Curriculum in radiology for residents: what, why, how, when, and where

Integrated cardio-thoracic imaging curriculum for residents: Design, implementation, and analysis of test and evaluation results

As the field of cardiac imaging has demonstrated exceptional growth over the past several decades, radiology departments and residency programs have struggled to integrate cardiac imaging instruction into training curricula.

PURPOSE

To create an integrated cardio-thoracic teaching and lecture curriculum and resident rotation in accordance with AGGME and Society of Thoracic Radiology (STR) guidelines.

MATERIALS AND METHODS

Consecutive PGY-2 to PGY-4 residents (n = 14) rotating through our Cardiothoracic Imaging (CTI) section from 1/1/2021 to 04/18/2022 were give pre- and post- rotation tests of knowledge and feedback evaluations. Attending feedback of the curriculum was obtained at 3-months and 9-months post curriculum implementation. A Wilcxon test was used to evaluate differences in improvement between pre- and post- rotation resident feedback scores, test scores for thoracic and cardiac test questions in addition to attending feedback scores at 3 and 9-months post curriculum implementation.

RESULTS

The overall post-rotation scores in addition to thoracic only and cardiac only scores improved, with the difference between improved versus stable or decreased scores being statistically significant overall (P = 0.039) and for cardiac scores (P = 0.003), but not for thoracic scores (P = 0.22). The overall (P = 0.002), thoracic (P = 0.027), and cardiac (P = 0.026) resident feedback scores were significantly improved post-rotation. Similarly, the overall attending feedback scores significantly improved over time (P = 0.021).

CONCLUSION

An integrated Cardio-thoracic Imaging teaching curriculum was well received by both residents and attendings with significant improvement in post rotation feedback scores by both groups. Moreover, residents demonstrated improved scores on knowledge tests post rotation.

Core and Advanced Thoracic Imaging Curricula to Guide Residency and Fellowship Training: A Framework From the Canadian Society of Thoracic Radiology

RATIONALE

A well-defined curriculum with goals and objectives is an inherent part of every radiology training program.

MATERIALS AND METHODS

Following a needs assessment, the Canadian Society of Thoracic Radiology Education Committee developed a thoracic imaging curriculum using a mixed- method approach, complimentary to the cardiac curriculum published as a separate document.

RESULTS

The Thoracic Imaging Curriculum consists of two separate yet complimentary parts: a Core Curriculum, aimed at residents in-training, with the main goal of building a strong foundational knowledge, and an Advanced Curriculum, designed to build upon the core knowledge and guide a more in-depth subspecialty training.

CONCLUSION

The curricular frameworks aim to enhance the educational experience of residents and fellows and provide an educational framework for clinical supervisors and residency and fellowship program directors.

SUMMARY STATEMENT

The Canadian Society of Thoracic Radiology championed the creation of Cardiovascular and Thoracic Imaging curricula encompassing clinical knowledge and technical, communication, and decision-making skills with the goal of providing direction to a strong foundational knowledge for residents and to guide specialty training for fellowship programs.

National Core and Advanced Cardiac Imaging Curricula: A Framework From the Canadian Society of Thoracic Radiology Education Committee

RATIONALE

Well-defined curriculum with goals and objectives is an inherent part of every radiology residency program.

MATERIALS AND METHODS

Following a needs assessment, the Canadian Society of Thoracic Radiology education committee developed a cardiac imaging curriculum using a mixed method collaborative approach.

RESULTS

The Cardiovascular Imaging Curricula consist each of two separate yet complimentary granular parts: a Core Curriculum, aimed at residents in-training, with the main goal of building a strong foundational knowledge and an Advanced Curriculum, designed to build upon the core knowledge and guide a more in-depth fellowship subspecialty training.

CONCLUSION

The curricular frameworks aim to enhance the educational experience of trainees (residents and fellows) and provide an educational framework for clinical supervisors and residency and fellowship program directors.

