Undergraduate radiology teaching in a UK medical school: a systematic evaluation of current practice

Radiology image interpretation services in a low-resource setting: Medical doctors' experiences and the potential role of radiographers

INTRODUCTION

Medical doctors can encounter significant challenges in both the radiology image interpretation service and their ability to interpret images to promote effective patient management. This study aimed to explore the experiences of medical doctors in a low-resource setting regarding the image interpretation service received in state-funded hospitals and the potential role of radiographers.

METHODS

A qualitative approach with a descriptive phenomenology design was employed. Thirteen medical officers and medical interns, with a maximum of three years of experience, were purposively selected from three state-funded hospitals. Semi-structured interviews were conducted in English, and data analysis followed the conventional content analysis method using Atlas.ti for Windows (version 9).

RESULTS

Three main themes emerged from the data. The first theme was a poor image interpretation service which highlighted issues such as long turnaround times for image reporting and compromised patient management. The second theme was training and support deficiency which revealed the inadequacy of image interpretation training and the need for additional on-the-job support. The third theme was the inconspicuous radiographer role which showcased the potential opportunities for radiographers to aid in filling the gaps in the image interpretation system.

CONCLUSION

Medical doctors in this low-resource setting experience significant delays in radiology image interpretation, leading to compromised patient management. Their training in image interpretation is inadequate, and they often lack on-the-job support. Radiographers potentially play a role in image interpretation which may provide solutions to these contextual challenges.

IMPLICATIONS FOR PRACTICE

There is a need to review and develop a comprehensive image interpretation system that effectively supports medical doctors in image interpretation, possibly involving the collaboration of radiographers.

One-week radiology boot camp for pre-clerkship medical students: A novel format improving image interpretation and confidence

RATIONALE AND OBJECTIVES

To measure change in radiology knowledge, confidence in radiology skills, and perceptions pertaining to radiology following a one-week boot camp elective for undergraduate medical students.

MATERIALS AND METHODS

A five-day comprehensive radiology boot camp was developed including sessions on image interpretation, procedural skills, and appropriate image ordering. A multiple-choice quiz was administered before and after the elective, utilizing radiology questions from the validated AMSER STARS database. Additionally, a pre- and post-elective survey was administered assessing radiology career interest, confidence in radiology-based skills, and the potential ability of radiology-based skills to increase confidence in specialties other than radiology. Responses from the assessments were analysed using paired t-tests.

RESULTS

15 students enrolled in the course and 14 completed all assessments. The average score on the quiz increased from 50.1% to 66.0% (p<0.001). On the post-elective survey, the average student confidence score increased by more than one point on a six-point Likert scale in each of radiographic interpretation (p=0.004), ultrasound interpretation (p=0.0002), CT/MRI interpretation (p=0.02), general radiology knowledge including procedural skills (p=0.0001), and appropriate image ordering (p=0.004). Average student satisfaction with the elective was 8.1 out of 10.

CONCLUSION

A one-week radiology boot camp for pre-clerkship medical students improved radiology knowledge and confidence in radiology skills, showing potential for this format to meet the demand for increased radiology content in undergraduate training. Students indicated that confidence in radiology knowledge would increase confidence on non-radiology clerkship rotations, highlighting the importance of how a one-week radiology bootcamp can impact both future radiology and non-radiology clerkship experiences.

Radiology for anatomy educators: Success of an online, 2-day course for radiology training

Incorporation of radiology training into anatomy education from community college to health professional schools is becoming increasingly popular. However, anatomy educators generally lack training in common radiology modalities, including X-ray, CT, MRI, and ultrasound. Professional development or continuing education courses provide current and new educators the chance to gain new skills within a short timeframe. Here, a 2-day, online course for anatomy educators was created. The goals of which were for the participants: to gain basic knowledge of different radiology modalities, recognize normal radiographic images, and apply that information to common diseases or injuries in interactive case studies. Each day focused on different modalities, where Day 1 studied X-ray, CT, and MRI; and Day 2 studied Ultrasound. A 10-question pre- and post-test was taken by attendees for each day of instruction on a voluntary basis. Following the completion of the course, attendees were provided a survey to determine their perceptions on course content and knowledge acquired. Most attendees instructed undergraduates at 4-year universities, though several attendees came from community colleges and high schools. All attendees showed a significant improvement in knowledge from their pre- to post-test scores in X-ray, CT, MRI, and ultrasound following training. This was also reflected in their survey responses, where attendees felt the course was effective in increasing their knowledge and confidence in radiology. Overall, this study demonstrates the effectiveness of online continuing education courses and the need for more introductory radiology courses for anatomy educators.

The Use of Ultrasound in Undergraduate Medical Anatomy Education: a Systematic Review with Narrative Synthesis

This systematic review aimed to synthesize the literature on how ultrasound is currently used in anatomy education within medical schools. A systematic search of Ovid MEDLINE, Scopus, and Educational Resources Information Centre was conducted. Thirty-four relevant unique articles were included from the 1,272 identified from the databases and analyzed via narrative synthesis. Thematic analysis generated two domain summaries: "Successful Aspects of Ultrasound Teaching" and "Barriers to Implementation," each with additional subthemes, aimed to help educators inform best teaching practices from the current evidence base in this field.

