Undergraduate radiology teaching from the student's perspective

Clinical-year Students' Competency in Chest X-ray Interpretation: A Theoretical-based Intervention

Background

Chest radiography is important in detecting chest abnormalities, an essential skill for medical students during their transition into clinical years. Although critical, limited research has evaluated students' competencies in chest X-ray interpretation, a recognized area of weakness.

Objectives

This study aims to (1) assess medical students' competencies and confidence in chest X-ray interpretation, (2) measure the effectiveness of an educational intervention, and (3) determine the influence of clinical history on students' decision-making.

Materials and Methods

This experimental pre- and post-design study included clinical-year students from College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, and was conducted between November 2022 and April 2023. It was executed in three phases: pre-intervention assessment, an intervention involving a lecture based on Thomas and Kern's six-step approach, and a post-intervention assessment.

Results

The study comprised 77 students. Mean self-reported knowledge and confidence scores were 3.08 ± 0.6 and 2.78 ± 0.7, respectively. There was a significant difference in the mean scores for the pre-test without clinical history (6.29 ± 2.38) compared with the pre-test with clinical history scores (8.58 ± 2.65) (P < 0.001). Post-intervention scores were also significant (9.40 ± 2.91) compared to both pre-tests without and with clinical history (P < 0.001 and 0.034, respectively). Students exhibited high accuracy in diagnosing pneumoperitoneum with and without clinical history (88% and 97%, respectively). Confidence scores were elevated when clinical history was provided and the students had access to their patients' histories.

Conclusions

A lecture-based intervention built on Thomas and Kern's approach markedly enhanced students' capacities to interpret chest X-rays. Integrating clinical history proved beneficial, underscoring the necessity for comprehensive teaching methodologies in medical education.

Measuring the effectiveness of a radiology-based lecture series on both confidence and career prospects of UK-based undergraduate medical students: a survey-based quantitative study

AIMS

Studies investigating Radiology Teaching within the undergraduate population suggest that medical students do not feel adequately trained in radiological scan interpretation. This study aims to address this shortfall by designing and evaluating a longitudinal teaching series based upon the nationally recognised RCR Curriculum. By doing this, a framework can be provided for other centres to reproduce and develop their own teaching programme.

MATERIALS AND METHODS

Participants were pre-clinical and clinical medical students across the United Kingdom. The course consisted of 2 sessions per anatomical system across 6 systems, one covering anatomy and the other pathology. These were Thorax, Abdomen, Musculoskeletal (MSK), Central Nervous System (CNS), Paediatric and Trauma Radiology. Surveys were filled before and after each session with questions on level of training, confidence in interpreting radiological scans out of 10 and outlook on Radiology as a career.

RESULTS

Analysis of 59 pre-lecture and 60 post-lecture feedback forms showed an overall increase in confidence in scan interpretation, from 4/10 points (3-5) which increased to 7/10 points (6-8) (p<0.001). In those who filled both forms, the increase was 51%, from 4.3 ± 1 points to 6.5 ± 1.3 points (p=0.04).

CONCLUSION

The results show a promising increase in participants' subjective confidence in interpretation, which can help medical students post-graduation. With most participants reporting their exposure to radiology in medical school being inadequate, this course can serve as a base for formal teaching which educational institutions can refine upon.

Diagnostic radiography clinical resources in a workplace-based learning setting

INTRODUCTION

Workplace-based learning (WBL) is a method that combines theoretical knowledge with practical experience, promoting learner autonomy. Diagnostic radiography students in South Africa face challenges due to inconsistencies in clinical resources from the public and private sectors. Insufficient clinical resources can negatively impact students' competence and confidence in their skills. This study explored diagnostic radiography students' understanding of clinical resources.

METHODS

A qualitative exploratory-descriptive and contextual study with 21 participants at a single Higher Education institution (HEI) in South Africa was conducted through one-on-one semi-structured interviews on Microsoft Teams. The data collection tool was an interview guide. Students' narratives were transcribed and analysed using thematic analysis.

RESULTS

Thematic analysis revealed four themes: Theme one: Defining clinical resources in WBL; Theme two: Experiences with clinical resources in WBL; Theme three: Accessibility of clinical resources in WBL and Theme four: Defining clinical resources in WBL.

CONCLUSION

Clinical resources are essential for radiography learning, promoting skills development and independent work. Balancing these resources with other activities is crucial for a comprehensive WBL experience. However, unequal access can hinder learning. Alternative solutions should be explored for specialised imaging techniques. Integrating simulation and collaborative practice between clinical practices and HEIs can enhance students' preparedness for real-world scenarios.

Medical Image sharing: What do the public see when reviewing radiographs? A pilot study

INTRODUCTION

Policymakers wish to extend access to medical records, including medical imaging. Appreciating how patients might review radiographs could be key to establishing future training needs for healthcare professionals and how image sharing could be integrated into practice.

METHOD

A pilot study in the UK using a survey was distributed to adult participants via the online research platform Prolific. All subjects were without prior professional healthcare experience. Participants reviewed ten radiographs (single projection only) and were asked a two-stage question. Firstly, if the radiograph was 'normal' or 'abnormal' and secondly, if they had answered 'abnormal', to identify the abnormality from a pre-determined list featuring generic terms for pathologies.

RESULTS

Fifty participants completed the survey. A mean of 65.8 % of participants were able to correctly identify if radiographs were normal or abnormal. Results in relation to the identification of a pathology were not as positive, but still notable with a mean of 46.4 % correctly identifying abnormalities. Qualitative data demonstrated that members of the public are enthralled with reviewing radiographs and intrigued to understand their performance in identifying abnormalities.