SUMMARY STATEMENT

The Canadian Society of Thoracic Radiology (CSTR) championed the creation of Cardiovascular and Thoracic Imaging curricula encompassing clinical knowledge and technical, communication, and decision-making skills with the goal of providing direction to a strong foundational knowledge for residents and to guide specialty training for fellowship programs.

Responsive Web-based Breast Imaging Core Curriculum for International Radiology Residents with Self-Assessment: A Pilot Study

RATIONALE AND OBJECTIVES

Lack of uniformity in radiology resident education is partially attributable to variable access to subspecialty education. Web-based courses improve standardization, but with growing emphasis on competency based education, more evaluation of their effectiveness is needed. We created a responsive web-based breast imaging curriculum for radiology residents including self-assessment and a satisfaction survey.

MATERIALS AND METHODS

Two global academic institutions collaboratively developed a breast imaging curriculum to address radiology residents' educational needs. This virtual course comprised 11 video lectures, nine didactic (with attached pre-test and post-test assessments) and two case review sessions. In April 2020, this optional curriculum was made available to all 56 radiology residents in one residency program cluster in Singapore, to be accessed alongside the breast imaging rotation as a supplement. A voluntary anonymous satisfaction survey was provided upon completion.

RESULTS

A total of 39 of the 56 radiology residents (70%) completed the course. For the average score of nine lectures (maximum score 5), there was a significant increase in mean pre and post - test scores (mean = 2.2, SD = 0.7), p < 0.001. The proportion of residents with improvement between the pre-test score and the post-test score ranged from 74% to 100% (mean, 84%). Thirty three of the 39 participants (85%) completed the satisfaction survey, and all agreed or strongly agreed that the curriculum increased their knowledge of breast imaging.

CONCLUSION

This web based breast imaging curriculum supplement was viewed positively by participating residents and improved their self-assessed knowledge. Curriculum access could be expanded to improve global radiology education.

Core curriculum online lecture series in musculoskeletal imaging: initial results

OBJECTIVE

To augment the educational resources available to training programs and trainees in musculoskeletal (MSK) radiology by creating a comprehensive series of Web-based open-access core curriculum lectures.

MATERIALS AND METHODS

Speakers with recognized content and lecturing expertise in MSK radiology were invited to create digitally recorded lecture presentations across a series of 42 core curriculum topics in MSK imaging. Resultant presentation recordings, organized under curriculum subject headings, were archived as open-access video file recordings for online viewing on a dedicated Web page (http://radiologycorelectures.org/msk/). Information regarding the online core curriculum lecture series was distributed to members of the International Skeletal Society, Society of Skeletal Radiology, Society of Chairs of Academic Radiology Departments, and the Association of Program Directors in Radiology. Web page and online lecture utilization data were collected using Google Analytics (Alphabet, Mountain View, CA, USA).

RESULTS

Forty-two lectures, by 38 speakers, were recorded, edited and hosted online. Lectures spanned ACGME curriculum categories of musculoskeletal trauma, arthritis, metabolic diseases, marrow, infection, tumors, imaging of internal derangement of joints, congenital disorders, and orthopedic imaging. Online access to the core curriculum lectures was opened on March 4, 2018. As of January 20, 2019, the core curriculum lectures have had 77,573 page views from 34,977 sessions.

CONCLUSIONS

To date, the MSK core curriculum lecture series lectures have been widely accessed and viewed. It is envisioned that the initial success of the project will serve to promote ongoing content renewal and expansion to the lecture materials over time.

Creating and Sustaining a Successful Fellowship Program: Challenges and Solutions

Subspecialty expertise and fellowship training are two of the most desirable attributes in new radiology hires and, not surprisingly, the vast majority of diagnostic radiologists entering the job market today have had fellowship training. Fellowship training imparts not only expertise beyond that which is attainable during residency, but also a unique opportunity for professional maturation. In this article, we offer guidance in planning, building and sustaining a successful fellowship. The key steps in this process include strategic planning, development of a curriculum that can be customized to meet the educational goals of any individual fellow, professional development and trainee preparation for the marketplace, and approaches to ensure program longevity and success through local, regional and national fellow recruitment efforts. While many of the ideas presented are framed from the perspective of their integration into a newly formed fellowship program, they can also be adapted for use by existing fellowship programs as opportunities for program growth and improvement.

