Medical students and radiology residents: can they learn as effectively with the same educational materials?

Pediatric radiologist-driven didactics for a pediatric residency program: a quality initiative

BACKGROUND

Pediatric residents exhibit knowledge gaps in appropriateness of imaging utilization.

OBJECTIVE

This study evaluates the value of radiologist-driven imaging education in a pediatric residency program. The primary goals of this educational program were to provide pediatric residents with resources such as the American College of Radiology Appropriateness Criteria, support optimal resource utilization and patient care, increase resident understanding of radiation risk, and determine the value of integrating radiologists into pediatric education.

MATERIALS AND METHODS

A needs assessment was performed in which the chief residents of a large pediatric program were surveyed. The consensus of chief residents was that a four-part lecture series delivered by a pediatric radiology fellow would be beneficial to the pediatric residents. Topics included general radiation risk as well as basic imaging topics in the chest, abdomen, neurological system, extremities and vasculature. Each lecture integrated appropriate ordering, ALARA (As Low As Reasonably Achievable)/Image Gently, and basic image interpretation. Residents were asked, using a Likert scale, to rate their understanding of radiation risk, the ACR Appropriateness Criteria, and other topics of interest before and after each lecture. Pediatric residents were given a 10-item quiz before and after the lecture series to assess their knowledge regarding the best test to order in clinical scenarios.

RESULTS

The average pre-lecture score for knowledge of radiation risk was 3.27 (95% confidence interval [CI]: 3.02-3.51) out of 5, which improved to 4.27 (95% CI: 4.09-4.57) post-lecture. There was an increase in understanding of ACR appropriateness, with pre-lecture rating of knowledge increasing from 1.91 (95% CI 1.54-2.29) out of 5 to 3.61 (95% CI 3.33-3.90) post-lecture. The residents averaged 82.7% (95% CI 77.3%-88.1%) on the appropriateness pre-test and 93.8% (95% CI 90.3%-97.2%) on the post-test. Residents provided positive feedback upon conclusion of the program and reported a beneficial effect on their education.

CONCLUSION

A radiologist-driven lecture series in a pediatric residency can improve resident understanding of appropriate ordering practices and radiation risk. Radiologist participation in pediatric residency training is well-received.

Performance of an Interactive Upper Extremity Peripheral Nerve Training Module Among Medical Students, Radiology Residents, and Fellows: A Multi-institutional Study

BACKGROUND AND PURPOSE

Chronic pain is a common problem and imaging is becoming increasingly utilized in the characterization of peripheral neuropathy, although this topic is not emphasized during medical training. We hypothesized that an electronic module and nerve atlas would be effective in improving comprehension among trainees.

MATERIALS AND METHODS

In this IRB-approved study, a training module was created that included a side-by-side comparison of normal upper extremity nerves on magnetic resonance imaging and ultrasound (US), with embedded questions and cases, followed by a brief hands-on US scanning session. Thirty volunteers with variable training were enrolled in 1 institution, while 14 volunteers were enrolled in another. Pre- and post-test scores were collected and compared.

RESULTS

There was a response rate of 100% at both institutions. At the first institution, subjects were divided into 2 groups: group 1 (16 medical students) and group 2 (14 residents/fellows). There was a baseline deficit of knowledge among both groups, with a mean pretest score of 37.5% and 47.5% for group 1 and group 2, respectively (P = 0.017). After module completion, both groups improved with a mean post-test score of 67.2% for group 1 and 76.1% for group 2. At the second institution, there was similar improvement even if the scanning session was not done.

CONCLUSIONS

Use of an electronic module helps trainees to become more familiar with peripheral nerve imaging, regardless of level of training. Use of the module, even in the absence of hands-on US scanning, results in an improved understanding of this topic.

Ultrasound curriculum taught by first-year medical students: A four-year experience in Tanzania

BACKGROUND

Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries (LMICs) such as Tanzania. The introduction of ultrasound can significantly impact treatment in these countries due to its portability, low cost, safety, and usefulness in various medical assessments. This study reviews the implementation of a four-week ultrasound course administered annually from 2013-2016 in a healthcare professional school in Mwanza, Tanzania by first-year allopathic US medical students.

METHODS

Participants (n=582, over 4 years) were recruited from the Tandabui Institute of Health Sciences and Technology to take the ultrasound course. Subjects were predominantly clinical officer students, but other participants included other healthcare professional students, practicing healthcare professionals, and school employees. Data collected includes pre-course examination scores, post-course examination scores, course quiz scores, demographic surveys, and post-course feedback surveys. Data was analyzed using two-tailed t-tests and the single factor analysis of variance (ANOVA).

RESULTS

For all participants who completed both the pre- and post-course examinations (n=229, 39.1% of the total recruited), there was a significant mean improvement in their ultrasound knowledge of 42.5%, P<0.01.