CONCLUSION

In the pilot, members of the public could identify if a radiograph is normal or abnormal to a reasonable standard. Further detailed interpretation of images requires supportive intervention. This pilot study suggests that patients can participate in image sharing as part of their care. Image sharing may be beneficial to the therapeutic relationship, aiding patient understanding and enhancing consultations between healthcare professional and patient. Further research is indicated.

How much do Latin American medical students know about radiology? Latin-American multicenter cross-sectional study

BACKGROUND

Radiology is a useful tool for diagnosis and intervention in medical practice, and all the components within the teaching-learning process of this subject during undergraduate studies influence successful knowledge application.

OBJECTIVE

This study aimed to describe the level of knowledge in radiology of students in the last two years of medical school and curricular characteristics of their courses in seven Latin American countries.

METHODS

A multicenter cross-sectional study was carried out on medical students of 7 Latin American countries (Bolivia, Brazil, Colombia, Ecuador, Mexico, Paraguay, and Peru) in their final two years of medical school, using an online questionnaire validated by experts and adapted for each country that assessed knowledge and curricular characteristics in radiology subject. Scores were assigned according to the number of correct answers for the knowledge test. The T-test, and regression analysis with one-way ANOVA were used to search for relationships between the level of knowledge and other variables.

RESULTS

A total of 1514 medical students participated in this study. All countries had similar participation (n > 200); most participants were women 57.8%. The country with the highest knowledge score was Brazil. Male, sixth year (internship) and from public universities students had higher knowledge score (n < 0.05). Participants, who considered radiology more important, and who reported higher compliance with teaching staff with the proposed syllabus, and programmed classes, obtained better scores (n < 0.05).

CONCLUSIONS

Latin American medical students included in this study have a regular overall level of knowledge of Radiology, apparently influenced by curricular differences such as class and academic program compliance. Efforts to better understand and improve academic training are indispensable.

LIMITATIONS

The study was subject to selection bias determined by non-probability convenience sampling. The questionnaire assessed only theoretical knowledge and the evaluation system was designed by the investigators.

The Effects of Various Teaching Methods on Chest X-ray Interpretation Skills Among Medical Students and Interns: A Systematic Review

Chest X-ray (CXR) is a common tool used in medical practice. Medical students and interns should acquire knowledge of CXR interpretation, as it is an essential diagnostic tool for a large spectrum of diseases. This systematic review aimed to compare the effect of different intervention techniques on the competency of medical students and interns to demonstrate the level of confidence and competence in interpreting common presentations of CXRs. The population, intervention, comparison, and outcomes (PICO) framework was used to formulate the review question. All related articles in five databases (PubMed, Web of Science, Scopus, Medline, and Embase) were retrieved and the search was completed in March 2023 with no limiters on date and time. The number of relevant studies was 469. A multi-level approach through the Rayyan platform was used for the screening and exclusion processes. Eleven articles were included in the systematic review consisting of eight randomized controlled trials, one quasi-experimental study, one cross-sectional study, and one interventional cohort. Results showed significant effects of teaching methods utilizing deductive or inductive approach, clinical history, patient care comfort survey, and SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled). Contrarily, no significant effect was shown by flipped classroom models and mixed and blocked practice, peer-assisted learning vs. expert-assisted learning, and Chester, an artificial intelligence tool. This review identified beneficial approaches that may enhance the learning outcomes of interpreting CXRs for medical students and interns, highlighting the remarkable impact of SAFMEDS on medical students' ability to identify CXR findings as well as the availability and practicality of online and e-learning resources for students.

Diagnostic radiology training for medical students - a Brazilian multicenter survey

OBJECTIVE

This study aimed to assess diagnostic radiology training and exposure during medical school, from the perspective of medical students in Brazil.

METHODS

In this multicenter study approved by the Institutional Review Board, medical students from multiple universities in Brazil filled out an online questionnaire regarding their perception about diagnostic radiology training during medical school, including knowledge and use of the American College of Radiology Appropriateness Criteria and their confidence level in interpreting common radiological findings. Medical students from different regions of Brazil were sent invitations to participate in the anonymous survey through radiology group emails initiated by radiology professors and a group of ambassadors representing different institutions. Informed consent was obtained electronically at the beginning of the survey.

RESULTS

The survey demonstrated diagnostic radiology is frequently included in preclinical exams; however, radiology training during medical school was considered inadequate from the medical students´ perspective. Overall, radiological imaging teaching was provided by radiologists for more than half of the survey respondents; however, radiological imaging is frequently shown to students by non-radiologist physicians during case discussion rounds. Moreover, few respondents had a mandatory radiology training rotation during medical school.

CONCLUSION

This Brazilian medical student survey demonstrated that from the medical students' perspective, diagnostic radiology is an important subject in clinical practice; however, their radiology training and exposure are overall heterogeneous.

Seeing Radiology Curricula Through Turkish Medical Students' Eyes: A Survey of Turkish Medical Schools' Radiology Education

INTRODUCTION

Radiology education is essential for nonradiologist specialists and practitioners as well as for radiologists. We conducted a survey to gather the opinions of Turkish medical students from first to sixth grade regarding their radiology curricula, radiology education content, and perceptions of various imaging modalities and to assess the amount, adequacy, and homogeneity of radiology education in various schools.

METHODS

Turkish medical students were reached by student ambassadors from 10 different schools of medicine via social media and email. They were provided with a 20-question survey-via the SurveyMonkey platform-related to their radiology curriculum and their perceptions of the radiology education at their schools and of different imaging modalities. Subjective parameters were scaled by a 4-point Likert scale and the results are reported by percentages of students.

