Immediate and long-term effects of a sophomore radiology elective

Teaching radiology in Egyptian medical schools: Where do we stand and how can we start?

Background

Radiology serves in the diagnosis and management of many diseases. Despite its rising importance and use, radiology is not a core component of a lot of medical school curricula. This survey aims to clarify current gaps in the radiological education in Egyptian medical schools. In February–May 2021, 5318 students enrolled in Egyptian medical schools were recruited and given a 20-multiple-choice-question survey assessing their radiology knowledge, radiograph interpretation, and encountered imaging experiences. We measured the objective parameters as a percentage. We conducted descriptive analysis and used Likert scales where values were represented as numerical values. Percentages were graphed afterwards.

Results

A total of 5318 medical students in Egypt answered our survey. Gender distribution was 45% males and 54% females. The results represented all 7 class years of medical school (six academic years and a final training year). In assessing students’ knowledge of radiology, most students (75%) reported that they received ‘too little’ education, while 20% stated the amount was ‘just right’ and only 4% reported it was ‘too much.’ Sixty-two percent of students stated they were taught radiology through medical imaging lectures. Participants’ future career plans were almost equally distributed. Near half of participants (43%) have not heard about the American College of Radiology Appropriateness Criteria (ACR-AR), while 39% have heard about it but are not familiar with.

Conclusions

Radiology is a novel underestimated field. Therefore, medical students need more imaging exposure. To accomplish this, attention and efforts should be directed toward undergraduate radiology education to dissolve the gap between radiology and other specialties during clinical practice. A survey answered by medical students can bridge between presence of any current defect in undergraduate radiology teaching and future solutions for this topic.

The Integration of Active Learning Teaching Strategies Into a Radiology Rotation for Medical Students Improves Radiological Interpretation Skills and Attitudes Toward Radiology

PURPOSE

In recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes toward radiology, as well as impact on departmental efficiency.

METHODS

This was a prospective cohort study involving fourth year medical students completing a 1-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes toward radiology.

RESULTS

A total of 105 students enrolled in the study. The mean postrotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% vs 62%; P < 0.001). The integrated rotation freed up 7 hours of radiologists' time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology.

CONCLUSIONS

The integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' postrotation radiological competency and attitudes toward radiology.

Patient-Centered and Specialty-Specific Case Work-Up: An Effective Method for Teaching Appropriateness of Imaging to Medical Students

RATIONALE AND OBJECTIVES

Our institution has developed a mini-course program within the diagnostic radiology elective curriculum that promotes active learning, using patient cases specifically tailored to students' future specialties. The purpose of this study is to evaluate the effectiveness of this mini-course on medical student knowledge of imaging appropriateness and attitude toward radiologist consultation.

MATERIALS AND METHODS

During each month-long radiology elective course, students were divided into teams of up to four students based on their specialty interest and assigned recent patient cases with imaging findings relevant to their specialties. The students researched their customized patient cases, integrated pertinent clinical and imaging findings, and presented their findings in a final preceptor-led session. A five-point Likert-type item preprogram and postprogram survey assessing knowledge of imaging appropriateness and attitude toward radiologist consultation was sent to the enrolled medical students.

RESULTS

Out of 36 medical students, 33 (92%) completed the preprogram survey and 31 (86%) completed the postprogram survey. Students reported improved confidence in knowledge of imaging appropriateness, such as indications for intravenous contrast (p < 0.0005) and oral contrast (p < 0.0005). Furthermore, students reported an improved understanding of how to utilize radiologists (p < 0.005) and how to provide pertinent clinical historical information when requesting a radiology exam (p < 0.0005). Students reported that researching the patient's historical and clinical information in conjunction with the radiology images made them more invested in the case.

CONCLUSION

Assigning customized patient cases to medical students on diagnostic radiology elective, tailored to their future specialties, is an effective and active way to teach imaging appropriateness and to improve attitudes toward radiologist consultation.

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.