Attracting the next generation of radiologists: a statement by the European Society of Radiology (ESR)

With demand increasing each year for diagnostic imaging and imaging guided interventions, it is important for the radiology workforce to expand in line with need. National and international societies such as the European Society of Radiology have an important role to play in showcasing the diversity of radiology, and highlighting the key role radiologists have in patient care and clinical decision-making to attract the next generation of radiologists. Medical students are an important group to engage with early. Meaningful exposure of undergraduates to radiology with an integrated programme and clinical placements in radiology is essential. Elective courses and dedicated 1-year Bachelor or Masters imaging programmes provide medical students with an opportunity for more in-depth study of radiology practice. Undergraduate radiology societies improve opportunities for engagement and mentorship. Innovations in imaging such as augmented-reality simulation and artificial intelligence and image-guided intervention also offer exciting training opportunities. Through these opportunities, students can gain insight into the wide variety of career opportunities in radiology.

Practice-Based Learning Using Smart Class: A Competency-Based Model in Undergraduate Radiology Education

RATIONALE AND OBJECTIVES

A need for adequate and early exposure to radiology practice is rising in undergraduate students, taking competency development as the orientation. We aimed to develop a competency-based model of practice-based learning for undergraduate radiology education.

MATERIALS AND METHODS

The model of practice-based learning was constructed upon an e-learning smart class environment, with case-based learning and simulators for competency development. To assess the model effectiveness, a randomized controlled experiment was performed, where 57 third-year medical students received the model (Smart-Class group) and another 57 received traditional teaching (Traditional group). Seven quizzes, a final exam, and a survey were performed in both groups.

RESULTS

Smart-Class group achieved higher mean score in the quizzes (r = -0.4, p < 0.001) and application subscore in the final exam (r = -0.3, p = 0.005) compared to Traditional group. Smart-Class group also gave higher ratings in students' perceptions concerning promotion of learning interests, radiology skills, and diagnostic reasoning (r = -0.2 to -0.3, p = 0.001-0.034).

CONCLUSION

Practice-based learning using smart class improved students' application ability and satisfactions in undergraduate radiology education, suggesting it a practical model for early exposure to radiology practice and competency development for undergraduate medical students.

Twelve tips for interpreting abdominal CT scans

BACKGROUND

Abdominal computerised tomography (CT) scans are a crucial tool in the diagnosis and management of the acute abdomen. Currently, medical students are not widely and extensively trained in the interpretation of abdominal scans.

AIM

We aim to provide advice about interpreting abdominal CT scans.

METHODS

We used the critical reflection of our experiences, both in clinical practice and in teaching, alongside advice from the literature to develop these tips.

RESULTS

Twelve tips following the '4As, 3Bs, 2Cs and 1D' approach are presented to assist doctors and medical students with interpreting abdominal CT scans.

CONCLUSION

The early identification of pathology on CT scans has been demonstrated to improve patient outcomes in certain cases, while a formal radiologist's report is awaited. Following a systematic approach, such as the one we presented here, may aid trainees in looking at abdominal CT scans.

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.

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.

Feasibility of a paediatric radiology escape room for undergraduate education

OBJECTIVES

To develop a paediatric radiology themed escape room session for undergraduate education and secondly, to determine participant satisfaction and improvement in knowledge.

METHODS

A paediatric radiology escape room with accompanying tutorial was developed around key learning objectives set within the RCR and ESR undergraduate curriculum. Students were recruited from two different universities and undertook the escape room themed teaching. An 8-question single best answer (SBA) test was completed before, immediately after and at 2 weeks post-teaching to determine participant improvement and retention of knowledge. The general feedback was also collected.

RESULTS

The escape room sessions were held three times, for 19 students (6-7 students per session). All groups completed the escape room in ≤ 20 min. Students enjoyed the experience, assigning an average satisfaction score of 9.4/10 (range 7-10). The majority (17/19, 89.5%) preferred this method of teaching to a lecture-based tutorial alone, although all said they found the tutorial component useful. For the SBA test, there was an average increase in 3.6 marks (range 1-6 marks) per participant between before and after the escape room. This improved knowledge was mostly sustained after 2 weeks, with an average increase of 3.4 marks difference (range 1 to 6) per participant compared to before the teaching.

CONCLUSIONS

A paediatric radiology themed escape room is a feasible teaching method, enjoyed by participants and associated with an increase in radiological knowledge. Further work with larger sample size and direct comparison with other traditional teaching methods is required.

Predoctoral Curricular Revision for Dental Radiographic Interpretation Competence Based on OSCE Results

Teaching radiographic interpretation skills to predoctoral dental students is challenging. The results of an objective structured clinical examination (OSCE) at one U.S. dental school failed to yield expected outcomes for students' radiographic interpretation skills. The purpose of this article is to describe the development of the radiology OSCE and subsequent curricular revisions based on the outcomes. Examples of curricular changes are a series of self-assessed radiographic interpretation cases using the university learning management system. Each case contains a set of four intraoral radiographs and a series of questions. In year 4, an OSCE and final radiographic interpretation competency exam are administered; students are required to pass both exams. OSCE outcomes over a period of six years were used to evaluate the effectiveness of the curricular revisions. A questionnaire developed to capture student perceptions of the curricular changes was administered. The pilot OSCE of 2.9% first attempt pass rates initiated curricular revision. The strongest results to date occurred in 2018 with a 73.3% first attempt pass rate. Results from the questionnaire showed that students reported greater confidence in their interpretation skills when it came to recognizing radiographic errors, dental caries, and periodontal disease/pathologies (65%, 64%, and 57%, respectively). The use of the OSCE for programmatic assessment revealed the need for curricular revision in radiology. Students' participation in the newly revised radiology curriculum resulted in improved student performance and outcomes. This article emphasizes the importance of global and programmatic assessment for assessing student competence along with analysis of how assessment and accompanying data can inform curricular decisions.

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.

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.