Medical students who choose a radiology elective: career decisions, motivations, and intentions

Resident Physicians' Perceptions of Diagnostic Radiology and the Declining Interest in the Specialty

RATIONALE AND OBJECTIVES

The relative competitiveness of radiology and the number of first-choice applicants to diagnostic radiology have steadily declined over the past decade. The purpose of this study was to identify factors contributing to the declining interest in diagnostic radiology as a career and to explore factors affecting specialty choice.

MATERIALS AND METHODS

A retrospective survey was distributed to resident physicians at a single academic center between July and August 2017. Participants identified factors affecting career choice and evaluated level of agreement with statements regarding radiology using 5-point Likert scales. Higher scores indicated stronger agreement.

RESULTS

One hundred and fifty-two resident physicians from Canada participated (21.5% response rate): 20 radiology and 132 nonradiology. Of the total, 27% were registered in postgraduate year (PGY) 1, 23% in PGY 2, 15% in PGY 3, 19% in PGY 4, and 16% in PGY 5, or above. Sixty-one percent of the respondents self-reported as female, 34% as male, and 5% as other/unknown. Of those in radiology, 40% self-reported as female, 55% as male, and 5% as other/unknown, compared to 64% female, 31% male, and 5% other/unknown in other specialties. Regardless of specialty, positive clinical/mentoring experiences strongly affected career choice. Radiology residents were attracted to diverse pathology (M = 4.5) and positive staff/resident interactions (M = 4.4). Nonradiology residents were deterred by lack of patient contact (M = 3.9) and dark work environment (M = 3.6). Resident physicians who had applied to radiology were more likely to report positive mentorship during medical school, disagree that technology will replace radiologists, and desire a higher income specialty (Wald = 56.6, p < 0.001). More recent graduates showed a higher level of concern regarding the potential negative impact of technology and outsourcing on the profession (F (3, 189) = 2.6, p = 0.05). Several trainees (21%) considered radiology, but lacked mentorship (52%) and identified job market concerns (29%).

CONCLUSION

More recent graduates are relatively more concerned about technology replacing radiologists, and radiology applicants have less concern about artificial intelligence replacing radiologists. As positive interactions with radiologists and mentorship are key influencers, our results advocate for early training exposure and reinforcement regarding the positive outlook of the profession.

Patient-Centered and Specialty-Specific Case Work-Up: An Effective Method for Teaching Appropriateness of Imaging to Medical Students

RATIONALE AND OBJECTIVES

Our institution has developed a mini-course program within the diagnostic radiology elective curriculum that promotes active learning, using patient cases specifically tailored to students' future specialties. The purpose of this study is to evaluate the effectiveness of this mini-course on medical student knowledge of imaging appropriateness and attitude toward radiologist consultation.

MATERIALS AND METHODS

During each month-long radiology elective course, students were divided into teams of up to four students based on their specialty interest and assigned recent patient cases with imaging findings relevant to their specialties. The students researched their customized patient cases, integrated pertinent clinical and imaging findings, and presented their findings in a final preceptor-led session. A five-point Likert-type item preprogram and postprogram survey assessing knowledge of imaging appropriateness and attitude toward radiologist consultation was sent to the enrolled medical students.

RESULTS

Out of 36 medical students, 33 (92%) completed the preprogram survey and 31 (86%) completed the postprogram survey. Students reported improved confidence in knowledge of imaging appropriateness, such as indications for intravenous contrast (p < 0.0005) and oral contrast (p < 0.0005). Furthermore, students reported an improved understanding of how to utilize radiologists (p < 0.005) and how to provide pertinent clinical historical information when requesting a radiology exam (p < 0.0005). Students reported that researching the patient's historical and clinical information in conjunction with the radiology images made them more invested in the case.

CONCLUSION

Assigning customized patient cases to medical students on diagnostic radiology elective, tailored to their future specialties, is an effective and active way to teach imaging appropriateness and to improve attitudes toward radiologist consultation.

Value of case-based learning in a nuclear medicine clerkship

PURPOSE

Medical imaging, including nuclear medicine, is a powerful tool for supporting learning in human morphology and physiology and understanding the nature of disease and response to treatment. The purposes of this study were to create a new case-based learning (CBL) model and to compare CBL and the traditional instructional approach (TIA) in a nuclear medicine clerkship.

METHODS

Internal consistency and expert validity were assessed for the instrument. A quasi-experimental, two-group pretest-posttest design was used for this study. A combination of CBL and the TIA was applied to the experimental group and the TIA only to the control group. Subjects were 70 undergraduate year 5 medical students in a clerkship curriculum. Before and after the educational intervention, students were tested with the instrument.

