Improving undergraduate education in radiology

Students' and junior doctors' perspectives on radiology education in medical school: a qualitative study in the Netherlands

BACKGROUND

Modern medicine becomes more dependent on radiologic imaging techniques. Over the past decade, radiology has also gained more attention in the medical curricula. However, little is known with regard to students' perspectives on this subject. Therefore, this study aims to gain insight into the thoughts and ideas of medical students and junior doctors on radiology education in medical curricula.

METHODS

A qualitative, descriptive study was carried out at one medical university in the Netherlands. Participants were recruited on social media and were interviewed following a predefined topic list. The constant comparative method was applied in order to include new questions when unexpected topics arose during the interviews. All interviews were transcribed verbatim and coded. Codes were organized into categories and themes by discussion between researchers.

RESULTS

Fifteen participants (nine junior doctors and six students) agreed to join. From the coded interviews, four themes derived from fifteen categories arose: (1) The added value of radiology education in medical curricula, (2) Indispensable knowledge on radiology, (3) Organization of radiology education and (4) Promising educational innovations for the radiology curriculum.

CONCLUSION

This study suggests that medical students and junior doctors value radiology education. It provides insights in educational topics and forms for educational improvement for radiology educators.

Radiology in the Undergraduate Medical Curriculum: The Student Perspective

OBJECTIVE

Despite the importance of radiology in the diagnosis and management of patients, studies suggest that medical graduates exhibit a minimal level of radiology knowledge. This study aimed to assess the satisfaction of Kuwait's medical students with the radiology teaching and their confidence in their knowledge regarding basic radiological principles, as well as their views and suggestions for adequate teaching time and pattern of radiology teaching at the undergraduate level.

SUBJECTS AND METHODS

This cross-sectional study was conducted among medical students in Kuwait University. The study employed a questionnaire, which aimed to assess the students' perception of the current radiological teaching approach. Ethical approval was obtained, and descriptive analysis was conducted using SPSS.

RESULTS

Ninety-one percent of the 451 participants believed that the radiologist is an important part of the medical team. Ninety-seven percent of them believed that having a grasp of general radiological concepts is essential for clinical practice. More than half of the participants (55%) believed that the amount of radiology teaching they receive is inadequate. Most students claimed to lack the radiological skills that a competent doctor should own, such as reading X-rays, CTs, and MRIs. Most students chose hospital-based and problem-based learning sessions as their most desired methods for radiology learning.

CONCLUSION

Radiology is an essential part of modern medicine. Adequate exposure to radiological techniques and adequate time to radiological teaching must be allocated to students during their undergraduate medical curriculum to improve the proper management of patients.

Multidisciplinary Approach in Teaching Diagnostic Radiology to Medical Students: The Development, Implementation, and Evaluation of a Virtual Educational Model

PURPOSE

The aim of this study was to develop, implement, and evaluate the effectiveness of an online multidisciplinary approach for teaching diagnostic radiology to medical students.

METHODS

An online 10-session case-based learning course was designed and taught by a multidisciplinary team of radiologists, surgeons, and internists. Session topics included common clinical case scenarios for different systems and were hosted on a videoconferencing platform. Students from six medical schools across Texas enrolled in the course. The effectiveness of each session was evaluated using a pretest-posttest design. Students completed a final survey after the course to evaluate their experience.

RESULTS

An average of 108 attended the live sessions, with attendance peaking at 220. On average, 75 students completed both the pretest and posttest of each session. Posttest scores were an average of 46% higher than pretest scores. A total of 109 students completed the final survey; more than 90% of participants agreed that the program was relevant, that its multidisciplinary approach was valuable, and that it increased their knowledge of imaging as a diagnostic tool. Seventy-four percent said that the program increased their interest in radiology. Almost all participants said that the topics presented were thought to be "excellent and clinically important to learn" by most of the students (70%). Participants reported increased confidence in basic radiology skills after completion of the program.

CONCLUSIONS

An online multidisciplinary approach can be feasibly implemented to address the radiology education needs of a large number of medical students across a group of medical schools.

Musculoskeletal Radiology Teaching at a UK Medical School: Do We Need to Improve?

The United Kingdom is currently facing crisis due to a shortage of radiology consultants despite ever-increasing demand for medical imaging. The specifics of how best to teach radiology has generated increasing interest. This study aims to determine whether musculoskeletal (MSK) radiology teaching at the University of Nottingham (UoN) Medical School is perceived to be satisfactory by medical students, Foundation-Year doctors, and senior medical professionals in preparing students for the demands working as Foundation-Year doctors. Questionnaires were distributed to all medical students and Foundation-Year doctors that graduated from UoN (n = 307). Semi-structured interviews were conducted with consultants and teaching staff (n = 13). Forty-nine percent of preclinical medical students, 43% of clinical students and 27% of Foundation-Year doctors thought MSK radiology teaching was not sufficient in preparing them for the radiology challenges Foundation-Year doctors' face. This difference was statistically significant (P < 0.001). The consensus from senior medical professionals was that MSK Radiology teaching is currently adequate and producing competent students. Interestingly, only 5% of students were considering a career in radiology compared to 34% of Foundation-Year doctors. Overall, there seems to be concern among students regarding MSK radiology teaching and students have a lack of confidence with MSK radiology. Foundation-Year doctors and senior medical professionals do not share this view. This may be due to medical students' lack of clarity on what is required of them. Formal documentation of set learning objectives for MSK radiology throughout the curriculum may address this.

