两所高等医学院校临床本科生介入放射学认知度调查

目的 探讨介入放射学课程对临床医学本科生介入放射学认知度的影响.方法 采用问卷式调查方式对两所高等医学院校分别独立修学(教学组)和未修学(对照组)介入放射学课程临床医学专业本科实习生介入放射学知识进行匿名调查,主要调查内容为介入放射学知识掌握情况、介入放射学职业前景评判等.采用频数分析和x2检验对两组调查数据结果进行比较.结果 对照组75％学生(71/95)对介入放射学知识了解“少”或“无”,教学组28％学生(28/100)对介入放射学知识了解“少”或“无”,教学组学生对介入放射学知识了解程度明显高于对照组(P＜0.05).两组共有87％学生认为介入放射学有较好就业前景,但仅有13％学生考虑将其作为终身职业(对照组20％,19/95;教学组6％,6/100).部分学生因不了解介入放射学知识而不愿意将其作为终身职业(对照组85％,65/76;教学组23％,22/94).结论 临床医学本科生系统学习介入放射学理论知识,有助于提高介入放射学认知度.     

Teaching radiology to medical students: an integrated approach

RATIONALE AND OBJECTIVES: This study assessed medical student satisfaction with radiology lectures integrated into the 3rd-year student internal medicine clerkship, compared with faculty lectures in an independent radiology course, and investigated the effects of integrated instruction on departmental compensation from the medical school. MATERIALS AND METHODS: Students' evaluations were compared, with two-way analysis of variance, for faculty who presented lectures in an integrated radiology course and faculty who presented lectures in an independent radiology course from July 1998 to June 2001. Radiology department compensation from the medical school for each course was computed per contact hour. RESULTS: For the integrated course (663 evaluations), the mean overall faculty rating was 1.44 (1 = excellent, 5 = poor), lower (more positive) than the mean overall rating of 1.53 for the independent course (518 evaluations) (P = .037). The interaction between type of instruction and topic was significant only for chest and musculoskeletal imaging, which were rated more positive and less positive in the integrated course, respectively (P < .001). For the integrated course the radiology department received $762 per lecture hour, and for the independent course it received $296 per contact hour (all types) and $1,183 per lecture hour. CONCLUSION: Student ratings of faculty lectures in an integrated course were excellent and comparable to those in an independent radiology course. The medical school differentiated the efforts of radiology faculty in the two courses through its budgeting process, awarding greater compensation per contact hour for participation in the integrated course. If only lecture hours are considered, compensation was greater for the independent course.     

Profile of medical student teaching in radiology: teaching methods, staff participation, and rewards

RATIONALE AND OBJECTIVES: The purpose of this study was to collect demographic information about radiology departments and rewards for teaching activities, as well as the impact of new digital imaging methods on teaching. MATERIALS AND METHODS: Two surveys were conducted of directors of medical school clerkships in radiology. The initial survey focused on numbers of staff and students, courses taught, and perception of rewards for teaching. The follow-up survey more specifically addressed teaching methods. RESULTS: Sixty-nine (50%) of the initial surveys sent to 139 departments and 46 (39% of a total of 119) of the follow-up surveys were returned. Clerkship directors spent an average of 9 hours per week teaching and performing administrative tasks, with most given no additional time off. Eighty-four percent of departments provide either no or insignificant rewards for teaching. Many departments have integrated the use of computers in teaching, and most have computers that students use during the radiology course. At the same time, digital imaging and picture archiving and communication systems (PACS) are used, or will be used within 1 year, in most departments. CONCLUSION: Clerkship directors receive little compensation in terms of time and rewards for medical student teaching. Teaching methods are evolving in response to the increasing use of computers, digital imaging, and PACS for at least part of the workload in most radiology departments.     

Distributed Web-supported radiology clerkship for the required clinical clerkship year of medical school: development,implementation, and evaluation

RATIONALE AND OBJECTIVES: The authors performed this study to develop, implement, and evaluate a new radiology clerkship for the required clinical clerkship year of medical school. MATERIALS AND METHODS: A mandatory radiology clerkship experience was added to the required clinical clerkships as a series of 10 independent half-day teaching sessions. These sessions were distributed as one session per existing clerkship throughout the year. To provide continuity and organization, Web-based curriculum materials were designed and implemented as a component of the radiology clerkship. The new clerkship was evaluated with observations, pretest and posttest measures with a control group, structured and unstructured student and faculty surveys, and individual and small group interviews. RESULTS: The clerkship was successfully developed and implemented. Ninety-five students have completed the clerkship. Their mean posttest score (84.8) was significantly higher than their mean pretest score (58.8, P < .001) and the mean control group score (59.7, P < .001). Students rarely used the Web site. Disadvantages of the distributed clerkship were identified. CONCLUSION: A radiology clerkship distributed among existing clerkships is feasible but has many disadvantages. Students greatly prefer live instruction, and Web-based educational materials are more valuable to faculty and administrators than to students.     