RESULTS

Cronbach's α coefficients of the instrument ranged from 0.79 to 0.95, indicating acceptable to strong internal consistency. For expert validity, the suitability and fitness of the instrument were verified. The overall score was significantly improved for the experimental group (from 3.51 to 3.65, P = .03) but not for the control group (from 3.48 to 3.44, P = .49). The experimental group also showed significantly improved scores in teacher assessment and learning satisfaction, the latter the only domain showing a significant difference of the differences (P = .020).

CONCLUSIONS

The integration of CBL, allied with the TIA, into clinical clerkships provides medical students with the opportunity to learn a nuclear medicine curriculum in an interactive and case-based format tailored specifically for medical students.

Exposure to, understanding of, and interest in interventional radiology in American medical students

RATIONALE AND OBJECTIVES

The purposes of this study were to determine the degree to which medical students are exposed to interventional radiology (IR) in medical school, to assess their knowledge of the field, and to gauge their interest in IR as a career choice.

MATERIALS AND METHODS

An institutional review board-approved survey was generated using the website www.surveymonkey.com. Medical student participation nationwide was elicited by sending e-mails to administrators of medical schools and radiology residency program directors and asking them to distribute the survey link to their students.

RESULTS

Seven hundred twenty-nine medical students from 21 states responded to the survey. Although 58% of students said they were interested in a hands-on career, only 5.5% of students said they had participated in an IR rotation and only 12.7% were interested in IR. Less than half of the IR domain-related questions used to assess understanding of IR were answered correctly, with greater understanding found among the students who had participated in an IR rotation.

CONCLUSIONS

Exposure to IR in accredited US medical education programs is inconsistent, although interest in the field is moderate among medical students compared with interest in other hands-on specialties. Understanding of IR is limited among the study population. Improved understanding of the field and recruitment could result from greater exposure.

Creating and enhancing radiology student interest groups

Student interest groups are an important forum in which medical students learn about and develop interest in different medical specialties. To attract top students to radiology and promote understanding and appreciation of radiology among future physicians, it is important that radiology educators help to develop and sustain such groups at their institutions. This article reviews key considerations in creating and enhancing a radiology student interest group.

Radiological clerkships as a critical curriculum component in radiology education

OBJECTIVE

The aim of this research was to explore the perceived value of clinical clerkships in the radiology curriculum as well as the impact of radiology clerkship on students' beliefs about the profession of radiology as a whole and as a career.

METHODS

This study is a sequel to a previous survey in which student perceptions about radiology curriculum components were investigated. The present study focuses on a further analysis of a subsection in this study, based on 14 statements about radiology clerkship and two statements about radiology as a career.

RESULTS

Perceived usefulness of the aspects of radiology clerkship as "radiology examination", "skills development" and "diagnosis focus" were awarded the highest scores. The predict value of the subscale "radiology examination" on the level of performance was very high (adjusted R(2)=0.19, p<.001).

CONCLUSION

Students expressed highly favorable evaluation of clerkship as a learning environment to learn to order and to interpret imaging studies as well as an unique possibility to attend various radiological examinations and to access to specific radiology software systems, as well as to get a better view on radiology and to improve image interpretation skills. This positive attitude towards clerkship is closely tied to students' beliefs about the profession of radiology as a whole. These aspects of dedicated radiology clerkship are crucial for effective and high-quality education as well as for the choice of radiology as a career.

Ensuring the radiologist workforce: opportunities during education

The authors conducted a literature review to better understand the current trends in the medical workforce and, specifically, the effect these have had in radiology. The cyclic nature of the radiology workforce supply has paralleled similar experiences in the general medical profession and other specialties. A review of proven education and training initiatives demonstrates positive workforce effects in particular circumstances. The adaptation of proven education initiatives should enhance the future radiology workforce in both private and academic settings.

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

RATIONALE AND OBJECTIVES

The aim of the study is to design and implement an elective course in which first-year medical students learn about radiology by actively integrating imaging with hospital records and radiology reports, rather than passively observing radiologists or images.

MATERIALS AND METHODS

Twenty students enrolled in an elective entitled "Introduction to Clinical Radiology." Students were divided into groups of two or three and given a case file describing the hospital visit of a patient with a common computed tomographic (CT) diagnosis. Files contained a PowerPoint presentation with all images from the patient's CT examination (allowing students to scroll through the images as if viewed on a picture archive and communication system workstation), as well as emergency department records, admission and discharge summaries, surgical notes, pathology reports, and radiology reports. Group discussion was facilitated by radiology staff acting as consultants, rather than instructors. As a final project, each group presented its case to the students and faculty.

RESULTS

Compared with before the course, students' understanding of the role of radiologists in the clinical management of patients significantly increased, but interest in radiology as a specialty was unchanged. Students significantly preferred scrolling through images on their own, rather than being shown static images in a didactic format. Students significantly agreed that they would recommend the course to a classmate.

