White Paper: Radiological Curriculum for Undergraduate Medical Education in Germany

Effects of undergraduate ultrasound education on cross-sectional image understanding and visual-spatial ability - a prospective study

INTRODUCTION/AIM

Radiological imaging is crucial in modern clinical practice and requires thorough and early training. An understanding of cross-sectional imaging is essential for effective interpretation of such imaging. This study examines the extent to which completing an undergraduate ultrasound course has positive effects on the development of visual-spatial ability, knowledge of anatomical spatial relationships, understanding of radiological cross-sectional images, and theoretical ultrasound competencies.

MATERIAL AND METHODS

This prospective observational study was conducted at a medical school with 3rd year medical students as part of a voluntary extracurricular ultrasound course. The participants completed evaluations (7-level Likert response formats and dichotomous questions "yes/no") and theoretical tests at two time points (T1 = pre course; T2 = post course) to measure their subjective and objective cross-sectional imaging skills competencies. A questionnaire on baseline values and previous experience identified potential influencing factors.

RESULTS

A total of 141 participants were included in the study. Most participants had no previous general knowledge of ultrasound diagnostics (83%), had not yet performed a practical ultrasound examination (87%), and had not attended any courses on sonography (95%). Significant subjective and objective improvements in competencies were observed after the course, particularly in the subjective sub-area of "knowledge of anatomical spatial relationships" (p = 0.009). Similarly, participants showed improvements in the objective sub-areas of "theoretical ultrasound competencies" (p < 0.001), "radiological cross-section understanding and knowledge of anatomical spatial relationships in the abdomen" (p < 0.001), "visual-spatial ability in radiological cross-section images" (p < 0.001), and "visual-spatial ability" (p = 0.020).

CONCLUSION

Ultrasound training courses can enhance the development of visual-spatial ability, knowledge of anatomical spatial relationships, radiological cross-sectional image understanding, and theoretical ultrasound competencies. Due to the reciprocal positive effects of the training, students should receive radiology training at an early stage of their studies to benefit as early as possible from the improved skills, particularly in the disciplines of anatomy and radiology.

Update of the competence-based catalog of learning objectives in nuclear medicine for the study of human medicine in Germany

AIM

To update the subject-specific, competence-based catalog of learning objectives for medical studies in Germany published by the German Society of Nuclear Medicine (DGN) in 2018, prioritizing relevant learning objectives.

METHODS

Based on the previous catalog, the writing group compiled nuclear medicine topics and formulated competence-based learning objectives, including medical developments, device innovations and new radiopharmaceutical approvals. These were presented for prioritization to the 180 habilitated DGN members as an expert group in a Delphi process. The first round of voting assessed firstly the topics in terms of necessity or dispensability, and secondly the detailed learning objectives of the topics were assessed for their relevance to academic teaching in nuclear medicine. The results of the first survey were used to draft a catalog of learning objectives with final approval by the expert group in a second survey. The time available for teaching nuclear medicine was also recorded.

RESULTS

The writing group developed 240 competence-based learning objectives from 41 topics. After a first Delphi round, 73 detailed competence-based learning objectives from 15 topics were compiled. The mean teaching time was 8.4 h for lectures, 3.7 h for seminars and 3.6 h for practical courses. In a second Delphi round, the agreement of the expert group was at least 95% for the selected topics and at least 90% for the detailed learning objectives.

SUMMARY

The catalog of subject-specific learning objectives, updated by expert consensus, provides basic knowledge, skills and competences related to the most relevant diagnostic and therapeutic procedures in nuclear medicine, taking into account both long-established topics and recently introduced innovations.