Bridging the gap between basic and clinical sciences: A description of a radiological anatomy course

A wide variety of medical imaging techniques pervade modern medicine, and the changing portability and performance of tools like ultrasound imaging have brought these medical imaging techniques into the everyday practice of many specialties outside of radiology. However, proper interpretation of ultrasonographic and computed tomographic images requires the practitioner to not only hone certain technical skills, but to command an excellent knowledge of sectional anatomy and an understanding of the pathophysiology of the examined areas as well. Yet throughout many medical curricula there is often a large gap between traditional anatomy coursework and clinical training in imaging techniques. The authors present a radiological anatomy course developed to teach sectional anatomy with particular emphasis on ultrasonography and computed tomography, while incorporating elements of medical simulation. To assess students' overall opinions about the course and to examine its impact on their self-perceived improvement in their knowledge of radiological anatomy, anonymous evaluation questionnaires were provided to the students. The questionnaires were prepared using standard survey methods. A five-point Likert scale was applied to evaluate agreement with statements regarding the learning experience. The majority of students considered the course very useful and beneficial in terms of improving three-dimensional and cross-sectional knowledge of anatomy, as well as for developing practical skills in ultrasonography and computed tomography. The authors found that a small-group, hands-on teaching model in radiological anatomy was perceived as useful both by the students and the clinical teachers involved in their clinical education. In addition, the model was introduced using relatively few resources and only two faculty members. Anat Sci Educ 9: 295-303. © 2015 American Association of Anatomists.

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.

Computed tomography-enhanced anatomy course using enterprise visualization

Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors.

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.

Value of case-based learning in a nuclear medicine clerkship

PURPOSE

Medical imaging, including nuclear medicine, is a powerful tool for supporting learning in human morphology and physiology and understanding the nature of disease and response to treatment. The purposes of this study were to create a new case-based learning (CBL) model and to compare CBL and the traditional instructional approach (TIA) in a nuclear medicine clerkship.

METHODS

Internal consistency and expert validity were assessed for the instrument. A quasi-experimental, two-group pretest-posttest design was used for this study. A combination of CBL and the TIA was applied to the experimental group and the TIA only to the control group. Subjects were 70 undergraduate year 5 medical students in a clerkship curriculum. Before and after the educational intervention, students were tested with the instrument.

RESULTS

Cronbach's α coefficients of the instrument ranged from 0.79 to 0.95, indicating acceptable to strong internal consistency. For expert validity, the suitability and fitness of the instrument were verified. The overall score was significantly improved for the experimental group (from 3.51 to 3.65, P = .03) but not for the control group (from 3.48 to 3.44, P = .49). The experimental group also showed significantly improved scores in teacher assessment and learning satisfaction, the latter the only domain showing a significant difference of the differences (P = .020).

CONCLUSIONS

The integration of CBL, allied with the TIA, into clinical clerkships provides medical students with the opportunity to learn a nuclear medicine curriculum in an interactive and case-based format tailored specifically for medical students.

Radiological clerkships as a critical curriculum component in radiology education

OBJECTIVE

The aim of this research was to explore the perceived value of clinical clerkships in the radiology curriculum as well as the impact of radiology clerkship on students' beliefs about the profession of radiology as a whole and as a career.

METHODS

This study is a sequel to a previous survey in which student perceptions about radiology curriculum components were investigated. The present study focuses on a further analysis of a subsection in this study, based on 14 statements about radiology clerkship and two statements about radiology as a career.

RESULTS

Perceived usefulness of the aspects of radiology clerkship as "radiology examination", "skills development" and "diagnosis focus" were awarded the highest scores. The predict value of the subscale "radiology examination" on the level of performance was very high (adjusted R(2)=0.19, p<.001).

CONCLUSION

Students expressed highly favorable evaluation of clerkship as a learning environment to learn to order and to interpret imaging studies as well as an unique possibility to attend various radiological examinations and to access to specific radiology software systems, as well as to get a better view on radiology and to improve image interpretation skills. This positive attitude towards clerkship is closely tied to students' beliefs about the profession of radiology as a whole. These aspects of dedicated radiology clerkship are crucial for effective and high-quality education as well as for the choice of radiology as a career.

A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology

Introduction: This study compares the attitudes between preclinical and clinical medical students towards radiology, following the introduction of a new radiology curriculum for 1st year students. Materials and Methods: Revision of the 1st year medical school curriculum for the academic year of 2008/9 with the inclusion of 13 one-hour formal radiology lectures integrated with each body system was done in an undergraduate Southeast Asian medical school. In the old curriculum, 1st and 2nd year medical students are not exposed to radiology. They received limited radiology teaching in their 3rd and 5th years with 2 one-hour lectures as part of their medicine and surgery rotations. In the 4th year, they have a one week non-examinable posting in radiology. A survey was administered to preclinical (new curriculum) and clinical (old curriculum) students. Survey responses were tabulated and attitudes between preclinical and clinical students were compared. Results: More than half of the preclinical students (155 out of 270 students, 59%) and 90 out of 720 clinical students (12.5%) responded. Students exposed to the new curriculum had attended one or two dedicated radiology lectures and were considering radiology as a clinical elective. Both groups of students did not feel familiar with radiology as with other specialties, were not considering radiology as a career, but felt that radiology was interesting and important to the overall practice of medicine. Conclusions: Exposure of 1st year students to radiology increases their interest in the subject. Further intervention, fi ne-tuning of the curriculum and follow-up surveys will be carried out to see if this interest persists throughout their clinical years. Keywords: Curriculum, Medical Schoo1, Undergraduate

Incorporating radiology into medical gross anatomy: does the use of cadaver CT scans improve students' academic performance in anatomy?

