Medical Student Radiology Externs: Increasing Exposure to Radiology, Improving Education, and Influencing Career Choices

Impact of a Reading Room Coordinator on Efficiency of On-Call Radiology Residents

OBJECTIVES

Few level I trauma, tertiary care, academic centers have a paid, permanent reading room coordinator (RRC) to facilitate image management services during off-hour calls, to minimize interruptions to reading workflow. The purpose of this study is to investigate the effect of an RRC on the efficiency of radiology residents signing preliminary reports for emergency department (ED) and inpatient studies.

METHODS

A pre- and postintervention retrospective review was performed, using carestream PACS to retrieve imaging studies read on call during two time periods-July 1 to December 1, 2019 (pre-RRC), and July 1 to December 1, 2021 (post-RRC). Efficiency of residents signing preliminary reports was measured by turnaround time (TAT), defined as the time from when a study was marked complete by a technologist to when a preliminary report was signed by a resident, in PACS.

RESULTS

In the above time periods, residents interpreted a total of 64,406 studies on call. For ED studies, the mean TAT was 7.0 min shorter post-RRC, compared with pre-RRC (95% confidence interval [CI]: -7.8 to -6.1, (t = 15.50, degrees of freedom (df) = 31,866, P < .0001). The percentage of ED studies signed within 30 min increased from 57.7% to 65.8%, an increase of 8.1% (95% CI: 7.0% to 9.1%) after employing an RRC (χ2 = 228.11, df = 1, P < .0001). For inpatient studies, the mean TAT was 10.2 min shorter post-RRC (95% CI: -12.3 to -8.0, t = 9.22, df = 25,193, P < .0001).

CONCLUSIONS

An RRC increased radiology resident on-call workflow efficiency, facilitating care for patients in both the ED and inpatient setting.

Implementation of Medical Students as Radiology Reading Room Coordinators

OBJECTIVE

Effort has been made to minimize the burden of non-interpretive tasks (NITs), in particular by hiring and training non-radiologist support staff as reading room coordinators (RRCs). Our medical center recruited and trained senior medical students from our affiliated school of medicine to work alongside on-call radiology residents as RRCs.

METHODS

A 12-month Malpractice Carrier monetary grant was acquired to fund medical students at with the aim to reduce malpractice risk. After the first year, residents were surveyed regarding the impact of the RRCs on perceived on-call efficiency and morale. Furthermore, report turnaround times (TAT) on call shifts that were and were not accompanied by a RRC were compared.

RESULTS

89 % of residents strongly agreed that the RRC improved workflow efficiency, decreased distractions, and felt less stressed during the call shift when the RRC was on duty. 78 % strongly agreed to be more likely to contact a referring clinician when the RRC was able to help coordinate. The mean TAT in the presence of a RRC was 36.8 min, and the mean TAT in the absence of a RRC was 36.9 min DISCUSSION: After hiring medical students to assist on-call radiology residents with noninterpretive tasks, residents reported subjective indicators of program success, but average report turnaround time was unaffected. Nevertheless, we predict that this type of program will continue to grow among academic radiology departments, though additional research is required to evaluate national trends and impacts on radiologist productivity and well-being.

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.

Resident Physicians' Perceptions of Diagnostic Radiology and the Declining Interest in the Specialty

RATIONALE AND OBJECTIVES

The relative competitiveness of radiology and the number of first-choice applicants to diagnostic radiology have steadily declined over the past decade. The purpose of this study was to identify factors contributing to the declining interest in diagnostic radiology as a career and to explore factors affecting specialty choice.

MATERIALS AND METHODS

A retrospective survey was distributed to resident physicians at a single academic center between July and August 2017. Participants identified factors affecting career choice and evaluated level of agreement with statements regarding radiology using 5-point Likert scales. Higher scores indicated stronger agreement.