Principles for teaching sonography - current status

Since many young medical residents require sonographic skills early on during training, increased attention has been paid to including sonography classes in undergraduate medical education, among both professional societies and medical educators responsible for medical licensing exams. Medical schools worldwide have developed and implemented a variety of ultrasound teaching formats.This article addresses evidence-based solutions to crucial challenges in planning and implementing undergraduate sonography education. In order to achieve a sustainable increase in practical sonographic competence, we suggest small-group classes with sufficient individual hands-on scanning time for each student. We recommend concentrating on a circumscribed topic and teaching it thoroughly and practically rather than superficially outlining a broad subject area. Provided that peer teachers undergo adequate training, student peer teachers are not inferior to physicians as teachers, as far as student satisfaction, theoretical knowledge and practical skills acquisition are concerned. The assessment of acquired practical skills should consist of practical examinations, such as an objective structured clinical examination (OSCE) or a direct observation of procedural skills (DOPS). In contrast to using healthy volunteers as training models, simulation trainers allow the demonstration of pathological findings in authentic sonographic images, with the disadvantages of unrealistically easy image acquisition, as well as the lack of interaction with the patient.

The current situation of Radiology training in medical studies in Spain

Radiology is now an essential part of Clinical Medicine, but undergraduate training does not reflect its importance in medical practice. In the current course, there are 46 medical schools in our country. According to the information published on the institutional websites, the study plans are very different in terms of the presence of Diagnostic Radiology and the organization of teaching. The estimated number of teaching hours in diagnostic radiology (mean ± standard deviation) is 61.3 ± 22.2 h (range from 26 h to 137 h). There is a great shortage of clinical university professors, and a generational change is essential. The current situation poses various challenges, including adapting to new teaching methods and technologies and promoting the presence of radiology in medical study plans, paying special attention to hospital practices, the Final Degree Project (FDP) and the Objective Structured Clinical Examination (OSCE).

A commentary on the practice of integrated medical curriculum in the interdisciplinary field of medical engineering

Shanghai University School of Medicine was a newly established medical college in 2018. It is founded on the national health development policies, international medical development trends and the close relationship between the advantages of new medical courses and medical artificial intelligence, it is dedicated to using intelligent medicine as the breakthrough point, training graduate students in two interdisciplinary medical engineering subjects as the priority, and implementing the integrated medical curriculum teaching reform. In this paper, we introduce the background of the integrated medical curriculum system at the Shanghai University School of Medicine, the horizontal and vertical integration of medical courses in interdisciplinary medical engineering subjects, the cross-integration of traditional integrated medical courses with other disciplines and specialties, and the transformation mode of medical science and technology innovation led by artificial intelligence under the support of three-dimensional curriculum integration, putting forward the prospect of the curriculum integration system and providing experiences and references for other medical schools.KEY MESSAGESThis paper introduces the necessity and feasibility of implementing integrated medical course teaching in a newly established medical college.This paper introduces the strategies and concrete measures we took to implement integrated medical course teaching.The analysis of examination papers and other evaluations revealed that the integrated medical teaching for graduate students with non-medical professional backgrounds is feasible.

Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology

BACKGROUND

 Ultrasound (US) is widely used as a fast and cost-efficient first-choice imaging technique without relevant side effects for a variety of diagnostic tasks. Due to technical advances, more complex and sophisticated methods such as color-coded duplex ultrasound, image fusion, contrast-enhanced ultrasound (CEUS), and ultrasound-guided interventions have become increasingly important in diagnostic algorithms.

METHOD

 This study presents an overview of all aspects regarding the establishing of an interdisciplinary US center based on five representative examples in Germany. These aspects include topics of ultrasound education, research, economics, and administration.

RESULTS

 The goal of an interdisciplinary US center is to bundle the use of equipment, staff, rooms, and infrastructure resources (optimization of equipment availability and use of new techniques) to expand the range of examinations, to promote resident training, and to boost continuing medical education of residents. This should result in better patient care and has additionally improved patient care while considering the added value for the participating institutions involved. Interdisciplinary US centers allow a reduction of the number of US devices needed in a hospital and more efficient use of available equipment through bedside time optimization by central organization within interdisciplinary management. The focused application of special US techniques such as CEUS or image fusion for complex, difficult interventions as well as the training and education of younger colleagues in using these techniques is centrally organized by experts and can be improved through the multidisciplinary experience available.

