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.     

The State of Radiologic Teaching Practice in Preclinical Medical Education: Survey of American Medical,Osteopathic, and Podiatric Schools

PurposeThis study describes the state of preclinical radiology curricula in North American allopathic, osteopathic, and podiatric medical schools.MethodsAn online survey of teaching methods, radiology topics, and future plans was developed. The Associations of American Medical Colleges, Colleges of Osteopathic Medicine, and Colleges of Podiatric Medicine listing for all US, Canadian, and Puerto Rican schools was used for contact information for directors of anatomy and/or radiology courses. Letters were sent via e-mail to 198 schools, with a link to the anonymous survey.ResultsOf 198 schools, 98 completed the survey (48%). Radiology curricula were integrated with other topics (91%), and taught by anatomists (42%) and radiologists (43%). The majority of time was spent on the topic of anatomy correlation (35%). Time spent teaching general radiology topics in the curriculum, such as physics (3%), modality differences (6%), radiation safety (2%), and contrast use (2%) was limited. Most schools had plans to implement an innovative teaching method in the near future (62%). The major challenges included limits on: time in the curriculum (73%); resources (32%); and radiology faculty participation (30%). A total of 82% reported that their curriculum did not model the suggestions made by the Alliance of Medical Student Educators in Radiology.ConclusionsThis survey describes the current state of preclinical radiology teaching: curricula were nonstandard, integrated into other courses, and predominantly used for anatomy correlation. Other important contextual principles of the practice of radiology were seldom taught.     

Implementation of a new undergraduate radiology curriculum: experience at the University of British Columbia.

OBJECTIVES: The purpose of this study was to review and revise the undergraduate radiology curriculum at the University of British Columbia to improve radiology education to medical students and to meet the needs of a medical program with province-wide distribution. METHODS: We identified the radiology content of the curriculum from the Curriculum Management and Information Tool online database, from personal interviews with curriculum heads, and from published information. Undergraduates' and recent graduates' opinions were solicited by means of surveys. Information on radiology curricula at medical schools across Canada was gathered from email surveys and personal contacts with members of the Canadian Heads of Academic Radiology (CHAR). RESULTS: Review of our curriculum indicated that lack of a unified syllabus resulted in redundant content, gaps in knowledge, and lack of continuity in the curriculum. Results from the survey of programs across Canada indicated that most schools also lacked a formal radiology curriculum for medical students. By adapting the guidelines from the Association of Medical Student Education in Radiology, we revised our undergraduate radiology curriculum to emphasize integration and self-learning. The modified curriculum includes a combination of instructional technology, focused lectures in preclinical years, and in-context seminars in clerkship rotations. CONCLUSION: Most medical schools in Canada do not have a formal radiology curriculum for medical students. A structured curriculum is required to improve the quality of radiology teaching for medical students.     

Limitations of student evaluations of curriculum

RATIONALE AND OBJECTIVES: Medical student surveys are used extensively in the development and modification of curriculum. The purpose of this study was to look at medical student surveys of a radiology lecture series, evaluating the accuracy of student perceptions of learning and factors affecting them. MATERIALS AND METHODS: After a "Case of the Week" lecture series, 156 3rd-year medical students returned a survey evaluating the experience with 10 questions on a four-point scale (1 = disagree, 4 = agree very much) and took a clinical competency assessment (CCA) examination with a radiology substation. Survey responses were compared with actual examination performance, analyzed for how overall learning was characterized in specific educational objectives, and evaluated for factors affecting perceived learning. RESULTS: The mean response for perceived CCA examination preparedness was 1.83. The mean radiology station test score was 90.43%. Correlations between student perception of learning and the scoring of focused learning objectives ranged from 0.33 to 0.48 (P < .01). Students responding 1 to items assessing perceived lecture organization, stimulation to read, and interest in the field of radiology had mean scores for perception of overall learning of 2.09-2.44 and mean scores for recommendation of course continuation of 1.68-2.46. Students responding 4 had means of 3.25-3.81 and 3.06-4.0, respectively. CONCLUSION: Student perceptions of the value of curriculum were inaccurate compared with external measures of performance, and students poorly related their general impressions to specific learning objectives. Perceived lecture organization, stimulation to read, and interest in radiology as a specialty affected perceived overall learning and perceived value of the lecture series.     