CONCLUSION

Case-based instruction in radiology, in which first-year medical students are actively engaged in the integration of clinical and imaging information, can affect students' views on the role of radiologists and their clinical management of patients.

Medical students' perceptions of pathology and the effect of the second-year pathology course

To explore the perceptions of medical students regarding pathology and the effect of the sophomore pathology course, a questionnaire was given to second-year students from 5 different medical schools at the beginning and again at the completion of their pathology course. The questionnaire was given to students in the class of 1995 and then again for those in the class of 2002, with nearly 1,500 surveys collected over the study period. The survey included questions that sought to determine students' affinity for pathology, their understanding of the typical duties of a pathologist, and how they viewed pathology relative to other specialties and perceived positives and negatives of being a pathologist. Overall, the second-year pathology course had little effect on medical students' perceptions of pathology but did provide some increase in their understanding of pathology as a profession. Responses were in general stable when comparing the different classes. Those students interested in pathology emphasized the intellectual aspects of pathology although being less deterred by negative factors such as limited patient contact. In our sample of medical schools, the sophomore pathology course was ineffective at influencing students' perceptions of pathology. Furthermore, those students who are interested in pathology are drawn because of a perceived fit between their personalities and the perception of pathology as a solely scholarly and isolated specialty. Better education about the practice of pathology in the second year, and more importantly, continuing into the clinical years, is necessary to combat these misconceptions about pathology.

Immediate and long-term effects of a sophomore radiology elective

RATIONALE AND OBJECTIVES

The purpose of this study was to determine the influence of sophomore electives in radiology on medical students' career choices and later clinical practice as physicians and to assess the need for change in the curriculum.

MATERIALS AND METHODS

A survey questionnaire created by the Department of Radiology was sent to graduates of the Chicago Medical School, North Chicago, Ill, who had been offered a series of three sophomore electives in radiology between academic years 1978 and 1998. The survey included five questions concerning the utility of the electives.

RESULTS

Of the 2,883 questionnaires mailed, 31 were undeliverable and 411 (14%) were completed and returned. A total of 347 (84%) of the respondents had enrolled in one or more of the sophomore radiology electives, and 325 of 340 (96%) stated that the instruction received was valuable to their careers. In addition, 54 of 333 respondents (16%) indicated that the radiology electives influenced their choice of specialty, and 322 of 328 (98%) believed that the courses should remain part of the sophomore year elective choices. Within the respondent pool, 40 of 261 (15%) identified themselves as radiologists. Among radiologists and nonradiologists, respectively, 39 of 40 (98%) and 308 of 371 (83%) had enrolled in one or more of the sophomore electives in radiology, 34 of 39 (87%) and 291 of 301 (97%) stated that knowledge gained from the courses proved valuable to their careers, 30 of 39 (77%) and 24 of 303 (8%) were influenced by the electives in their choice of specialty, and 37 of 39 (95%) and 285 of 289 (99%) stated that radiology should continue to be offered during the sophomore year.

CONCLUSION

Practicing physicians overwhelmingly supported the continuation of the sophomore radiology electives. Some suggested that radiology should be a required course or clinical clerkship.

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.

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.

Radiologists as clinical tutors in a problem-based medical school curriculum

RATIONALE AND OBJECTIVES

The authors sought to evaluate the experience of radiologists teaching in a problem-based pre-clinical medical school curriculum.

MATERIALS AND METHODS

The undergraduate medical school curriculum at Wake Forest University includes 2 problem-based preclinical years that integrate basic and clinical sciences. Sixteen radiology fellows served as general clinical tutors for 5-9 weeks, each guiding the work of six 2nd-year students, often in tandem with a basic science tutor. On completion of the tutoring. the radiologists and the students were surveyed by means of a questionnaire. A follow-up group interview was conducted with the radiologists.

RESULTS

The response rate to the questionnaire was 81% for the radiologists and 47% for the students. On average, radiologists spent 6.1 hours weekly on preparation and tutoring and 3.5 hours in total on administration and grading. All radiologists thought tutoring was rewarding, but seven of the 13 respondents (54%) disliked assigning grades. Radiologists spent less time teaching radiology residents and performing research, but few thought their clinical work was adversely affected. Nearly half of the radiologist-tutors thought that the preliminary orientation and training provided to them by the medical school was not adequate, and nearly all of them thought that they could have been better prepared. All of the medical students improved their perceptions of radiologists after having had a radiologist as a tutor, and most thought that the radiologist-tutors performed as well as or better than tutors from other disciplines.