RESULTS

A total of 988 medical students (F/M: 61%/39%) from 41 different medical schools participated in this survey. Of those, 57% were preclinical students (≤ third year of medical school), while 43% were clinical students (> third year). More than half of the students (51%) stated that the amount of radiology education included in their curriculum was too little, while 44% of them stated it was just right and only 5% stated it was too much. Only 31% of the participants stated that they were able to review radiology images on their own. When asked about their level of confidence in identifying the position of lines and tubes, pneumonia, pneumothorax, and pleural effusion on chest radiographs, 41%, 39%, 41%, and 41% of the participants, respectively, stated that they were not confident. Thirty-five percent of the participants had not received any training in comparing normal to abnormal imaging of bone fractures, pneumonia, pleural effusion, subdural hemorrhage, or pneumothorax. The majority of the Turkish medical students in this survey had never heard (57%) nor used (64%) the American College of Radiology Appropriateness Criteria.

CONCLUSIONS

The radiology curriculum in Turkey differs among various schools and most students stated that preclinical radiology course content was inadequate. Further studies and improvements must be conducted to provide high-quality, equitable radiology education that begins during preclinical training with respect to the students' opinions.

Teaching radiology in Egyptian medical schools: Where do we stand and how can we start?

Background

Radiology serves in the diagnosis and management of many diseases. Despite its rising importance and use, radiology is not a core component of a lot of medical school curricula. This survey aims to clarify current gaps in the radiological education in Egyptian medical schools. In February–May 2021, 5318 students enrolled in Egyptian medical schools were recruited and given a 20-multiple-choice-question survey assessing their radiology knowledge, radiograph interpretation, and encountered imaging experiences. We measured the objective parameters as a percentage. We conducted descriptive analysis and used Likert scales where values were represented as numerical values. Percentages were graphed afterwards.

Results

A total of 5318 medical students in Egypt answered our survey. Gender distribution was 45% males and 54% females. The results represented all 7 class years of medical school (six academic years and a final training year). In assessing students’ knowledge of radiology, most students (75%) reported that they received ‘too little’ education, while 20% stated the amount was ‘just right’ and only 4% reported it was ‘too much.’ Sixty-two percent of students stated they were taught radiology through medical imaging lectures. Participants’ future career plans were almost equally distributed. Near half of participants (43%) have not heard about the American College of Radiology Appropriateness Criteria (ACR-AR), while 39% have heard about it but are not familiar with.

Conclusions

Radiology is a novel underestimated field. Therefore, medical students need more imaging exposure. To accomplish this, attention and efforts should be directed toward undergraduate radiology education to dissolve the gap between radiology and other specialties during clinical practice. A survey answered by medical students can bridge between presence of any current defect in undergraduate radiology teaching and future solutions for this topic.

Expanding our concept of simulation in radiology: a "Radiology Requesting" session for undergraduate medical students

Objectives

Whilst radiology is central to the modern practice of medicine, graduating doctors often feel unprepared for radiology in practice. Traditional radiological education focuses on image interpretation. Key areas which are undertaught include communication skills relating to the radiology department. We sought to design teaching to fill this important gap.

Methods

We developed a small group session using in situ simulation to enable final and penultimate year medical students to develop radiology-related communication and reasoning skills. Students were given realistic cases, and then challenged to gather further information and decide on appropriate radiology before having the opportunity to call a consultant radiologist on a hospital phone and simulate requesting the appropriate imaging with high fidelity. We evaluated the impact of the teaching through before-and-after Likert scales asking students about their confidence with various aspects of requesting imaging, and qualitatively through open-ended short answer questionnaires.

Results

The session was delivered to 99 students over 24 sessions. Self-reported confidence in discussing imaging increased from an average of 1.7/5 to 3.4/5 as a result of the teaching (p < 0.001) and students perceived that they had developed key skills in identifying and communicating relevant information.

Conclusions

The success of this innovative session suggests that it could form a key part of future undergraduate radiology education, and that the method could be applied in other areas to broaden the application of simulation.

Advances in knowledge

This study highlights a gap in undergraduate medical education. It describes and demonstrates the effectiveness of an intervention to fill this gap.

A call to action; national survey of teaching radiology curriculum to medical students

Objectives:

Radiology and medical imaging are important yet often an underrepresented facet of medical education. Notably, there is concern among radiologists that students do not receive enough radiology exposure and that they struggle to interpret image findings on entering residency. Therefore, this survey aims to identify how medical students perceive the radiology curriculum and to determine gaps in delivery.

Material and Methods:

Students were recruited from United States (US) medical schools and given a 21-question survey assessing their perception of the radiology curriculum as well as asking about their confidence levels regarding medical imaging. The inclusion criteria were age >18 and enrolled in US medical school. The surveys were completed in April–July 2020 by students across the US. Objective parameters were measured as percentage correct, while subjective parameters used a 4-point Likert scale.

Results:

A total of 472 medical students across 31 medical schools completed the surveys with a response rate of 69%. Responses represented all class years within medical schools and showed equal distribution among the future career plans. Students responded that didactic lectures were the most common teaching method and that radiologists were their primary teachers during preclinical education. Students were unfamiliar with the American College of Radiology appropriateness criteria with 65% responding they had never heard of it and 33% reporting that they have heard of it but never used it. In assessing students’ perceptions of radiology education, 72% of students responded that they received too little, and 28% of students responded, “Just right.” <1% of students responded that there was “Too much” radiology in their curriculum.

Conclusion:

Radiologists are increasing their educational representation in medical school curricula. Despite this, radiology continues to be under-represented with students desiring more exposure to medical imaging. Integrating the student’s perceptions with existing curricula suggests that efforts should focus on increasing awareness of which studies are appropriate and teaching students how to systematically interpret an image.

[Evaluation of a structured e-learning-based approach to CT anatomy of the paranasal sinuses for medical students : A pilot study]

BACKGROUND

Computed tomography (CT) anatomy is not an integral part of undergraduate medical training in many countries. Radiology seems to be well suited for new online-based teaching methods.

