1996 Joseph E. Whitley, MD, Award. Evaluation of an introductory course in chest radiology

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.

The role of preliminary interpretation of chest radiographs by radiographers in the management of acute medical problems within a cardiothoracic centre

Radiographic staff in a regional cardiothoracic centre were asked to assess all pre- and post-operative chest radiographs over a 6-month period. Radiographs showing new, acute changes were noted and a red dot placed on the film. Medical staff were notified of radiographs with red dots, and these were subsequently reported by radiologists. Using reports by radiologists as the gold standard, an audit was performed of the radiographers' accuracy in identifying new abnormalities. The absence of a necessary red dot as well as inappropriate use were noted. To enhance the accuracy of radiograph interpretation, a series of lectures on the chest radiograph and a protocol for red dot use were developed by senior radiologists. During this 6-month period 8614 chest radiographs were taken; red dots were applied to 464 (5%). These red dots were considered incorrect in 100 radiographs. Radiographers misinterpreted or missed potentially important changes in 38 of the remaining 8150 radiographs without red dots (sensitivity and specificity of 90% and 99%, respectively). Radiographers appeared to err on the side of caution when confronted with an abnormal chest radiograph, especially when previous radiographs and reports were unavailable. This resulted is a relatively high false positive rate. Future audits will show whether this rate can be reduced by continued training. Subtle interpretation is crucial to distinguish between an abnormal chest radiograph needing urgent medical attention and an abnormal chest radiograph with normal post-operative changes. The opinion of the experienced and trained radiographer is immediate and may be invaluable to the diagnostic care of the patient.

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

Developing a curriculum in chest radiology should follow the same general principles that are used when developing a curriculum in any subspecialty area of radiology. A curriculum is more than a "list of topics" with which a resident should be familiar after 4 years of training. It includes objectives and goals, content, faculty, methods, and evaluation. Numerous resources are available for those who are charged with developing a curriculum in chest radiology. In addition to faculty members in the department, whose input during development can ensure successful implementation of the curriculum, organizations (i.e., ACR, APDR, STR) already have begun to develop "model" curricula. Attending the annual meeting of the Association of American Medical Colleges is a way to meet and hear from professionals who develop and oversee curriculum development at their medical schools, and another important resource available at some medical schools is the Office of Medical Education. The faculty within such offices are uniquely qualified to assist with curriculum and faculty development, especially for those areas in which radiology faculty traditionally are less experienced, such as development of valid and reliable assessment forms and construction of behaviorally based objectives.