CONCLUSION

Radiologists can be successful as general tutors in a problem-based medical school curriculum. benefiting both radiologists and students. Better orientation and training by the medical school would improve the program.

Diagnostic radiology in an integrated curriculum: evaluation of student appraisal

RATIONALE AND OBJECTIVES

This study determined student perceptions of the effectiveness of an integrated radiology curriculum in a 6-year undergraduate medical school program.

MATERIALS AND METHODS

Student perceptions of the effectiveness of an integrated radiology curriculum were assessed with a self-administered questionnaire that was developed in house and consisted of Likert-type and open-ended items. The questionnaire was distributed to 1997-1998 and 1998-1999 cohorts of 2nd- to 6th-year medical students. Quantitative data were analyzed by using descriptive statistics.

RESULTS

Ninety-nine of 173 students (57% response) returned completed questionnaires. Overall, students perceived integrated radiology teaching as satisfactorily achieved and useful in facilitating learning. Compared with students in the 2nd and final years of undergraduate medical education and training, those in years 3-5 considered integrated radiology teaching to be very effective. Results of the survey suggest future modifications to improve the effectiveness of integrated radiology teaching.

CONCLUSION

Radiology can be successfully integrated into modern medical curricula. Student comments indicate the need to structure and organize the integrated teaching better and to introduce it earlier in the medical school curriculum.

The value of good medical student teaching: increasing the number of radiology residency applicants

RATIONALE AND OBJECTIVES

The authors attempted to define the value of good medical student teaching to the profession of radiology by examining the effect of radiology course improvements on the number of 4th-year students applying to radiology residencies.

MATERIALS AND METHODS

Course evaluation and residency application data were obtained from six consecutive classes of 4th-year medical students at the study institution, and these data were compared with national data.

RESULTS

Between 1995 and 2000, the number of 4th-year U.S. medical students applying to radiology increased 1.6 times. At the study institution, that number increased 4.5 times, a statistically significant difference (P = .020, chi2 test). Student survey data indicate that this increase reflects a general increase in the quality of radiology teaching in the study institution and specific changes in a required 2nd-year medical school course.

CONCLUSION

These results strongly suggest that good medical student teaching pays important dividends, not only to the departments that provide it but also to the profession of radiology as a whole. Exposing students to good radiology teaching early in their medical school careers is especially important. Radiology departments that provide outstanding medical student education should be studied to help develop a model of educational best practices.

Perceptual skill, radiology expertise, and visual test performance with NINA and WALDO

RATIONALE AND OBJECTIVES

The goal of this study was to determine if radiologists possess superior visual search and analysis skills compared with those of laypeople.

MATERIALS AND METHODS

In two experiments, radiologists and laypeople searched one of two complex pictorial scenes for hidden targets. Eye position was recorded during the search. Two measures of performance were obtained: accuracy of detecting targets as measured by using alternative free response receiver operating characteristic analysis and visual search efficiency as measured by using eye position analysis.

RESULTS

There were no statistically significant differences in detection performance between radiologists and laypeople for either of the search tasks. Radiologists took longer on average to search the images and to first fixate on the targets than did the laypeople. For both groups, true-positive and false-positive decisions were associated with longer dwell times than true-negative decisions. As with radiology search tasks, false-negative decisions were also associated with longer dwell times than true-negative decisions.

CONCLUSION

Performance on two visual search and detection tasks indicate that radiologists do not possess superior visual skills compared with laypeople. Radiology expertise is more likely to be a combination of specific visual and cognitive skills derived from medical training and experience in detecting and determining the diagnostic importance of radiographic findings.

Medical students' attitudes toward radiology: comparison of matriculating and graduating students

RATIONALE AND OBJECTIVES

To determine graduating medical students' perceptions of radiology and to document changes in their perceptions since they entered medical school.

MATERIALS AND METHODS

A survey questionnaire was distributed to 213 graduating students. Questions were similar to those answered by the same group of students as they entered medical school nearly 4 years earlier.

RESULTS

The survey was anonymously completed by 140 students. Seventy percent of students changed their choice of medical specialty since entering medical school. Factors with a major or important influence on specialty choice included intellectual excitement (96%), high patient contact (86%), opportunity for a good family life (72%), and regular hours (57%). Radiology was perceived to be a well-paid (89%), "high-tech" (86%) specialty with a healthy lifestyle (82%), regular hours (99%), and good family life (92%), but it was not perceived to offer high patient contact (1%) and was intellectually exciting to only 33% of students. This perception was unchanged from freshman year.

CONCLUSIONS

This 4-year longitudinal study of a medical student class documents surprisingly little change in the perception of radiology throughout medical school. High patient contact and intellectual excitement, both factors of major or important influence on specialty choice, were thought to be lacking in radiology.