OBJECTIVE

The aim of this study was to evaluate whether e‑learning is appropriate for introducing complex learning contents such as sinus CT anatomy to novices and to assess whether identification of relevant anatomical variants in sinus CT scans by medical students can be improved with a sinus CT checklist.

MATERIALS AND METHODS

Medical students were asked to assess sinus CT scans for anatomical variants before and after implementation of the CLOSE mnemonic (cribriform plate, lamina papyracea, Onodi cell, sphenoid sinus pneumatization, and [anterior] ethmoidal artery). Sinus CT anatomy and the CLOSE mnemonic were introduced by e‑learning. The rate of correctly identified variants and the results of the individual CLOSE items were recorded. A questionnaire was distributed for subjective evaluation of the usefulness of the checklist and e‑learning.

RESULTS

Ten students took part in this pilot study. The rate of correctly identified variants improved significantly, from 33.3 to 61.1%. The analysis of the individual CLOSE items showed a significant improvement for C, S, and E. The subjective evaluation of the CLOSE mnemonic and e‑learning was very positive.

CONCLUSION

E‑learning was able to transfer complex learning contents in previously non-trained medical students and was evaluated as an appropriate introduction to the topics. Structured assessment of paranasal sinus CT scans using the CLOSE criteria can significantly improve the recognition of anatomical variants.

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.

Multimodal Three-Dimensional Visualization Enhances Novice Learner Interpretation of Basic Cross-Sectional Anatomy

While integrated delivery of anatomy and radiology can support undergraduate anatomical education, the interpretation of complex three-dimensional spatial relationships in cross-sectional and radiological images is likely to be demanding for novices. Due to the value of technology-enhanced and multimodal strategies, it was hypothesized that simultaneous digital and physical learning could enhance student understanding of cross-sectional anatomy. A novel learning approach introduced at a United Kingdom university medical school combined visualization table-based thoracic cross-sections and digital models with a three-dimensional printed heart. A mixed-method experimental and survey approach investigated student perceptions of challenging anatomical areas and compared the multimodal intervention to a two-dimensional cross-section control. Analysis of seven-point Likert-type responses of new medical students (n = 319) found that clinical imaging (mean 5.64 SD ± 1.20) was significantly more challenging (P < 0.001) than surface anatomy (4.19 ± 1.31) and gross anatomy (4.92 ± 1.22). Pre-post testing of students who used the intervention during their first anatomy class at medical school (n = 229), identified significant increases (P < 0.001) in thoracic cross-sectional anatomy interpretation performance (mean 31.4% ± 15.3) when compared to the subsequent abdominal control activity (24.1% ± 17.6). Student test scores were independent of mental-rotation ability. As depicted on a seven-point Likert-type scale, the intervention may have contributed to students considering cross-sectional interpretation of thoracic images (4.2 ± 1.23) as significantly less challenging (P < 0.001) than comparable abdominal images (5.59 ± 1.14). These findings could have implications for how multimodal cross-sectional anatomy learning approaches are implemented within medical curricula.

White Paper: Radiology Curriculum for Undergraduate Medical Education in Germany and Integration into the NKLM 2.0

OBJECTIVE

 The aim was to develop a new curriculum for radiology in medical studies, to reach a national consensus and to integrate it into the new national competence-based learning objectives catalog (NKLM 2.0). In this statement of the German Radiological Society (DRG), the process of curriculum development is described and the new curriculum is presented together with suggestions for practical implementation.

MATERIALS AND METHODS

 The DRG has developed a new curriculum for radiology. This was coordinated nationally among faculty via an online survey and the result was incorporated into the NKLM 2.0. Furthermore, possibilities for the practical implementation of the competency-based content are shown and different teaching concepts are presented.

RESULTS

 The developed curriculum is competency-based and aims to provide students with important skills and abilities for their future medical practice. The general part of the curriculum is divided into the topics "Radiation Protection", "Radiological Methods" and radiologically-relevant "Digital Skills". Furthermore, there is a special part on the individual organ systems and the specific diseases. In order to implement this in a resource-saving way, new innovative teaching concepts are needed that combine the advantages of face-to-face teaching in small groups for practical and case-based learning with digital teaching offers for resource-saving teaching of theoretical content.

CONCLUSION

 We have created a uniform radiology curriculum for medical studies in Germany, coordinated it nationally and integrated it into the NKLM 2.0. The curriculum forms the basis of a uniform mandatory radiology teaching and should be the basis for the individual curriculum development of each faculty and strengthen the position of radiology in the interdisciplinary context.

KEY POINTS

  · A radiology curriculum for undergraduate medical education was developed.. · The curriculum was brought into agreement among the faculties in Germany and integrated into the NKLM 2.0.. · This curriculum is intended to be the basis for curriculum development and to strengthen the position of radiology.. · In order to implement the competence-based teaching, new innovative teaching concepts are necessary..

CITATION FORMAT

· Dettmer S, Barkhausen J, Volmer E et al. White Paper: Radiology Curriculum for Undergraduate Medical Education in Germany and Integration into the NKLM 2.0. Fortschr Röntgenstr 2021; 193: 1294 - 1303.

Bridging the divide between medical school and clinical practice: identification of six key learning outcomes for an undergraduate preparatory course in radiology

BACKGROUND

There exists a significant divide between what is learnt in medical school and subsequently what is required to practice medicine effectively. Despite multiple strategies to remedy this discordance, the problem persists. Here, we describe the identification of a comprehensive set of learning outcomes for a preparation for practice course in radiology.

METHODS

Assessment of interns' readiness to interact with the radiology department was conducted using a national survey of both interns and radiologists. In parallel, group concept mapping (GCM) which involves a combination of qualitative and quantitative techniques was used to identify the shared understanding of participants from a diverse range of medical specialties regarding what topics should be included in an intern preparatory course for interacting with the radiology department.