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.     

Emergency radiology services at medical schools in the United States.

RATIONALE AND OBJECTIVES. Little has been published on the delivery of emergency radiologic services in academic radiology training programs. METHODS. The author surveyed 127 medical schools in the United States concerning aspects of radiology services for their emergency rooms, including who interprets images, what training in emergency radiology is provided, and problems with film retrieval. RESULTS AND CONCLUSIONS. Emergency department radiographs most often are initially interpreted by a radiology resident and subsequently reviewed by a faculty radiologist who does not have a major interest in or time commitment to emergency radiology. Most schools describe problems such as disappearance of emergency department films and a paucity of provided clinical information. Only one third of schools provide formal instruction in emergency radiology for their radiology residents.     

Medical Student Performance After a Vertically Integrated Radiology Clerkship

PurposeProper selection of imaging examinations and basic image interpretation skills are essential for all physicians, yet only approximately 25% of US medical schools require clerkships in radiology. Although there is limited time in most medical school curricula to allow the addition of a required radiology clerkship, the authors developed one that is vertically integrated over a two-year period. This clerkship includes one week of contact with radiologists distributed over the M2 and M3 years, podcasts, online modules, required readings, and presentations. A standard national examination is administered at the end of the clerkship period. This clerkship was designed to address the educational needs of students while occupying minimal time in the curriculum. The purpose of this study was to determine if students completing this clerkship perform as well on a national radiology examination as students from other medical schools, regardless of their curricula.MethodsAt the end of the M3 year, these students take a computer-based radiology examination developed by the Alliance of Medical Student Educators in Radiology and used by students at multiple medical schools nationally. The mean and median scores of these students were compared with those of students at these other institutions.ResultsThe mean and median scores of the students were 74% and 74% (standard deviation, 7.5%) compared with 74% and 50% (standard deviation, 8.4%) at other institutions.ConclusionsStudents completing this vertically integrated radiology clerkship had test scores comparable with those of students at other medical schools.     

Medical education research: challenges and opportunities

Medical education research is not as well understood or established as is basic science or clinical research. The reasons for this are many, but most importantly, there is insufficient funding for medical education research and a dearth of skilled and experienced medical education researchers. There is no nationally centralized force to build and sustain a medical education research enterprise. Yet faculty and training programs are held accountable for the quality of patient care rendered by those that they train. New regulatory requirements at all levels of physician training demand assurance that physicians are competent to practice in the current health care environment and provide optimal patient care. Documenting the relationship between education and patient outcomes represents one of the biggest challenges and greatest opportunities in medical education research. There is no research infrastructure in place to support such outcomes studies. The majority of medical education research that is currently being done is supported by volunteer faculty time and resources. This is not a viable model to sustain a medical education research mission. Compared with medicine in general, these challenges are multiplied in radiology, where there are relatively fewer extramural research dollars available and skilled investigators to carry out radiology education research. Building a critical mass of radiology education researchers through education fellowship programs specific to radiology and mobilizing the existing radiology education researchers into one group with a shared vision are opportunities for elevating the status of radiology education research.     

Diagnostic imaging in undergraduate medical education: an expanding role

Radiologists have been involved in anatomy instruction for medical students for decades. However, recent technical advances in radiology, such as multiplanar imaging, "virtual endoscopy", functional and molecular imaging, and spectroscopy, offer new ways in which to use imaging for teaching basic sciences to medical students. The broad dissemination of picture archiving and communications systems is making such images readily available to medical schools, providing new opportunities for the incorporation of diagnostic imaging into the undergraduate medical curriculum. Current reforms in the medical curriculum and the establishment of new medical schools in the UK further underline the prospects for an expanding role for imaging in medical education. This article reviews the methods by which diagnostic imaging can be used to support the learning of anatomy and other basic sciences.     

Student and faculty perceptions of interactive learning in the radiology clerkship.