RESULTS

One hundred and fifty-two resident physicians from Canada participated (21.5% response rate): 20 radiology and 132 nonradiology. Of the total, 27% were registered in postgraduate year (PGY) 1, 23% in PGY 2, 15% in PGY 3, 19% in PGY 4, and 16% in PGY 5, or above. Sixty-one percent of the respondents self-reported as female, 34% as male, and 5% as other/unknown. Of those in radiology, 40% self-reported as female, 55% as male, and 5% as other/unknown, compared to 64% female, 31% male, and 5% other/unknown in other specialties. Regardless of specialty, positive clinical/mentoring experiences strongly affected career choice. Radiology residents were attracted to diverse pathology (M = 4.5) and positive staff/resident interactions (M = 4.4). Nonradiology residents were deterred by lack of patient contact (M = 3.9) and dark work environment (M = 3.6). Resident physicians who had applied to radiology were more likely to report positive mentorship during medical school, disagree that technology will replace radiologists, and desire a higher income specialty (Wald = 56.6, p < 0.001). More recent graduates showed a higher level of concern regarding the potential negative impact of technology and outsourcing on the profession (F (3, 189) = 2.6, p = 0.05). Several trainees (21%) considered radiology, but lacked mentorship (52%) and identified job market concerns (29%).

CONCLUSION

More recent graduates are relatively more concerned about technology replacing radiologists, and radiology applicants have less concern about artificial intelligence replacing radiologists. As positive interactions with radiologists and mentorship are key influencers, our results advocate for early training exposure and reinforcement regarding the positive outlook of the profession.

The Current State of Radiology Call Assistant Triage Programs Among US Radiology Residency Programs

RATIONALE AND OBJECTIVES

Given increasing volume and workflow interruptions in radiology, we sought to identify and characterize radiology call assistant triage (RCAT) programs among US radiology residency programs.

MATERIALS AND METHODS

A survey was created using Qualtrics survey software and emailed to all members of the Association of Program Directors in Radiology listserv. A total of 296 active members belong to this listserv, including program directors and assistant program directors. The survey included questions about the existence and specifics of a call triage assistant program.

RESULTS

Data were obtained from 88 active members of the Association of Program Directors in Radiology (30% response rate). Of those, 20 programs (23%) have an RCAT program. Triage assistant staffing includes nonmedical or clerical staff (60%), medical students (30%), first-year radiology residents (5%), and technologists (5%). All respondents with RCAT programs report satisfaction with their program and plan to continue. A significant majority (75%) have no plans to change, whereas the remaining 25% are considering program expansion and pay increases. Among residency programs without RCAT programs, none reported termination of their triage program. The most common reasons for not having triage assistants include cost, lack of awareness, differing opinions on utility, and the presence of 24/7 attending coverage.

CONCLUSION

Twenty US radiology residency programs report having an RCAT program. All report satisfaction with their program despite different staffing models. RCAT programs may represent an effective measure in limiting interruptions and potentially decreasing interpretative errors made by residents on call.

Expectations of Medical Student Neuroradiology Education: A Survey of Practicing Neuroradiologists and Neurologists

The purpose of this study is to evaluate which neuroradiological diseases neuroradiologists and neurologists believe medical students should be exposed to during their neuroradiology rotation. Members of the American Society of Neuroradiology (ASNR) and the American Academy of Neurology (AAN) were surveyed. Respondents were presented 32 diseases with neuroimaging findings and asked which ones medical students should be exposed to during a neuroradiology rotation. Using a 50% response threshold per disease entity, results were tabulated into 3 groups: diagnoses that (1) more than 50% of neuroradiologists and neurologists felt medical students should see radiologically by rotation completion, (2) less than 50% of respondents in both the groups felt were important, and (3) both the groups disagree are important. Both the groups thought medical students should be exposed to imaging of intraparenchymal hemorrhage (ASNR = 80.4% vs AAN = 84.3%; P = 0.346) and subarachnoid hemorrhage (ASNR = 74% vs AAN = 78%; P = 0.394). Both the groups (>50%) thought subdural hematoma, acute ischemic stroke, epidural hematoma, and spinal cord compression are important. Conditions such as spine fractures, nonacute stroke, arteriovenous malformation, and ear-nose-throat pathology showed varied results between both the groups. Varying degrees of similarity and differences exist between the expectations of neuroradiologists and neurologists regarding medical student neuroradiology education, presenting a positive opportunity for greater consensus, dialogue, and joint curriculum formation.