RESULTS

The survey demonstrated that most interns and radiologists felt that undergraduate medical training did not prepare interns to interact with the radiology department. GCM identified six learning outcomes that should be targeted when designing a preparatory module: requesting investigations; clinical decision support; radiology department IT and communication; adverse reactions and risks; interpretation of radiology results and urgent imaging. The thematic clusters from the group concept mapping corroborated the deficiencies identified in the national survey.

CONCLUSION

We have identified six key learning outcomes that should be included in a preparation for practice module in radiology. Future courses targeting these thematic clusters may facilitate a smoother transition from theory to practice for newly graduated doctors.

Teaching Medical Students How to Interpret Chest X-Rays: The Design and Development of an e-Learning Resource

INTRODUCTION

The teaching of radiology to medical students has often been criticised for being inadequate and unstructured, with students reporting lack of confidence in assessing x-rays. In this paper, we describe how an e-learning resource, on how to interpret a chest x-ray for medical students, was designed and developed. The aim of the resource was to provide medical students with knowledge of how to interpret a chest x-ray in a systematic approach.

METHODS

The technology used to design the e-learning resource was Xerte Online Toolkits. The design and development of the e-learning resource was based upon andragogical principles and followed Overbaugh's guidelines and Mayer's 12 multimedia principles. An instructional design model called ADDIE was used to help develop the resource and its content. These included cases of common conditions, a quiz and summary table at the end. The paper focuses mainly on the way in which instructional design, education and multimedia principles were used to inform the development of the resource.

FINDINGS

A preliminary evaluation was completed by 18 medical students from year 3-5 who completed the e-learning resource. The feedback was positive with an average rating of 9/10 and 100% of students saying they would recommend the resource to a colleague. Students commented that they liked the resource as it was easy to navigate, had good visual learning and contained good explanations with relevant content.

CONCLUSION AND FUTURE IMPLICATIONS

This paper demonstrates how, with the use of instructional models, educational theories and principles, an e-learning resource can be created. Preliminary evaluation showed that students were satisfied with the resource and felt it helped them acquire knowledge on how to interpret chest x-rays. This resource can be further utilized either as a standalone resource or before starting clinical placements and may prove particularly useful in the current and challenging learning environment where there is an increased need for digital resources.

Evaluating the integration of pre-mortem body donor imaging into a dissection-based medical anatomy course

BACKGROUND

Medical faculties are currently embracing a modernistic approach to anatomical education that integrates diagnostic imaging largely through post-mortem computed tomography scanning of body donors. Post-mortem imaging, however, poses a multitude of challenges. The purpose of this study was to assess the implementation of pre-mortem donor-specific diagnostic imaging on student learning and dissection experience in addition to understanding the potential impact on students' preparation for clinical practice.

METHODS

Students in a fourth-year medicine elective course were divided into groups; group 1 received pre-mortem donor-specific diagnostic imaging, while group 2 received pathology-specific diagnostic imaging, a collection of images relating to the type(s) of pathologies the donors exhibited, though not specific to the donors themselves. Both groups also received a donor-specific case vignette. A convergent, parallel mixed methods design was employed. This included integrating data from group responses to a study participant survey and students' academic assessment scores analyzed quantitatively through statistical analyses with data from focus group sessions investigating the psychosocial aspects of the student dissection experience and perceptions of the imaging use in the course analyzed qualitatively.

RESULTS

As compared to students receiving pathology-specific diagnostic imaging, the quantitative results demonstrated that students receiving pre-mortem donor-specific diagnostic imaging more positively supported the relevancy of diagnostic imaging to their understanding of anatomy, valued the integration for future practice, and suggested an earlier integration within their medical curriculum. Qualitatively, two main themes were observed: the influence of diagnostic imaging integration on dissection experience and on professional mindset. Although both student groups received imaging corresponding to their body donor, consideration towards the humanistic nature of the body donor as a patient with a history was limited to student feedback from the donor- specific diagnostic imaging group.

CONCLUSION

Overall the integration of pre-mortem donor-specific diagnostic imaging into anatomical dissection provided students with practical skill development, an enhanced dissection experience, and reinforced personal qualities critical for future practice.

Effectiveness of blended learning in radiological anatomy for first year undergraduate medical students

PURPOSE

The aim of the study was to assess the effectiveness of blended learning modules for radiological anatomy among first-year medical students by estimating knowledge gain and evaluating student perceptions.

METHODS

A single-group, pre- and post-test study design was utilized. Five radiological anatomy modules consisting of online presentations and self-assessment quizzes were developed for the upper limb, lower limb, head and neck, thorax, and abdomen and pelvis. The content of the modules was uploaded on to a learning management system called TYRO. Each module focused on the normal anatomical features observed on plain and contrast radiographs. Other relevant imaging modalities and clinical contexts were also introduced. During the classroom session, the students were instructed to peruse the modules and answer the self-assessment quiz. The teacher in the classroom acted as a facilitator and was available to the students for any clarifications. A pre- and post-test was administered to the students before and after exposure to the modules, respectively. A paired t test was used to estimate differences in the pre- and post-test scores. Students' perceptions were assessed using a questionnaire.

RESULTS

One-hundred students attended both the tests. The mean and standard deviation of pre- and post-test scores were 17 ± 5.5 and 26 ± 7.6, respectively, and this difference was significant. Students' perceptions about the intervention were on the whole positive.

CONCLUSION

A significant improvement in the knowledge of radiological anatomy was noted after exposure to five blended learning modules of radiological anatomy. The modules were well received by the students.

Effectiveness of the clinical decision support tool ESR eGUIDE for teaching medical students the appropriate selection of imaging tests: randomized cross-over evaluation

OBJECTIVES

To evaluate ESR eGUIDE-the European Society of Radiology (ESR) e-Learning tool for appropriate use of diagnostic imaging modalities-for learning purposes in different clinical scenarios.