Dedicated core clerkship in radiology for medical students development, implementation, evaluation, and comparison with distributed clerkship

RATIONALE AND OBJECTIVES: The authors performed this study to develop, implement, and evaluate a dedicated core clerkship in radiology for the required clinical clerkship year of medical school, and to compare it with the distributed core clerkship that it replaced. MATERIALS AND METHODS: A dedicated 5-day clerkship was added to the clinical core year of medical school. The course offered a variety of learning experiences, including lectures, clinical observation, case discussions, and a team project. Learner achievement was measured by posttest and compared with a control group. Student satisfaction was determined by structured and unstructured surveys. Faculty comment was elicited by survey, and administrative staff perspective was established through interviews. The evaluation of the dedicated clerkship was compared with the distributed clerkship along the dimensions of learner achievement, student satisfaction, faculty comment, and administrative staff perspective. RESULTS: The dedicated clerkship was developed and implemented successfully. Compared with the distributed clerkship, there was no significant difference in learner achievement or student satisfaction for the dedicated clerkship, but the dedicated clerkship was easier to conduct for faculty and administrative staff. CONCLUSION: The dedicated clerkship was advantageous for faculty and administrative staff, whereas maintaining a comparable level of learner achievement and student satisfaction as the distributed clerkship.     

我院医学生临床技能考核结果分析研究

目的：探索医学生临床技能考核的科学方法。方法：对本院4个年级的985名临床医学专业本科生的临床技能(包括病历书写、问诊、查体、查房和操作)的考试成绩进行分析和比较，查找这些医学生在临床技能方面存在的主要问题，并提出改进意见和建议。结果：在临床技能的考核项目中，体格检查成绩最低；此外还存在问诊抓不住重点，对分管病床病历不够熟悉、操作定位不准确、操作不规范、消毒不符合规定、操作完成后忘记处理敷料等问题。经过心理学教研室的调查，发现考前准备不充分和心理紧张是影响考核效果的重要因素。结论：本文为2000年以来的4个年级的医学生临床技能教学考核结果分析，为今后进一步提高临床教学和实习质量提供依据。     

Radiology as part of an objective structured clinical examination on clinical skills

Introduction

An objective structured clinical examination (OSCE) assessess clinical competence in a standardised and context related manner. Compared with written tests, OSCE's are more susceptible to reliability errors because of the use of multiple cases and multiple examiners. In the pre-clinical phase of the medical curriculum of the University Medical Centre Utrecht, an OSCE is organised as a medical consult. We evaluated the radiology station.

Method

Four questions were formulated:

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What is the internal consistency of the items of the radiology station?

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How do the scores on the radiology station compare with the scores on the test excluding radiology?

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How do different cases differ in scores?

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What are the differences in score between the examiners?

We analysed the OSCE results of second year medical students in 2004.

Results

Two hundred and sixty-five students were examined in the OSCE in 2004. Ninty-three Students were examined in the radiology station. Cronbach's alpha coefficient for the radiology station was 0.92. The average score for the radiology station was 3.8 (0.87). The average score for the test without radiology was 3.9 (0.32). The range of the average scores for the six different cases was 0.5 (3.6-4.1). The range of the average scores for the five examiners was 1.0 (3.3-4.3).

Conclusion

The internal consistency of the items in the radiology station is good. The average score for the radiology station is similar to that of the other stations. The range of the scores between the different cases was relatively small. The range of the scores between the different examiners was clearly larger.     

A study of the role of an objective structured clinical examination (OSCE) in assessing clinical competence in third year student radiographers

Purpose: To consider the logistics of performing an OSCE and to investigate whether an OSCE is an effective tool to measure clinical competence.Method: The staging of the OSCE is reviewed and the marks achieved in the OSCE are considered in comparison to the radiography students' overall (combined academic and clinical) profile of marks, their other clinical marks, their academic marks related to radiographic technique (achieved in clinical diagnostic imaging and evaluating imaging techniques) and the degree classification achieved. The correlation of student marks will be used to discuss the OSCE as an effective tool to measure clinical competence.Results: The OSCE ran as scheduled with no major problems. The marks achieved in the OSCE correlate significantly with all the marks achieved in years 1, 2 and 3, the marks achieved in years 2 and 3 (which give rise to the degree classification) and the marks achieved in the module clinical diagnostic imaging techniques. There was no significant correlation between the OSCE and the marks achieved in the module evaluating imaging techniques.Conclusion: The OSCE is a manageable form of assessment which is of value in assessing clinical competence of student radiographers.     