Radiological images show anatomical structures in multiple planes and may be effective for teaching anatomical spatial relationships, something that students often find difficult to master. This study tests the hypotheses that (1) the use of cadaveric computed tomography (CT) scans in the anatomy laboratory is positively associated with performance in the gross anatomy course and (2) dissection of the CT-scanned cadaver is positively associated with performance on this course. One hundred and seventy-nine first-year medical students enrolled in gross anatomy at Boston University School of Medicine were provided with CT scans of four cadavers, and students were given the opportunity to choose whether or not to use these images. The hypotheses were tested using logistic regression analysis adjusting for student demographic characteristics. Students who used the CT scans were more likely to score greater than 90% as an average practical examination score (odds ratio OR 3.6; 95% CI 1.4, 9.2), final course grade (OR 2.6; 95% CI 1.01, 6.8), and on spatial anatomy examination questions (OR 2.4; 95% CI 1.03, 5.6) than were students who did not use the CT scans. There were no differences in performance between students who dissected the scanned cadavers and those who dissected a different cadaver. These results demonstrate that the use of CT scans in medical gross anatomy is predictive of performance in the course and on questions requiring knowledge of anatomical spatial relationships, but it is not necessary to scan the actual cadaver dissected by each student.

Female medical students' interest in radiology careers

OBJECTIVE

Women are underrepresented in radiology. The aim of this study was to measure first-year medical students' level of interest in radiology and their attitudes toward factors that could affect residency specialty choices to further understand how to recruit women into radiology careers.

MATERIALS AND METHODS

First-year medical students were administered surveys before and after a 7-week required introductory radiology course. Students rated interest in radiology on a scale ranging from 0 to 10 (low to high). Ten factors that could affect residency choice ("competitive residency," "shorter residency," "role models," "more jobs," "above average income," "flexible work hours," "work is technological," "work is visual," "intellectual challenge," and "more patient contact") were each rated as negative, neutral, or positive. Correlations between level of interest in radiology and the 10 factors were analyzed using Spearman's coefficients.

RESULTS

The mean levels of interest in radiology were 4.5 for men and 4.0 for women (P = .38) among 116 precourse respondents and 5.2 for men and 4.3 for women (P = .11) among 80 postcourse respondents. The factors most frequently rated as having a positive impact on residency choice were "flexible work hours," "intellectual challenge," "role models," and "more patient contact." Compared with men, women less frequently rated "work is technological" (20% vs 43%; P = .0002) and "work is visual" (50% vs 72%; P = .03) as having a positive impact and more frequently rated "more patient contact" (89% vs 77%; P = .02) as having a positive impact. For women, the strongest correlation between level of interest in radiology and the 10 factors was for "role models" (correlation coefficient = .30, P = .03).

CONCLUSION

Interest in radiology did not differ by gender. Opportunities in radiology for flexible hours, intellectual challenge, patient care, and mentoring should be promoted early in medical education to female students to maintain and increase their interest in radiology.

Subspecialty choice: why did you become a rheumatologist?

OBJECTIVE

To determine the reasons trainees choose rheumatology as a subspecialty and to review the literature on career choices among physicians, particularly regarding the choice of subspecialty.

METHODS

A questionnaire was designed to identify and analyze factors that influence rheumatology fellows to join the field of rheumatology. The questionnaire was administered online and answers were collated through the American College of Rheumatology Training and Workforce Committee, Subcommittee on Medical Student and Resident Recruitment. We reviewed the medical literature, using Medline and PubMed to find references to career choice among medical trainees.

RESULTS

The majority of rheumatology fellows had their initial exposure to rheumatology as second-year and third-year medical students, and >75% solidified their decision during internship and residency. Clinical rotations in rheumatology and exposure to role models and mentors were the most influential factors. Approximately 40% of rheumatology fellows cite their intellectual interest in the field as the most important contributor to their decision.