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.

Exposure to, understanding of, and interest in interventional radiology in American medical students

RATIONALE AND OBJECTIVES

The purposes of this study were to determine the degree to which medical students are exposed to interventional radiology (IR) in medical school, to assess their knowledge of the field, and to gauge their interest in IR as a career choice.

MATERIALS AND METHODS

An institutional review board-approved survey was generated using the website www.surveymonkey.com. Medical student participation nationwide was elicited by sending e-mails to administrators of medical schools and radiology residency program directors and asking them to distribute the survey link to their students.

RESULTS

Seven hundred twenty-nine medical students from 21 states responded to the survey. Although 58% of students said they were interested in a hands-on career, only 5.5% of students said they had participated in an IR rotation and only 12.7% were interested in IR. Less than half of the IR domain-related questions used to assess understanding of IR were answered correctly, with greater understanding found among the students who had participated in an IR rotation.

CONCLUSIONS

Exposure to IR in accredited US medical education programs is inconsistent, although interest in the field is moderate among medical students compared with interest in other hands-on specialties. Understanding of IR is limited among the study population. Improved understanding of the field and recruitment could result from greater exposure.

Cross-specialty integrated resident conferences: an educational approach to bridging the gap

RATIONALE AND OBJECTIVES

Radiologists play a pivotal role in patient management, primarily through interacting with referring clinicians. Despite this extensive cross-specialty interaction, radiology resident education rarely involves direct education from clinicians outside the department. We surveyed resident attitudes toward integrated conferences with subspecialty referring physicians both before and after a pilot lecture series at our institution.

MATERIALS AND METHODS

Three thoracic-themed multidisciplinary conferences were organized, which involved a variety of clinicians lecturing during normal resident conference times. Resident surveys were administered before and after the complete lectures series as well as immediately after each individual lecture.

RESULTS

The prelecture series survey indicated residents felt neutral about their confidence in knowing what clinicians want from radiology reports and the current level of "clinician-focus" in the curriculum. Residents indicated a desire for more clinician involvement in lectures. After completion of the series, residents expressed that the integrated conferences were useful and that they had greater confidence in understanding the clinicians' expectation of reports. Resident interest in clinician participation in lectures was higher after series completion. Most residents indicated that prespecified, self-identified learning objectives were met by the lectures. After the completion of the series, most residents indicated that they wanted the series to continue, with the most commonly indicated desired frequency being once or twice a month.

CONCLUSION

Subspecialty clinician participation in a cross-specialty integrated resident lecture series was highly favored and well received. An "Integrated Clinical Lecture Series" may be a beneficial addition to radiology residency curriculums.

Rewarding the resident teacher

Residents routinely make significant contributions to the education of medical students. However, little attention has been paid to rewarding these individuals for their involvement in these academic activities. This report describes a program that rewards resident teachers with an academic appointment as a Clinical Instructor. The residents participate in the laboratory portion of the anatomy program at the Cleveland Clinic Lerner College of Medicine. They prepare weekly cadaver dissections and present these dissections to the first year medical students. Guidelines developed by the anatomy faculty and approved by the appropriate committees at both the Cleveland Clinic and Case Western Reserve University establish requirements that a resident must meet to qualify for an academic appointment. Evaluation of this program indicates that it has been very successful based on medical student feedback, resident interest in gaining teaching experience, and residency directors appreciation of the opportunity for residents to gain valuable teaching experience in an academic setting.