CONCLUSION

Our data suggests that trained first-year medical students can effectively teach a point of care ultrasound course to healthcare professional students within four weeks in Tanzania. Future investigation into the level of long-term knowledge retention, impact of ultrasound training on knowledge of human anatomy and diagnostic capabilities, and how expansion of an ultrasound curriculum has impacted access to care in rural Tanzania is warranted.

Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective: A Comparison of MS-IIs, MS-IIIs, and MS-IVs

RATIONALE AND OBJECTIVES

Correct selection of imaging tests is essential f or clinicians but until recently has been largely neglected in medical education. How and when students acquire such non-interpretive skills are unknown. This study will assess student knowledge of imaging test selection before and after a general radiology elective.

MATERIALS AND METHODS

Between 2008 and 2015, an unannounced 13-item test was administered to second, third, and fourth-year students on the first and last days of the Johns Hopkins School of Medicine radiology elective. Scores (0–13) were based on the American College of Radiology Appropriateness Criteria. Pre- and posttest means were compared using paired samples t tests. Whether performance on the pretest and posttest differed by class year was assessed using analysis of variance and Kruskal-Wallis, respectively, and whether year was associated with posttest score after controlling for pretest score was assessed using analysis of covariance.

RESULTS

Posttest means were significantly higher than pretest means for students in all years (P values <.0001). Pretest scores differed by year (F(2, 360) = 66.85, P <.0001): fourth-year students scored highest (mean = 9.96 of 13) and second-year students scored lowest (mean = 7.01 of 13). Posttest scores did not differ (χ2(2, 270) = 0.348, P = .841). Year in school had no independent effect on posttest score (F(2, 239) = 0.45, P = .637).

CONCLUSION

Knowledge of modality selection increases with clinical training, but room for improvement remains. A general radiology elective increases this knowledge. Second-year students improve most, suggesting that taking radiology early is efficient, but further research to evaluate retention of this knowledge is needed. Medical student education in radiology must increasingly recognize and address non-interpretive skills and intelligent imaging utilization.

A feasibility study to determine if minimally trained medical students can identify markers of chronic parasitic infection using bedside ultrasound in rural Tanzania

BACKGROUND

Parasitic infections pose a significant health risk in developing nations and are a major cause of morbidity and mortality worldwide. In the Republic of Tanzania, the CDC estimates that 51.5% of the population is infected with one or more intestinal parasites. If diagnosed early, the consequences of chronic parasitic infection can potentially be avoided.

METHODS

Six first-year medical students were recruited to enroll patients in the study. They underwent ten hours of formal, hands-on, ultrasound which included basic cardiac, hepatobiliary, renal, pulmonary and FAST scan ultrasound. A World Health Organization protocol with published grading scales was adapted and used to assess for pathology in each patient's liver, bladder, kidneys, and spleen.

RESULTS

A total of 59 patients were enrolled in the study. Students reported a sensitivity of 96% and specificity of 100% for the presence of a dome shaped bladder, a sensitivity and specificity of 100% for bladder thickening, a sensitivity and specificity of 100% for portal hypertension and ascites. The sensitivity was 81% with a specificity of 100% for presence of portal vein distention. The sensitivity was 100% with a specificity of 90% for dilated bowel.

CONCLUSIONS

Ultrasound has shown a promise at helping to identify pathology in rural communities with limited resources such as Tanzania. Our data suggest that minimally trained first year medical students are able to perform basic ultrasound scans that can identify ultrasonographic markers of parasitic infections.

Pedagogical Approaches to Diagnostic Imaging Education: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine literature on how radiology is taught and learned by both radiology residents and undergraduates in the health professions.

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, 91 were found to be relevant to the purpose of this study. The literature retrieved reported pedagogical approaches to teaching radiology including the following: problem solving, technology as teacher, independent learning tools, visiting lectureships, case based teaching, and conferences. There was some exploration of the relative effectiveness of educational formats. Suggestions for future research identify 7 areas of relative consistency.

CONCLUSION

Radiology is a clinical skill that requires integration science, clinical information, clinical experiences, and information recorded on diagnostic imaging studies. The research in this area focuses on problem solving, the use of algorithm/scripts, introducing uncertainty in clinical scenarios, incorporating technology in learning environments, active learning techniques, and methods of independent learning. Although the literature in this area is still in its infancy, the research examining the relative effectiveness of these various educational formats is often contradictory, suggesting that this is a complex area of study with numerous factors influencing student learning.

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.

Student Evaluations, Outcomes, and National Licensure Examinations in Radiology Education: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine literature on radiological student evaluation and outcome assessments including national board examinations.

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, 54 were found to be relevant to the purpose of this study. Student grade point average correlates with board scores in the nursing, chiropractic, and medical professions. Scores on the chiropractic college admission test and undergraduate grade point average correlate with success in professional college. There is a correlation between board scores and college attended. Board preparation programs do not appear to affect board examination scores.