CONCLUSION

Career decision-making occurs throughout medical training. Exposure to clinical experiences and mentors are particularly influential and may have an impact during medical school, as well as during internal medicine residency training. These findings suggest that there are a variety of opportunities throughout medical training to influence career decision-making and improve recruitment into rheumatology. Additional financial resources that support recruitment efforts may be required, and followup studies assessing the effects of these efforts should be done.

Learning and retaining normal radiographic chest anatomy: does preclinical exposure improve student performance?

RATIONALE AND OBJECTIVES

Although most would concur that preclinical exposure to radiology is a desirable goal, specific learning objectives have been more difficult to delineate. It is also important to assess what is learned and to determine how well it is retained or "retrievable." This study was developed in an attempt to document the extent to which specific measures of preclinically acquired knowledge may be retained and retrieved for later clinical application.

MATERIAL AND METHODS

The Anatomic Structure Identification Quiz (ASIQ, or Quiz), previously described in Feigin et al (Academic Radiology 2005) was administered to 236 medical students at the conclusion of the required second-year course, as a 10-item written Quiz based on a projected frontal and lateral chest image. The 10-item Quiz was also administered to 555 senior medical students (194 of which had been included in previous work) on the first day of the Uniformed Services University of the Health Sciences basic radiology elective. Finally, the identical Quiz was completed by 74 of these 555 senior medical students at the conclusion of the academic portion of the elective, approximately 3 weeks after the administration of the first quiz.

RESULTS

The second-year students scored a mean of 7.15 points of a possible 10 points with a standard deviation (SD) of 1.42. The senior students completing the quiz at the beginning of the elective scored an average of 4.42 (SD 1.34) compared to a score of 8.65 (SD 1.24) 3 weeks later.

CONCLUSION

Long-term recall of specific radiologic structures learned in the second year of medical school was poor despite evidence documenting good initial (short-term) retention of tested information. However, after a brief review, consisting of the Quiz itself, followed by 3 weeks of general radiology emphasizing abnormal chest imaging, the senior students demonstrated a near doubling of their ability to correctly identify these structures, as well as an improvement compared with scores obtained during the second year. Thus the value of a preclinical course in radiology may be not only to teach principles of radiology and to stimulate interest in the discipline, but also, by repetition and reinforcement, to facilitate and possibly improve later recall and retention of important radiographic material.

Application of the case method in medical student radiology education

RATIONALE AND OBJECTIVES

Our goal is to design, implement, and evaluate a rich educational activity to engage medical students in learning the importance of providing clinical histories when ordering radiological examinations. We adapted the format of the case method commonly used in business schools.

MATERIALS AND METHODS

In the setting of a 1-week required radiology course offered during the third year of medical school, we created an unknown case assignment consisting of two chest radiographs and a concise history for three- to four-person study teams. Unknown to students, each team received the same images, but different patient histories. After turning in their written analyses, students had a classroom opportunity to discuss their conclusions. A written evaluation of the entire experience using both Likert items and unstructured response items was conducted at the end of each session.

RESULTS

The evaluation was conducted during a 17-month period, and 141 evaluations were received from students. The response rate was 100%. Most teams met several times and worked on the assignment for 2 or 3 hours. Students agreed that the learning experience was worthwhile (95%), content was appropriate (93%), and the activity should be continued for subsequent classes (94%). Unstructured responses indicated that students learned the importance of clinical histories in the interpretation of radiological studies.

CONCLUSION

An educational activity based on the case method was well received by students and met its educational objectives. Activities of this type have potential for widespread application in radiology education.

Why don’t female medical students choose diagnostic radiology? A review of the current literature

While the number of women entering medical schools is approaching 50% nationally, women continue to be underrepresented in a number of specialties including diagnostic radiology. While diagnostic radiology has many characteristics that might be desirable to women, such as reasonable call hours, flexible scheduling, and high salaries, women still do not choose diagnostic radiology as a career. This article examines the literature to discern possible reasons for why women are entering diagnostic radiology at a lower rate. We address trends among women in academic medicine, which resemble trends among women in diagnostic radiology, and examine the effects of gender and socialization in medical school on specialty choices among women. The current literature suggests a constellation of factors may be responsible for the gender differences in diagnostic radiology. We suggest that further research is needed to elucidate why women do not seem to be choosing diagnostic radiology as frequently as one might predict based on the lifestyle of diagnostic radiologists and the numbers of women currently entering medical school. Once these reasons are made clear, it will be possible for residency program directors and medical schools to ensure that women are making informed specialty choices, whatever those choices may be.