CONCLUSION

 Organizational structures, sharing of materials, and standardization of diagnostic reports facilitate and accelerate cooperation with the referring specialty.

KEY POINTS

  · Interdisciplinary US centers foster clinical collaboration, research, and jointly organized, standardized training.. · Economic aspects include optimization of available equipment, use of the latest US techniques, and centralization of organizational structures.. · Common terminology and standardized reporting increase the satisfaction of referring doctors.

CITATION FORMAT

· Clevert DA, Jung EM, Weber M et al. Concepts in the Establishment of Interdisciplinary Ultrasound Centers: The Role of Radiology. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1853-7443.

[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.

CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic

PURPOSE

 During the SARS-CoV-2 pandemic, higher education worldwide had to switch to digital formats. The purpose of this study was to evaluate CoRad-19, a digital teaching tool created by the German Radiological Society for medical students during the COVID-19 pandemic.

MATERIALS AND METHODS

 A total of 13 German-speaking universities implemented CoRad-19 in their curriculum and partially or completely replaced their classes with the online courses. Previous experience and contact with radiology and the participants' opinions regarding the medium of e-learning were surveyed using a custom questionnaire. The subjective level of knowledge regarding the individual modules was also surveyed before and after participation to measure learning effects. The data of 994 medical students from the participating sites were analyzed and compared intraindividually using the Friedman test.

RESULTS

 From 4/1/2020-10/1/2020, 451 complete data sets from a total of 994 surveys were included. E-learning was rated "very useful" both before and after course participation (4 [IQR 3-4], p = 0.527, r = 0.16). E-learning as a method was also rated as a "very good" medium both before and after participation (4 [IQR 3-4], p = 0.414, r = 0.17). After participation, participants rated radiology as particularly suitable for digital teaching (before: 3 [IQR 3-4] vs. after 4 [IQR 3-4], p = 0.005, r = 0.6). Significant learning gains were measurable in all course modules (p ≤ 0.009). Post-hoc analysis showed interest in radiology to increase significantly after course participation (p = 0.02).

CONCLUSION

 In the representative survey, significant learning effects were observed in all course modules. In addition, it should be particularly emphasized that the students' interest in radiology was increased by course participation. Thus, the German Radiological Society provided significant support to German-speaking medical faculties with respect to maintaining excellent education using CoRad-19.

KEY POINT

· Co-Rad-19 course participation results in measurable subjective learning effects and increases student interest in radiology..

CITATION FORMAT

· Brendlin AS, Molwitz I, Oechtering TH et al. CoRad-19 - Modular Digital Teaching during the SARS-CoV-2 Pandemic. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1752-0624.

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.

DRG-Oriented Mathematical Calculation Model and Method of Integrated Medical Service Cost

In the context of the new round of medical and health reform, in order to alleviate the problem of "difficult to see a doctor and expensive to see a doctor," the state focuses on reducing the cost of medical services, so it puts forward the calculation and method research of medical costs. The purpose of this study is to calculate and predict the cost of medical services in a DRG-oriented integrated environment. In this study, activity-based costing and weighted moving average methods are used. First, basic data of medical services are collected, then all medical activities are confirmed and all service costs are collected, then a cost database is established, and a calculation model of medical costs is designed. Finally, calculation suggestions and optimization methods are put forward by analyzing the calculated data. The experimental results show that the actual demand of drugs predicted by the general moving average method is relatively insufficient, with the maximum error of 41%, the minimum of 5%, and the average error of 19.8%; the maximum error of drug demand predicted by the weighted moving average method is 24%, the minimum is 2%, and the average is 15.4%. It can be concluded that the prediction effect of the weighted moving average method is better than that of the ordinary moving average method, which plays a good and effective role in the prediction of medical cost. The activity-based costing method is more detailed and organized for the cost calculation and classification of medical services. It provides a certain value for the effective management and control of medical service cost.