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.

A practical description and student perspective of the integration of radiology into lower limb musculoskeletal anatomy

BACKGROUND

Anatomy educators are increasing their utilisation of radiology in anatomy education in line with growing requirements for undergraduate radiology competency and clinical need.

AIMS

We aimed to evaluate student perceptions of radiology and to outline the technical and academic considerations underlying the integration of radiology into musculoskeletal practical anatomy sessions.

MATERIALS AND METHODS

The formal integration of radiology into anatomy practical sessions took place over a 5-week period during the lower limb musculoskeletal component of the anatomy course taught to first-year medical students. During practical sessions, students were required to rotate between aligned audio-visual radiology presentations, osteology/anatomical models, and prosection/dissection learning stations. After completing the course, students were invited to complete a survey to establish their opinions on radiology as a mode of learning and their satisfaction with radiological integration in anatomical practical sessions.

RESULTS

Most students were not familiar with radiology prior to attending our university. All our students agreed or strongly agreed that learning to read radiographs in anatomy is important and most agreed that radiology is a valid assessment tool. Sixty percent stated that radiology facilitated their understanding of anatomy. The majority believed that radiology was best suited to clinically relevant anatomy and X-rays were their preferred learning tool.

CONCLUSIONS

The practical approach to integrating radiology into undergraduate musculoskeletal anatomy described here did not place strain on existing academic resources. Most students agreed that radiology should be increased in anatomy education and that learning to understand radiographs in anatomy was important for clinical practice.

Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope

This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial.

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.

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.

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.

Results of a survey by the European Society of Radiology (ESR): undergraduate radiology education in Europe-influences of a modern teaching approach

Objectives

The purpose of the present study is to determine in what way a conventional versus a modern medical curriculum influences teaching delivery in formal radiology education.

Methods

A web-based questionnaire was distributed by the ESR to radiology teaching staff from 93 European teaching institutions.

Results

Early exposure to radiology in pre-clinical years is typically reported in institutions with a modern curriculum. The average number of teaching hours related to radiology is similar in both curriculum types (60 h). Radiology in modern curricula is mainly taught by radiologists, radiology trainees (50%), radiographers (20%) or clinicians (17%). Mandatory clerkships are pertinent to modern curricula (55% vs. 41% conventional curriculum), which start in the first (13% vs. 4% conventional curriculum) or second year of the training (9% vs. 2% conventional curriculum). The common core in both curricula consists of radiology examinations, to work with radiology teaching files, to attend radiology conferences, and to participate in multidisciplinary meetings.

Conclusion

The influence of a modern curriculum on the formal radiology teaching is visible in terms of earlier exposure to radiology, involvement of a wider range of staff grades and range of profession involved in teaching, and radiology clerkships with more active and integrated tasks.

Main Message

• This study looks at differences in the nature of formal radiology teaching.

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.

Immediate and long-term effects of a sophomore radiology elective

RATIONALE AND OBJECTIVES

The purpose of this study was to determine the influence of sophomore electives in radiology on medical students' career choices and later clinical practice as physicians and to assess the need for change in the curriculum.

MATERIALS AND METHODS

A survey questionnaire created by the Department of Radiology was sent to graduates of the Chicago Medical School, North Chicago, Ill, who had been offered a series of three sophomore electives in radiology between academic years 1978 and 1998. The survey included five questions concerning the utility of the electives.

RESULTS

Of the 2,883 questionnaires mailed, 31 were undeliverable and 411 (14%) were completed and returned. A total of 347 (84%) of the respondents had enrolled in one or more of the sophomore radiology electives, and 325 of 340 (96%) stated that the instruction received was valuable to their careers. In addition, 54 of 333 respondents (16%) indicated that the radiology electives influenced their choice of specialty, and 322 of 328 (98%) believed that the courses should remain part of the sophomore year elective choices. Within the respondent pool, 40 of 261 (15%) identified themselves as radiologists. Among radiologists and nonradiologists, respectively, 39 of 40 (98%) and 308 of 371 (83%) had enrolled in one or more of the sophomore electives in radiology, 34 of 39 (87%) and 291 of 301 (97%) stated that knowledge gained from the courses proved valuable to their careers, 30 of 39 (77%) and 24 of 303 (8%) were influenced by the electives in their choice of specialty, and 37 of 39 (95%) and 285 of 289 (99%) stated that radiology should continue to be offered during the sophomore year.

CONCLUSION

Practicing physicians overwhelmingly supported the continuation of the sophomore radiology electives. Some suggested that radiology should be a required course or clinical clerkship.