Mid-level providers and emergency care: let's not lose the force

The progressive rise of ED visits globally, and insufficient numbers of emergency physicians, has resulted in the use of mid-level providers as adjuncts for the provision of emergency care, especially in the US and Canada. Military medics, midwives, aeromedical paramedics, EMT-Ps, flight nurses, forensic nurses, sexual assault nurse examiner nurses--are some examples of well-established mid-level provider professionals who achieve their clinical credentials through accredited training programmes and formal certification. In emergency medicine, however, mid-level providers are trained for general care, and typically acquire emergency medicine skills through on-the-job experience. There are very few training programmes for NPs and PAs in emergency care. The manpower gap for physicians in general, and emergency physicians specifically, will not be eliminated in the reasonable future. Mid-level providers--ENTs, paramedics, NPs, PAs--are an excellent addition to the emergency medicine workforce. However, the specialty of emergency medicine developed because specific and focused training was needed for physicians to practice safe and qualify emergency care. This same principle applies to mid-level providers. Emergency Medicine needs to develop a vision and a plan to train emergency medicine specialist NPs and PAs, and explore other innovations to expand our emergency care workforce.

The value of a medical student radiology triage program in enhancing clinical education and skills

RATIONALE AND OBJECTIVES

The Medical Student Radiology Triage Program (MSRTP) at Dartmouth-Hitchcock Medical Center recruits third- and fourth-year medical students to streamline imaging workflow for on-call radiology residents. We sought to evaluate the benefit of this program for improving medical student education.

MATERIALS AND METHODS

Members of the program were surveyed anonymously from 2010 to 2012 using a web-based survey. The survey asked the students to rate the program in several categories from 1 (very poor) to 5 (very good). Students also indicated if they are learning any of the identified skills.

RESULTS

Thirty of 54 (56%) former and current members responded to the survey. Support from on-call residents (mean rating 4.7) and interactions with residents (mean rating 4.7) were rated the highest of the categories. Students ranked training provided (4.2), interactions with technologists (4.2), and interactions with clinicians (4.1) the lowest. The medical training experience and overall experience were graded with means of 4.4 and 4.5, respectively. Ninety-six percent of students felt they acquired triaging skills, whereas 92% of students developed communication skills. Sixty-nine and sixty-two percent of students stated that they gained radiologic knowledge and general medical knowledge, respectively. Sixty-five and fifty percent of students developed imaging appropriateness criteria and image interpretation skills, respectively. The most popular reason for joining the program was for financial compensation (number of students = 12), followed by exposure to radiology (n = 8), radiology education (n = 8), and clinical exposure (n = 7). Major strengths of the program included interactions with residents, learning experience, and triaging of workflow. Students listed the top two problems with the program as computed tomography technologists and clinicians not wanting to speak to them.

CONCLUSIONS

The MSRTP serves as a valuable clinical learning experience as well as being highly beneficial to resident workflows on call. Participants of MSRTP gain clinical skills that they will use during residency.

Worldwide utilization of a web-based learning tool for pediatric radiology

OBJECTIVE

The purpose of this study was to determine the reach, appeal, and learning effectiveness of a Web-based pediatric radiology curriculum with attention to level of training, test format, program size, subspecialty, and country of study.

MATERIALS AND METHODS

Registration demographics, the 10-point evaluation form, and pre- and posttest scores from approximately 17,000 modules completed from October 2011 to July 2012 were analyzed.

RESULTS

There were 20,583 registered users from 298 institutions, 43 states and Puerto Rico, and 53 countries, with on average 256 new registrants each year. Evaluation scores were 3.30-4.16 of 5 points. Small programs benefited most with an average improvement of 16.78%, with an average improvement of 16.31% for medium and large programs (p < 0.001). First-year residents showed greatest improvement (18.15%), followed by second-year (16.74%), third-year (16.16%), and fourth-year (12.94%) residents. Radiology residents showed greater improvement (16.63%) over others collectively (16.21%), dependent on job training (p < 0.0001). Average improvement for true/false versus multiple-choice tests was 15.53% and 26.00%, respectively (p < 0.0001). Improvement was higher for international (16.91%) than North American (16.43%) users, with all modules showing improvement with similar trends for all modules; however, the pretest average was higher for United States and Canada than for the rest of the world (63.67% vs 61.92%). Mean improvement over all modules was 16.45% (SD, 18.36%) with 95% confidence interval of 16.18%-16.73% (p < 0.001).

CONCLUSION

The pediatric radiology curriculum is universally popular both within North America and internationally, easy to use and enjoyable, and effective for learners at all levels within radiology and allied fields. In addition, it serves as an excellent springboard for future development of more sophisticated learning tools.