CONCLUSION

Although evaluations can be effective teaching tools, they are not used by many radiology programs. Some programs have inadequate evaluations and do not allow students to review their evaluations. There are no definitive links between mastery of radiology and specific evaluations, outcomes, or pre-professional/clinical grades. Studies suggest that board examination scores reflect long-term mastery of knowledge rather than short-term memorization of facts.

Innovative Approach to Teaching Osteopathic Manipulative Medicine: The Integration of Ultrasonography

Context: Noninvasive diagnostic methods and palpatory physical examination skills are especially important for osteopathic medical students intending to work in rural, underresourced, or underserved areas. The A.T. Still University–Kirksville College of Osteopathic Medicine integrates ultrasonography into the osteopathic manipulative medicine (OMM) courses required during the first 2 years of medical school, allowing students to learn the technology and to visualize anatomical structures and regions. Objective: To assess the feasibility of integrating ultrasonography into the first-year and second-year OMM curriculum through the evaluation of students' success in demonstrating the technology and visualizing the anatomy. Methods: As part of their OMM requirements at the A.T. Still University–Kirksville College of Osteopathic Medicine, all first- and second-year students in OMM courses were given ultrasonography assignments that required them to obtain images of musculoskeletal structures in different regions of the body. First-year students studied craniocervical structures and the thoracic, lumbar, and sacral regions. Second-year students studied the glenohumeral joint and the suprapatellar recess. The assignments focused on identifying structures of interest, making annotations, and measuring the structures of interest. Handouts with detailed instructions and a demonstration were provided before each assignment. Results: A total of 183 first-year students and 165 second-year students participated. Of the first-year students, on average, 177 of 181 were able to successfully complete the assignments, with an average completion rate of 98%. The costotransverse joint assignment yielded the lowest completion rate (97%), and the craniocervical landmarks assignment had the highest completion rate (99%). Of the second-year students, 162 of 165 participants were able to successfully complete the assignments, with an average completion rate of 98%. Mean scores were the same for both second-year assignments. Conclusion: First-year and second-year osteopathic medical students successfully demonstrated their use and understanding of ultrasonography and found their assigned structures using live ultrasound imaging. The skills gained through these assignments added another dimension to students' understanding of normal and pathologic musculoskeletal anatomy and vasculature. The integration of ultrasonography into OMM courses may have created a foundation for learning ultrasound-guided injection techniques. J Am Osteopath Assoc. 2015;115(4):212-220 doi:10.7556/jaoa.2015.043

The sonographic digital portfolio: a longitudinal ultrasound image tracking program

Background

Ultrasonography (US) at the medical student level is developing. As clinical skills and simulation centers expand, US equipment miniaturizes, and more students are exposed to ultrasound; a digital portfolio comprised of US images and videos may be useful in demonstrating experience and possibly competency.

Methods

Medical students participated in US curricula consisting of didactics and hands-on training. From 1 July 2006 to 30 June 2008, student images and videos were saved. Total images and videos were evaluated and catalogued.

Results

A total of 10,074 images and 1,227 videos were saved during the 2-year period. For the academic year 2006 to 2007, 159 medical students obtained 3,641 of the images (84.9%) and 270 of the videos (86.0%). First year students obtained 778 images and 20 videos; second year students, 1,174 images and 64 videos; third year students, 211 images and 20 videos; and fourth year students, 1,478 images and 166 videos.

For the academic year 2007 to 2008, 222 medical students obtained 4,340 images (75%) and 619 videos (67.8%). First year students obtained 624 images and 109 videos; second year students, 555 images and 81 videos; third year students, 132 images and 14 videos; and fourth year students, 3,029 images and 415 videos.

Conclusions

The ultrasound digital portfolio allows medical students to collate and document their ultrasound experience. Currently, there is no requirement for ultrasound training, documentation of competency, or minimum numbers of US exams for medical education. The ultrasound digital portfolio may be a useful tool in documenting ultrasound proficiency.

Medical Imaging Resource Center (MIRC) for veterinary medicine: a digital image teaching file

RATIONALE FOR THE STUDY

Veterinary radiology has a need for software to facilitate the creation of digital image teaching files. The Medical Imaging Resource Center (MIRC) is widely used in medicine to create teaching cases and store data from clinical trials. This open-source software was identified as a solution for use in veterinary medicine.

METHODOLOGY

The additional fields needed to adapt the system for veterinary use were identified as sex, species, and breed. Breed and species codes from the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and from the Standard Nomenclature of Veterinary Diseases and Operations (SNVDO) were gathered and correlated.

RESULTS

The sex fields added were male, male neutered, female, and female neutered. The breed and species codes were combined into a single term. These were coded in eXtensible Markup Language (XML) and added to the software's veterinary document template and search capabilities.

CONCLUSIONS

MIRC was successfully adapted for use in creating digital teaching files for veterinary medicine.