METHODS

This anonymized evaluation was performed after approval of ESR Education on Demand leadership. Forty clinical scenarios were developed in which at least one imaging modality was clinically most appropriate, and the scenarios were divided into sets 1 and 2. These sets were provided to medical students randomly assigned to group A or B to select the most appropriate imaging test for each scenario. Statistical comparisons were made within and across groups.

RESULTS

Overall, 40 medical students participated, and 31 medical students (78%) answered both sets. The number of correctly chosen imaging methods per set in these 31 paired samples was significantly higher when answered with versus without use of ESR eGUIDE (13.7 ± 2.6 questions vs. 12.1 ± 3.2, p = 0.012). Among the students in group A, who first answered set 1 without ESR eGUIDE (11.1 ± 3.2), there was significant improvement when set 2 was answered with ESR eGUIDE (14.3 ± 2.5, p = 0.013). The number of correct answers in group B did not drop when set 2 was answered without ESR eGUIDE (12.4 ± 2.6) after having answered set 1 first with ESR eGUIDE (13.0 ± 2.7, p = 0.66).

CONCLUSION

The clinical decision support tool ESR eGUIDE is suitable for training medical students in choosing the best radiological imaging modality in typical scenarios, and its use in teaching radiology can thus be recommended.

KEY POINTS

• ESR eGUIDE improved the number of appropriately selected imaging modalities among medical students. • This improvement was also seen in the group of students which first selected imaging tests without ESR eGUIDE. • In the student group which used ESR eGUIDE first, appropriate selection remained stable even without the teaching tool.

Interdimensional Travel: Visualisation of 3D-2D Transitions in Anatomy Learning

Clinical image interpretation is one of the most challenging activities for students when they first arrive at medical school. Interpretation of clinical images concerns the identification of three-dimensional anatomical features in two-dimensional cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) images in axial, sagittal and coronal planes, and the recognition of structures in ultrasound and plain radiographs. We propose that a cognitive transition occurs when initially attempting to interpret clinical images, which requires reconciling known 3D structures with previously unknown 2D visual information. Additionally, we propose that this 3D-2D transition is required when integrating an understanding of superficial 2D surface landmarks with an appreciation of underlying 3D anatomical structures during clinical examinations.Based on educational theory and research findings, we recommend that 3D and 2D approaches should be simultaneously combined within radiological and surface anatomy education. With a view to this, we have developed and utilised digital and art-based methods to support the 3D-2D transition. We outline our observations and evaluations, and describe our practical implementation of these approaches within medical curricula to serve as a guide for anatomy educators. Furthermore, we define the theoretical underpinnings and evidence supporting the integration of 3D-2D approaches and the value of our specific activities for enhancing the clinical image interpretation and surface anatomy learning of medical students.

European Society of Radiology (ESR). ESR statement on new approaches to undergraduate teaching in Radiology

Medical education is evolving and electronic learning (e-Learning) strategies have now become an essential asset in radiology education. Radiology education is a significant part of the undergraduate medical curriculum and the use of e-Learning in radiology teaching in medical schools is on the rise. If coupled with clinical decision support systems, e-Learning can be a practical way of teaching students clinical decision making, such as selecting the diagnostic imaging tests that are best suited in certain clinical scenarios.The innovative concept of flipped classroom learning encourages students to work independently and maximises the application of learnt contents in interactive classroom sessions.For integrated curricula with their student-centred, problem-based, and community-based design, an approach to systematically integrate radiology may be to define diagnostic reasoning as one of the core goals. Radiologists as teachers and scholars may understand themselves as experts in diagnostic reasoning and in mentoring how to make medical decisions.Computer programs simulating the routine work are available and can be used to teach the recognition of anatomical structures and pathological patterns, and also to teach ultrasonography and interventional radiology, maximising patient safety.

The Integration of Active Learning Teaching Strategies Into a Radiology Rotation for Medical Students Improves Radiological Interpretation Skills and Attitudes Toward Radiology

PURPOSE

In recent years, there has been increased recognition of the benefits of teaching by active learning. However, there is a paucity of experimental studies utilizing active learning in undergraduate radiology rotations, which is traditionally a passive learning experience. We designed a new radiology rotation that integrated teaching by active learning. We prospectively examined the efficacy of this new rotation compared to our standard rotation in terms of students' radiological competency and attitudes toward radiology, as well as impact on departmental efficiency.

METHODS

This was a prospective cohort study involving fourth year medical students completing a 1-week radiology rotation at our department between January and April 2018. One cohort completed a rotational model which incorporated active learning sessions (integrated cohort) while the remainder were taught using traditional passive learning methods (standard cohort). All participants completed a radiology examination before and after the rotation and were surveyed on their attitudes toward radiology.

RESULTS

A total of 105 students enrolled in the study. The mean postrotation competency score obtained by the integrated cohort was significantly higher than that obtained by the standard cohort (82% vs 62%; P < 0.001). The integrated rotation freed up 7 hours of radiologists' time per week. While the students completing the integrated rotation had a more positive perception of radiology, they were no more likely to express a desire to pursue a career in radiology.

CONCLUSIONS

The integration of active learning sessions into an undergraduate radiology rotation results in an improvement in students' postrotation radiological competency and attitudes toward radiology.

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.

Raising the BAR: Challenges, Opportunities, and Hidden Gems in Radiology Education

RATIONALE AND OBJECTIVES

Medical student education in radiology has long been underrepresented in the curriculum despite the increased use of imaging in clinical medicine.

MATERIALS AND METHODS

The Beginning to Advanced Radiology Lab, was created with the dedicated purpose of integrating digital technology and interactive teaching methods into the UME curriculum in radiology.

