents reported an earlier start of their first breast rotation (PGY1-2) would affect their fellowship choice. Conclusion: This study assessed the current level of Canadian trainees' interest in BI and identified factors that influenced their decisions to pursue BI. Solutions for increased interest include earlier exposure to breast radiology and addressing inadequacies in residency training.

How can Artistic Paintings Broaden Medical Students' Understanding of the Radiology Profession?

RATIONALE AND OBJECTIVES

The purpose of this study is to explore how representational paintings of radiology encounters with patients may impact medical students' understanding and impression of both radiologists and the radiology profession.

METHODS

Participants included third year medical students at a single institution rotating through a one-week radiology elective. Three works of art were analyzed using the validated Visual Thinking Strategies technique. Data collected included a postsession questionnaire and transcriptions of audio-recorded sessions. Data analysis involved both qualitative and quantitative methodology.

RESULTS

Fifty students participated; all participants completed the postsession questionnaire and 10 participated in the audio recorded sessions. Total 82% found the experience "very enjoyable" and 86% agreed that the paintings positively affected their understanding of how radiologists provide care to patients; 96% would recommend this session to others. Exploring representational paintings of radiology encounters seemed to influence perception and understanding of radiology with students reporting "light bulb moments;" create a dissonance between the student experience and the experience depicted in the paintings; and address gaps in content specific knowledge.

CONCLUSION

The findings of this study suggest that analyzing paintings depicting radiology encounters with patients can challenge negative stereotypes that medical students have of the radiology profession and radiologists. This arts-based learning module employing a learning strategy such as Visual Thinking Strategies, should be considered by the radiology profession as a strategy to positively inform and educate trainees about the specialty.

Designing a Comprehensive Undergraduate Medical Education Radiology Curriculum Using the 5C's of Radiology Education Framework

The 5C's of Radiology Education is a tool created from a recent qualitative study designed to explore how radiology exposures impact medical student opinions and perceptions of radiology and radiologists. It outlines the factors that the medical students identified as important for their radiology education. These factors are curriculum, coaching, collaborating, career, and commitment. The purpose of this paper is to provide a review of the literature of undergraduate medical education both broadly and more specifically to radiology education using the 5C's of Radiology Education framework.

Introducing First-Year Medical Students to Radiology: Implementation and Impact

RATIONALE AND OBJECTIVES

The aims of our study were (1) to describe a new educational intervention for first-year medical students that gave a substantial, early exposure to radiology and (2) to examine how this early exposure was received by the students.

MATERIALS AND METHODS

Our new curriculum incorporated a new 2-week course very early in the M1 year entitled Foundations of Diagnostics and Therapeutics. Among other topics, the course included a substantial introduction to radiology primarily through small-group seminars and online materials, administered using a flipped-classroom approach. The students were given pre- and postcourse surveys that assessed the degree to which they felt prepared to learn about radiology, as well as their interest in radiology. Results were analyzed using the Wilcoxon signed-rank test.

RESULTS

Survey responses were obtained from 170 students before the course and 65 students afterward. Upon completing the course, students showed significantly increased academic interest in radiology (P = .008) and a heightened perception of the effect of radiology on patient care (P = .04), without a significant change in interest in pursuing radiology as a career. Students showed an overwhelmingly positive response to the course, although some noted that previous anatomy training would have been helpful. Eighty percent agreed or strongly agreed that the flipped-classroom structure was an effective educational model.

CONCLUSIONS

Our study demonstrated that students were very excited to gain exposure to radiology early in their medical school curriculum, and such exposure led to an improved perception of the field.

Radiology Exposure in the Undergraduate Curriculum: A Medical Student Perspective on Quality and Opportunities for Positive Change

Purpose

This article is a continuation of a qualitative study designed to explore how radiology exposures can impact medical student opinions and perceptions of radiology and radiologists. We focused on: 1) conducting a radiology exposure inventory from the perspective of the medical student; 2) student evaluation of the quality of the radiology exposures and suggestions for positive change; and 3) development of a framework to address the needs of medical students as it relates to radiology education in the undergraduate medical curriculum.

Methods

Research methodology and design for this qualitative study were described in detail in a previous article by Visscher et al [1] .

Results

Participants included 28 medical students; 18 were in medical school years 1 and 2 (preclerkship), and 10 were in years 3 and 4 (clerkship). Specific to the focus of this article, the data revealed 3 major findings: 1) multiple exposures to radiology exist, and they are received and valued differently depending on the medical student's stage of professional development; 2) medical students value radiology education and want their radiology exposure to be comprehensive and high quality; 3) Medical students have constructive suggestions for improving the quality of both formal and informal radiology exposures.

Conclusions

Performing a radiology exposure inventory from a medical student perspective is a useful way to explore how students receive and value radiology instruction. Medical students want a more comprehensive radiology education that can be summarized using the 5 C's of Radiology Education framework. The 5 C's (curriculum, coaching, collaborating, career and commitment) reflect medical students' desires to learn content that will support them in clinical practice, be supported in their professional development, and have the necessary information to make informed career decisions.