Emerging strategic themes for guiding change in academic radiology departments

Academic radiologists are faced with increasing demands on their time and energy, particularly in the clinical arena, where larger examination volumes and higher service expectations are the norm for most medical centers. These demands are intensified by the continuing shortage of academic radiologists. If academic radiology departments continue to devote most of their resources to the clinical mission at the expense of research and educational missions, then there are potentially serious adverse consequences for long-term viability of the profession of radiology. This dilemma represents a critical strategic problem, not just for academic radiology but also for the entire profession of radiology. In this article, the success and growth of academic radiology during the 20th century are framed as the result of the dogged pursuit of certain key strategic themes. With the concept of paradigm shift, introduced by Kuhn, several new strategic themes are identified that are just emerging from changes in work practices, organizational structure, and mind-sets in radiology departments at academic medical centers. One benefit of this approach is that it facilitates the ability of radiologists to articulate and focus on those strategic themes that will help academic radiology departments to adapt more rapidly and successfully to environmental changes during the 21st century.

O residente ideal em radiologia e diagnóstico por imagem

A Comissão Nacional de Residência Médica, em 2003, estabeleceu novos critérios para o credenciamento de programas de Residência Médica em Radiologia e Diagnóstico por Imagem. Apesar dessas normas representarem um avanço no treinamento do residente, outras competências e habilidades específicas deverão ser desenvolvidas no sentido de acompanhar o rápido desenvolvimento técnico e científico, e para atender as novas exigências do mercado de trabalho. Os autores apresentam as principais competências e habilidades que complementam a formação do radiologista, sugerindo modificação nos atuais programas para que os residentes possam adquiri-las.

A survey evaluating the beliefs of radiology residency program directors regarding incorporation of numeric standards into accreditation standards1

RATIONALE AND OBJECTIVES

Numeric standards do not exist for the evaluation and comparison of radiology resident education. The Accreditation Council for Graduate Medical Education has recently proposed the evaluation and assessment of residents by using numeric values for films read in various radiology modalities. The purpose of this study was to evaluate radiology residency program directors' perceived need for numeric standards for radiology residency programs.

MATERIALS AND METHODS

Program directors were surveyed via a three-part questionnaire. Initial contact was made by e-mail, with follow-up by telephone if necessary. The survey questions were: (1) Do you feel that a need exists for a set of numerical standards for the number of films read by radiology residents in each of the various subspecialties? (2) Specify the needs that you see. (3) What are the barriers and disadvantages to acquiring such data?

RESULTS

Survey responses were received from 44 of 192 radiology residency programs (23% response rate). Overall, 34 (77%) of 44 program directors were against implementation of the Accreditation Council for Graduate Medical Education proposal, whereas 8 (18%) of 44 program directors were in favor of the proposal and 2 (5%) of 44 were undecided. A variety of reasons, both for and against the proposal, were provided by program directors.

CONCLUSION

Among the program directors responding to the survey, there was strong opposition to implementation of mandatory standards for specific numbers of radiologic examinations by residents as the basis for program accreditation.

Results of the 2001 survey of the American Association of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Association of Academic Chief Residents in Radiology (A3CR2) conducts an annual survey of residency training programs. The survey data allow comparative analyses to be performed among training programs regarding resident education, benefits, clinical demands, and other resident-related issues.

MATERIALS AND METHODS

Questionnaires were mailed to all accredited programs registered in the A3CR2 database (150 total programs). The yearly questions address demographic information concerning the individual programs including academic affiliation, number of radiologic examinations performed per resident, changes in the number of residents per program, and financial compensation. The rotating questions, which are revisited every 4 years, focused on preparation for the American Board of Radiology examinations, educational issues, and employment outlook.

RESULTS

Completed surveys were received from 55 programs (37.3%). Among the responses, three issues prevailed: (a) increased number of examinations performed per resident, with resultant decrease in educational time, (b) decreased quality of education in all sections of radiology and decreased number of educational conferences, and (c) improved employment outlook, but continued trend of fewer residents choosing a career in academics.

CONCLUSION

The current boom in the radiology job market and the increased number of radiologic examinations performed annually appear to adversely affect radiologic education through a decreased number of conferences and an increased number of radiologic examinations performed per resident.