RESULTS

Results: Development of a novel educational space at the University of Colorado allowed us to identify unforeseen challenges in medical student education while exploring new opportunities CONCLUSIONS: Conclusion: Curriculum revision in UME radiology education creates both challenges and opportunities and this paper explores these issues in the context of the current paradigm change in medical education.

Integrating 3D Visualisation Technologies in Undergraduate Anatomy Education

Anatomy forms the basis of clinical examination, surgery and radiology and it is therefore essential that a fundamental understanding of the key concepts, structures and their relationships is gained by medical and healthcare students during their undergraduate training. Anatomy involves the study of three dimensional entities relating to the human body itself and its constituent structures. In our experience, the appreciation of 3D concepts is one of the most demanding areas for medical student learning of anatomy (ben Awadh et al. 2018, unpublished observations). The ability to interpret 3D anatomical features in 2D cross-sectional clinical images can be troublesome, while the dynamic nature of embryological development is a further challenge.The aim of introducing technology enhanced-learning (TEL) approaches into our practice is with a view to enhancing undergraduate medical student learning of clinically relevant anatomy. Here we will explore the importance of visualisation and visual learning in anatomy as a scholarly basis for the integration for TEL approaches. We will then describe examples of visualisation technologies that are currently being implemented within the School of Medical Education at Newcastle University based on a research informed understanding of how students learn anatomy. We will consider the available evidence that supports best practice, identify limitations where they arise, and discuss how these visual 3D learning technologies can be effectively utilised as adjuncts and self-directed resources to supplement more established approaches to undergraduate anatomy education.

E-learning for chest x-ray interpretation improves medical student skills and confidence levels

BACKGROUND

Radiology is an important aspect of medicine to which medical students often do not receive sufficient exposure. The aim of this project was to determine whether the integration of an innovative e-learning module on chest x-ray interpretation of the heart would enhance the radiological interpretive skills, and improve the confidence, of first year graduate entry medical students.

METHODS

All first-year graduate entry (all students had a prior university degree) medical students at the University of Limerick (n = 152) during academic year 2015-16 were invited to participate in this study. An assessment instrument was developed which consisted of 5 radiological cases to be interpreted over a designated and supervised 15-min time period. Students underwent a pre-, mid- and post-intervention assessment of their radiology interpretative skills. An online e-module was provided following the pre-test and additional practice cases were provided following the mid-intervention test. Assessment scores and confidence levels were compared pre-, mid- and post-intervention.

RESULTS

The overall performance (out of a total score of 25) for the 87 students who completed all three assessments increased from 13.2 (SD 3.36) pre-intervention to 14.3 (SD 2.97) mid-intervention to 15.8 (SD 3.40) post-intervention. This change over time was statistically significant (p < 0.001) with a medium effect size (eta-squared = 0.35). Increases from pre- to post-intervention were observed in each of the five areas assessed, although performance remained poor in diagnosis post-intervention. Of the 118 students who provided feedback after the intervention, 102 (86.4%) stated that they would recommend the resource to a colleague to improve their interpretative skills.

CONCLUSIONS

This study suggests that early exposure to e-learning radiology modules is beneficial in undergraduate medical school curricula. Further studies are encouraged to assess how long the improvement may last before attrition.

Knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students, foundation doctors, specialist radiology registrars and radiographers at a UK university teaching hospital

Objective:

Junior doctors routinely request radiological investigations for patients. Prior studies have noted that among this group there is a lack of knowledge on radiation legislation and radiation exposure in common radiological investigations. However, no studies have compared this against radiology trainees and radiographers. We compared knowledge of radiation legislation and radiation exposure in common radiological investigations among final year medical students (FYMS), foundation year doctors (FY1, FY2) against specialist radiology trainees (SRT) and radiographers (RG).

Methods:

A 12-question multiple choice questionnaire (MCQ) was distributed to FYMS, FY1, FY2, SRT and RG at a UK teaching hospital. Questions assessed knowledge of radiation legislation and radiation-dose estimates of common radiological investigations. Mean MCQ scores were compared using one-way ANOVA and Tukey post-test to determine statistical significance (p-value < 0.05).

Results:

127 participants were included in the study. Mean scores (%) for FYMS (49.3%), FY1 (52.6%) and FY2 (51.1%) were significantly lower compared to SRT (64.4%) and RG (66.3%) (p-value < 0.05). Mean test scores between FYMS, FY1 and FY2 did not significantly differ (p-value > 0.05).

Conclusion:

FYMS, FY1 and FY2 knowledge of radiation legislation and radiation exposure in common radiological investigations was poor compared to SRT and RG. Patients require knowledge of radiation risk to provide informed consent as per IRMER regulations, thus we propose formal teaching on the subject matter to promote radiation safety culture among medical undergraduates and postgraduates.

Advances in knowledge:

First study to compare knowledge of radiation legislation and radiation exposure in common radiological investigations between medical students and junior doctors to radiology trainees and radiographers.

Matching medical student achievement to learning objectives and outcomes: a paradigm shift for an implemented teaching module

INTRODUCTION

Low student achievement in a basic imaging module was the impetus for an assessment of the module.

METHODS

A valid, reliable, and structured Likert scale was designed to measure the degree of student satisfaction with the domains of the module, including learning objectives (LO), teaching strategy and tools (TT), assessment tools (AT), and allotted credit hours (CH). Further analysis was conducted of student dissatisfaction to determine the subdomain in which module improvement was to be implemented. Statistical analysis of data among Likert scale domains was conducted.