RATIONALE AND OBJECTIVES. The objective of this research is to develop and evaluate medical students' perceptions of interactive learning techniques for teaching the role of radiology in medical diagnosis to senior medical students. METHODS. Students in a 4-week radiology clerkship were given specific learning objectives and tasks that enabled them to be actively involved in radiology. Students rotated through six specialty areas in small groups. Some areas used the interactive format, whereas others used the traditional observation method. In the interactive format, clinical faculty involved student groups in examining patients, checking histories, making clinical/radiologic correlations, and discussing cases. RESULTS. Students consistently rated the interactive rotations higher (4.6 on a 5-point scale) than the observer format (3.3). The faculty and residents found the interactive format to be manageable and conducive to learning. CONCLUSION. Involving students in appropriate decision making and problem solving has proven to be a preferred way to teach radiology to medical students.     

Problem-based learning and radiology

The Royal College of Radiologists recently published documents setting out guidelines to improve the teaching of radiology to medical students. These included recommendations that clinicians who teach radiology should be aware of newer educational techniques, such as problem-based learning, and should be involved in the development of curricula and assessment in medical schools. This review aims to introduce the educational theories behind problem-based learning and describe how a problem-based learning tutorial is run. The relevance of problem-based learning to radiology and the potential advantages and disadvantages are discussed.     

Trends in Gender and Racial Profiles of US Academic Radiology Faculty

ObjectiveTo evaluate gender and racial profiles of US academic radiology faculty.Materials and MethodsThis is a retrospective analysis of the American Association of Medical College database of radiology faculty members from 2006 to 2017 by academic rank, chair position, race or ethnicity, and gender. The data were described with annual proportions and average annual counts and fit to a Poisson regression model. Comparison data were taken from American Association of Medical College on matriculants at US medical schools and from ACGME on radiology residents.ResultsWomen increased significantly in the ranks of professor by 4.5%, associate professor by 4.8%, and assistant professor by 4.8% (P < .05). Asian and multiple race non-Hispanic radiologists increased in the rank of professor by 5.9% and 3.1%, respectively (P < .05). Among department chairs, only women and Asian faculty increased by 6.4% and 7.5%, respectively (P < .05). The proportion of women chairs increased from 10.0% (19 of 191) in 2006 to 17.4% (39 of 224) in 2017. Black and Hispanic chairs collectively represented less than 10% of the total chairs every year.DiscussionThe significant percent annual increase in women faculty in academic ranks and chair positions suggests that the radiology faculty is becoming more diverse. However, the decreasing proportion of women with increasing academic ranks within each year of the study period suggests attrition or lack of promotion of women radiology faculty. The disparity in black and Hispanic faculty members and chairs suggests that emphasis should continue to be placed on tailored recruitment.     

The senior radiology clerkship. Disparate goals of students and faculty

A survey of medical students taking our radiology elective over the past five years revealed that 51% were chiefly interested in learning "to read x-rays." Other motivations for taking the elective, such as learning "radiographic workups" were relatively low-priority goals. On the other hand, a survey of our staff revealed a low priority placed on teaching medical students to interpret radiographic images and a high value placed on imparting an understanding of the role of radiology in clinical diagnosis and management. This disparity between the goals of the students and teachers delineates one of the major challenges in designing a radiology curriculum for medical schools.     

Medical student radiology training: what are the objectives for contemporary medical practice?

RATIONALE AND OBJECTIVES: The authors attempt to provide a set of objectives for medical student training in radiology for contemporary medical practice. MATERIALS AND METHODS: A questionnaire containing a list of educational objectives was sent to 32 radiologists in charge of medical student training in radiology at accredited residency programs in Australia and New Zealand. The importance of including each preselected objective in the curriculum was measured by respondents' agreement or disagreement on a scale of 1-6. Opportunity also was given to respondents to suggest objectives other than those presented on the questionnaire. RESULTS: Twenty of the 32 questionnaires were returned, and a set of educational objectives was established based on the responses. The objectives were ranked in importance according to the mean score assigned to each objective by the respondents. CONCLUSION: This new set of educational objectives for medical student radiology training reflects recent changes in radiologic and medical practice and points to potential future developments.     

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.     