Integrated medical school ultrasound: development of an ultrasound vertical curriculum

Background

Physician-performed focused ultrasonography is a rapidly growing field with numerous clinical applications. Focused ultrasound is a clinically useful tool with relevant applications across most specialties. Ultrasound technology has outpaced the education, necessitating an early introduction to the technology within the medical education system. There are many challenges to integrating ultrasound into medical education including identifying appropriately trained faculty, access to adequate resources, and appropriate integration into existing medical education curricula. As focused ultrasonography increasingly penetrates academic and community practices, access to ultrasound equipment and trained faculty is improving. However, there has remained the major challenge of determining at which level is integrating ultrasound training within the medical training paradigm most appropriate.

Methods

The Ohio State University College of Medicine has developed a novel vertical curriculum for focused ultrasonography which is concordant with the 4-year medical school curriculum. Given current evidenced-based practices, a curriculum was developed which provides medical students an exposure in focused ultrasonography. The curriculum utilizes focused ultrasonography as a teaching aid for students to gain a more thorough understanding of basic and clinical science within the medical school curriculum. The objectives of the course are to develop student understanding in indications for use, acquisition of images, interpretation of an ultrasound examination, and appropriate decision-making of ultrasound findings.

Results

Preliminary data indicate that a vertical ultrasound curriculum is a feasible and effective means of teaching focused ultrasonography. The foreseeable limitations include faculty skill level and training, initial cost of equipment, and incorporating additional information into an already saturated medical school curriculum.

Conclusions

Focused ultrasonography is an evolving concept in medicine. It has been shown to improve education and patient care. The indications for and implementation of focused ultrasound is rapidly expanding in all levels of medicine. The ideal method for teaching ultrasound has yet to be established. The vertical curriculum in ultrasound at The Ohio State University College of Medicine is a novel evidenced-based training regimen at the medical school level which integrates ultrasound training into medical education and serves as a model for future integrated ultrasound curricula.     

Redefining radiology education for first-year medical students: shifting from a passive to an active case-based approach

RATIONALE AND OBJECTIVES: The aim of the study is to design and implement an elective course in which first-year medical students learn about radiology by actively integrating imaging with hospital records and radiology reports, rather than passively observing radiologists or images. MATERIALS AND METHODS: Twenty students enrolled in an elective entitled "Introduction to Clinical Radiology." Students were divided into groups of two or three and given a case file describing the hospital visit of a patient with a common computed tomographic (CT) diagnosis. Files contained a PowerPoint presentation with all images from the patient's CT examination (allowing students to scroll through the images as if viewed on a picture archive and communication system workstation), as well as emergency department records, admission and discharge summaries, surgical notes, pathology reports, and radiology reports. Group discussion was facilitated by radiology staff acting as consultants, rather than instructors. As a final project, each group presented its case to the students and faculty. RESULTS: Compared with before the course, students' understanding of the role of radiologists in the clinical management of patients significantly increased, but interest in radiology as a specialty was unchanged. Students significantly preferred scrolling through images on their own, rather than being shown static images in a didactic format. Students significantly agreed that they would recommend the course to a classmate. CONCLUSION: Case-based instruction in radiology, in which first-year medical students are actively engaged in the integration of clinical and imaging information, can affect students' views on the role of radiologists and their clinical management of patients.     

The utilisation of radiology for the teaching of anatomy in Canadian medical schools

Objective

To determine the utilisation of diagnostic imaging (radiology) as a department and/or imaging medium in the teaching of anatomy at the Canadian undergraduate medical education level.

Methods

The study objectives were achieved through the use of a questionnaire and a literature review. The anatomy department head at each English-based Canadian Medical School was contacted, and the individual most responsible for anatomy teaching in the medical school curriculum was identified. This individual was subsequently asked to complete a questionnaire that evaluated the involvement of radiology for anatomy teaching in their curriculum.

Results

The use and integration of radiology is a common practice in the teaching of anatomy in Canadian undergraduate medicine. Although the methods and extent of its use varied among institutions, every English-based Canadian medical school, except one, was using diagnostic imaging material in their instruction of anatomy. Furthermore, half of the institutions had a radiologist as a faculty member of their anatomy department to help teach and to use imaging to its full potential.

Discussion

This audit of anatomy departments suggests that diagnostic imaging has an important role to play in anatomy teaching in Canadian English-speaking medical schools.     