RESULTS

Likert scale data showed the TT domain to be the major reason for low student achievement. Statistical studies revealed 57/117 students (48.6%) were dissatisfied with TT, compared with LO 16/117 (13.6%), AT 54/117 (46.1%), and CH 12/117 (10.2%). Significant P-values were obtained for LO vs TT (P<0.0001), LO vs AT (P<0.0001), LO vs CH (P<0.03), TT vs CH (P<0.0001), and AT vs CH (P<0.0001). No significant difference was observed between TT and AT (P<0.29). Regarding TT, 41/117 (34.9%) students were dissatisfied with lectures (L) compared to hospital-based teaching (HPT) 24/117 (20%), problem-based learning (PBL) 8/117 (6.8%), self-directed learning (SDL) 3/117 (2.5%), and seminars (S) 4/117 (3.4%). Significant P-values were obtained for L vs HPT (P<0.0001), L vs PBL (P<0.0001), L vs SDL (P<0.0001), L vs S (P<0.0001), HPT vs PBL (P<0.002), HPT vs SDL (P<0.0001), and HPT vs S (P<0.0001). Regarding lecture modifications, student satisfaction was 78.3% compared to 52% before modification. A significant P-value (P<0.0001) was obtained between Likert scale domains before and after modification. Lecture modification resulted in a good student response and satisfaction.

CONCLUSION

The major reason for low student achievement was the teaching tools, particularly the lectures. Major modifications to lectures improved student achievement. The students and most of the teaching staff were highly satisfied with the modifications, which provided for reciprocal discussion and interaction. These results should encourage and guide other medical schools to investigate the points of weakness in their curriculum.

Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students

"I am not young enough to know everything."Oscar Wilde.

BACKGROUND

There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students' training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics.

MATERIALS AND METHODS

The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance.

RESULTS

A total of 301 students were enrolled in the study. There was 58% (P < .01) and 85% (P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase (P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline (P = .03).

CONCLUSIONS

A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.

A review of peer-assisted learning to deliver interprofessional supplementary image interpretation skills

BACKGROUND

Peer-assisted learning provides a means through which individuals can learn from one another through a reciprocal process. Radiographic image interpretation skills are fundamental to both diagnostic radiography students and medical students due to their shared role in preliminary evaluation of conventional radiographic images. Medical students on graduation, may not be well prepared to carry out image interpretation, since evidence suggests that they perform less well than radiographers in e.g. Accident and Emergency situations.

METHOD

A review of literature was conducted exploring the application of peer-assisted learning within diagnostic radiography and health education more widely as well as the practice of initial image interpretation. An extensive and systematic search strategy was developed which provided a range of material related to the areas.

FINDINGS

An overview was obtained of the effectiveness of peer-assisted learning and the issues associated with development of image interpretation skills and a degree of discrepancy was identified between the two cohorts regarding their interpretative competence and confidence. This inconsistency may create an opportunity to apply peer-assisted learning, better preparing both disciplines for the practical application of image interpretation skills.

CONCLUSION

The review identified the lack of a substantial evidence base relating to peer-assisted learning in radiography. Peer-assisted learning is not widely embraced in an interprofessional context. Multiple positive factors of such an intervention are identified which outweigh perceived negative issues. Student teacher and learner may benefit as should the clinical service from enhanced practitioner performance. The findings justify further research to develop the evidence base.

Teaching Radiology to Medical Students-There Is a Need for Change to Better Prepare Students for Clinical Practice

RATIONALE AND OBJECTIVES

Deriving maximum benefit from radiology rotations in medical schools is challenging. Lack of education on appropriate imaging renders students feeling unprepared. This study compares the ability of undergraduate medical students to identify appropriate radiological investigations, both at the beginning and end of their final year of education, to those of residents in their first year of clinical practice.

MATERIALS AND METHODS

Twelve scenarios were extracted from the American College of Radiology's Appropriateness Criteria (ACR-AC) and a questionnaire was generated. One topic was selected from each of the 10 sections in the diagnostic section and two from the interventional section. The questionnaire was distributed to three groups. Group A was composed of medical students at the beginning of final year. Group B was composed of medical students at the end of final year. Group C was composed of residents at the end of their first year of clinical practice. Radiology residents were surveyed to assess familiarity with the ACR-AC among trainees in Ireland.

RESULTS

The total cohort included 160 participants. Group C (n = 35) performed significantly better than group A (n = 72) and group B (n = 53). There was no statistical difference in the mean scores achieved by group A and group B. Sixteen (73%) of 22 radiology trainees were familiar with the ACR-AC.

CONCLUSIONS

A minimal improvement in the knowledge of medical students in requesting radiological investigations over the course of the final medical year, yet a significant impact of a relatively short period of "on-the-job" learning in the clinical setting, was indicated. Emphasis on education on appropriateness may offer an improvement in the utilization of radiology services and improve patient care.

A combination of traditional learning and e-learning can be more effective on radiological interpretation skills in medical students: a pre- and post-intervention study

BACKGROUND

The ability to interpret an X-Ray is a vital skill for graduating medical students which guides clinicians towards accurate diagnosis and treatment of the patient. However, research has suggested that radiological interpretation skills are less than satisfactory in not only medical students, but also in residents and consultants.

METHODS

This study investigated the effectiveness of e-learning for the development of X-ray interpretation skills in pre-clinical medical students. Competencies in clinical X-Ray interpretation were assessed by comparison of pre- and post-intervention scores and one year follow up assessment, where the e-learning course was the 'intervention'.

RESULTS

Our results demonstrate improved knowledge and skills in X-ray interpretation in students. Assessment of the post training students showed significantly higher scores than the scores of control group of students undertaking the same assessment at the same time.

CONCLUSIONS

The development of the Internet and advances in multimedia technologies has paved the way for computer-assisted education. As more rural clinical schools are established the electronic delivery of radiology teaching through websites will become a necessity. The use of e-learning to deliver radiology tuition to medical students represents an exciting alternative and is an effective method of developing competency in radiological interpretation for medical students.