Europäisches Curriculum für die Weiterbildung in der Radiologie

The European training curriculum for radiology of the European Society of Radiology (ESR) aims to harmonize training in radiology in Europe. Levels I and II constitute the centerpiece of the curriculum. The ESR recommends a 5-year training period in radiology with 3 years of level I and 2 years of level II training. The undergraduate (U) level curriculum is conceived as a basis for teaching radiology in medical schools and consists of a modality-oriented U1 level and an organ-based U2 level. Level III curricula provide contents for subspecialty and fellowship training after board certification in radiology. The curricular contents of all parts of the European Training Curriculum are divided into the sections knowledge, skills as well as competences and attitudes. The European training curriculum is meant to be a recommendation and a basis for the development of national curricula, but is not meant to replace existing national regulations.     

Curriculum for musculoskeletal radiology.

Although general suggestions have been made regarding a radiology residency curriculum, no specific list of entities has been offered. Over the past ten years, we have developed a resident-run morning conference in musculoskeletal radiology that is supervised by faculty and covers a specific curriculum. We offer our curriculum as an example that may assist other departments in developing their own curricula.     

Survey on medical information education for radiologic technologists working at hospitals

Recently, the importance of medical information for radiologic technologists has increased. The purpose of this questionnaire survey was to clarify the method of acquiring skill in medical information for radiologic technologists from the point of view of the managers of radiology departments. The questionnaire was sent to 260 hospitals that had introduced picture archiving and communication systems (PACSs) for the person responsible for medical information in the radiology department. The response rate was 35.4% (92 hospitals). The results of this survey clarified that few hospital have staff for medical information in the radiology department. Nevertheless, the excellent staff who have the skills to troubleshoot and develop systems are earnestly needed in radiology departments. To solve this problem, many technologists should understand the content, work load, and necessity of medical information. In addition, cooperation between radiologic technologist schools and hospitals is important in the field of medical information education.     

Radiology curriculum topics for medical students: students' perspectives

RATIONALE AND OBJECTIVE: We sought to establish medical students' perspectives of a set of curriculum topics for radiology teaching. MATERIALS AND METHODS: A multicenter study was conducted in New Zealand. A modified Delphi method was adopted. Students enrolled in two New Zealand Universities received a questionnaire. Each learning topic was graded on a scale of 1 (very strongly disagree) to 6 (very strongly agree). Students could also put forward and grade suggestions that were not on the questionnaire. RESULTS: Of 200 questionnaires, 107 were returned. Fifty male and 57 female students participated, with an average age of 23.7 years. The five highest ranking curriculum topics in order of importance were developing a system for viewing chest radiographs (5.77, SD 0.7), developing a system for viewing abdominal radiographs (5.66, SD 0.8), developing a system for viewing bone and joint radiographs (5.56, SD 0.8), distinguishing normal structures from abnormal in chest and abdominal radiographs (5.38, SD 0.9), and identifying gross bone or joint abnormalities in skeletal radiographs (5.29, SD 0.9). CONCLUSION: Medical students want to know how to look at radiographs, how to distinguish normal from abnormal, and how to identify gross abnormalities.     

The State of Medical Student Teaching of Interventional Radiology: Implications for the Future

IntroductionThe formation of integrated interventional radiology (IR) residency programs has changed the training paradigm. This change mandates the need to provide adequate exposure to allow students to explore IR as a career option and to allow programs to sufficiently evaluate students. This study aims to highlight the availability of medical student education in IR and proposes a basic framework for clinical rotations.Materials and MethodsThe Liaison Committee on Medical Education (LCME) website was utilized to generate a list of accredited medical schools in the United States. School websites and course listings were searched for availability of IR and diagnostic radiology rotations. The curricula of several well-established IR rotations were examined to identify and categorize course content.ResultsIn all, 140 LCME-accredited medical schools had course information available. Of those schools, 70.5% offered an IR rotation; 84.6% were only available to senior medical students and only 2% were offered for preclinical students; and 8.1% of courses were listed as subinternships. Well-established IR clerkships included a variety of clinical settings, including preprocedure evaluation, experience performing procedures, postprocedure management, and discharge planning.ConclusionMedical student exposure to IR is crucial to the success of integrated IR residency programs. Current research shows few institutions with formal IR subinternship rotations. Although 70.5% of institutions have some form of nonstandardized IR course, 84.6% are available only to fourth-year students, and 2% are offered to preclinical students. This suggests there is a significant opportunity for additional formal exposure to IR through increasing availability of IR rotations and exposure during the clinical and preclinical years.