深化医学教学改革,加强介入放射学后备力量培养——医学生调查引起的反思

近年来介入放射学在疾病诊疗中的应用得到了广泛普及和认可,然而介入放射学科却面临着患者流失、人员缺乏等诸多挑战。本文着重从医学院校介入放射学教学现状和学生对本学科的认识上剖析其原因,以探求缓解供求矛盾的方法。     

Undergraduate radiology education in the era of dynamism in medical curriculum: An educational perspective

Radiology undergraduate curriculum has undergone a tremendous transformation in the decades reflecting a change in the structure, content and delivery of instruction. These changes are not unique to the discipline, but rather a response in the cycle of the re-engineering process in the medical curriculum in order to ensure its proper role into the ever-changing context. Radiology education is now more integrated across the curriculum than ever. The diversity of how radiology is being taught within the medical undergraduate curriculum is extensive and promising with the expanding role of the radiologist in the spectrum within the medical curriculum. A strong interface between the medical student and the clinicians must always be integrated in the learning process in order to convey the essential and practical use of the different aspects of radiology essential to the student's career as a future clinician. With the recent advancement in educational and technological innovations, radiology education is mobilized in the most pioneering ways, stimulating a rekindled interest in the field of medical imaging. This paper describes the increasing interest in current role of undergraduate radiology education in the context of constant medical curriculum innovations and in the digital age.     

Evaluation of clinical experience in a radiology residency program with quantitative profiling: rationale,methods, and application

RATIONALE AND OBJECTIVES: The author developed a technique for residency program evaluation, called "quantitative profiling," that is based on computer retrieval of radiologic reports. The hypothesis was that it would provide insights into the contributions of residents to clinical service, measures of resident experience and productivity for program evaluation, and benchmarks for comparison. MATERIALS AND METHODS: The radiology residency program of a major teaching hospital was studied retrospectively from 1989 to 1997. The number of radiologic reports signed by individual residents and faculty members was retrieved. The clinical experience of the 1993-1997 cohort of residents was described according to subspecialty area and modality. RESULTS: Residents signed 46.5% of all reports, with a mean total of 14,445 reports +/- 1,292 per resident during the entire residency. The distribution of examinations was as follows: thoracic, 42.1%; musculoskeletal, 26.1%; abdominal, 13.4%; sonography, 8.7%; neuroradiology, 4.3%; nuclear, 2.4%; breast, 1.6%; and vascular, 1.4%. The most frequently reported results were for one-view chest radiography. CONCLUSION: Quantitative profiling can help track the range and progress of resident experience, help determine the deployment of residents, and provide empirical data upon which decisions to modify residency programs may be based.     

临床医学生实践能力培养的研究

临床医学是一门实践性极强的应用学科。培养医学生临床实践能力，是适应素质教育，培养新世纪高素质医学专门人才的关键所在。为此，必须多途径、多方式地采取具体手段来加以实现。本文拟结合我院临床教学和管理实践，对培养五年制医学生临床实践能力的意义、内涵、途径和方法等方面加以探析。     

Predicting radiology resident errors in diagnosis of cervical spine fractures

RATIONALE AND OBJECTIVES: Our objective was to identify factors associated with resident errors of cervical spine fractures to enable targeted education. MATERIALS AND METHODS: We performed a retrospective cohort study of consecutive cases of after-hours resident interpreted cervical spine fractures over 27 months at a single level 1 academic trauma center. The outcome measure was appropriate identification of all fractures by the resident. Potential predictors of resident error or discrepancy were identified from chart review and included: age, gender; fracture location/pattern (upper/lower cervical spine, occipital condyle, C1 ring, dens, C2 pars, vertebral body, posterior column, lateral mass, transverse process); consecutive and nonconsecutive additional fractures; radiologist distracting factors (number of noncervical spine injuries); number of noncervical spine studies performed. Risk ratios with confidence intervals were calculated for categorical variables using epidemiological 2 x 2 tables, and for continuous variables using difference of means. RESULTS: There were 59 errors among 492 cervical spine fractures in a total of 327 patients. Fifty-seven of the errors were on computed tomography and 2 errors were on radiographs. Upper cervical fractures were significantly more likely to have been errors than lower cervical fractures: risk ratio (RR) of 2.2 (confidence intervals (CI) 1.3, 3.5; P = .001). Occipital condyle fractures were more likely to have been discrepant: RR = 2.2 (CI 1.3, 3.9; P = .006). Dens fractures were also significantly more likely to have been discrepant: RR = 2.0 (CI 1.0, 3.8; P = .05). Other potential predictors were not associated with significantly increased risk. CONCLUSION: Upper cervical spine fractures, in particular occipital condyle and dens fractures were significantly associated with an increased relative risk of resident missing or misinterpreting the fracture. These findings suggest that resident education should focus in particular on upper cervical spine injuries, occipital condyle, and dens fractures. The methods used in this study could also be applied to other imaging modalities and anatomic regions in the future to target resident education to more challenging areas.