Deep learning can be used to train naïve, nonprofessional observers to detect diagnostic visual patterns of certain cancers in mammograms: a proof-of-principle study

The scientific, clinical, and pedagogical significance of devising methodologies to train nonprofessional subjects to recognize diagnostic visual patterns in medical images has been broadly recognized. However, systematic approaches to doing so remain poorly established. Using mammography as an exemplar case, we use a series of experiments to demonstrate that deep learning (DL) techniques can, in principle, be used to train naïve subjects to reliably detect certain diagnostic visual patterns of cancer in medical images. In the main experiment, subjects were required to learn to detect statistical visual patterns diagnostic of cancer in mammograms using only the mammograms and feedback provided following the subjects’ response. We found not only that the subjects learned to perform the task at statistically significant levels, but also that their eye movements related to image scrutiny changed in a learning-dependent fashion. Two additional, smaller exploratory experiments suggested that allowing subjects to re-examine the mammogram in light of various items of diagnostic information may help further improve DL of the diagnostic patterns. Finally, a fourth small, exploratory experiment suggested that the image information learned was similar across subjects. Together, these results prove the principle that DL methodologies can be used to train nonprofessional subjects to reliably perform those aspects of medical image perception tasks that depend on visual pattern recognition expertise.

Successful integration of radiation oncology in preclinical medical education : Experiences with an interdisciplinary training project

PURPOSE

Modern impartation of both anatomic and radiation oncology (RO) knowledge in medical education enables a transfer of preclinical knowledge to clinical practice, which may be addressed by multidisciplinary concepts. The faculty's "Anatomy and imaging" course attempts to integrate RO, radiology and nuclear medicine into the preclinical curriculum. The present analysis focuses on the description of the course concept and discusses the potential didactic impact of the implementation of RO.

METHODS

In total 5 semester cohorts have undertaken the course since the introduction of RO in the winter semester of 2015/2016 with 682 students participating. It is designed as a small group circuit training with a teaching content of 8 h daily. Course evaluation was performed on a 100-item Likert scale.

RESULTS

General evaluation showed an average of 9.3-12.7 on a Likert scale (0 being the best, 100 being the worst grade). Use of media, relevance for medical training, gain of interest in medicine in general and overall satisfaction with the course received excellent mean values. For RO, there was a high degree of consent with the following statements: "the course was well organized", "subjects and presentation were well-structured", "topics were well chosen", "the time for exercises was sufficient" and "teaching by student tutors and physicians was adequate".

CONCLUSION

The present evaluation demonstrates the feasibility of introducing RO in the preclinical part of medical education. The course concept shows excellent results in evaluation and may help in broadening RO knowledge and in recruiting new doctoral candidates and residents.

An Internet-Based Radiology Course in Medical School: Comparison of Academic Performance of Students on Campus Versus Those With Absenteeism Due to Residency Interviews

BACKGROUND

Imaging and its optimal use are imperative to the practice of medicine, yet many students don't receive a formal education in radiology. Concurrently, students look for ways to take time away from medical school for residency interviewing. Web-based instruction provides an opportunity to combine these imperatives using online modalities.

OBJECTIVE

A largely Web-based course in radiology during the 4th year of medical school was evaluated both for its acceptance to students who needed to be away from campus for interviews, and its effectiveness on a nationally administered standardized test.

METHODS

All students were placed into a structured program utilizing online videos, online modules, online textbook assignments, and live interactive online lectures. Over half of the course could be completed away from campus. The Alliance of Medical Student Educators in Radiology test exam bank was used as a final exam to evaluate medical knowledge.

RESULTS

Positive student feedback included the freedom to travel for interviews, hands-on ultrasound training, interactive teaching sessions, and quality Web-based learning modules. Negative feedback included taking quizzes in-person, a perceived outdated online textbook, and physically shadowing hospital technicians. Most students elected to take the course during the interview months of October through January. The Alliance of Medical Student Educators in Radiology final exam results (70.5%) were not significantly different than the national cohort (70%) who took the course in-person. Test scores from students taking the course during interview travel months were not significantly different from students who took the course before (P=.30) or after (P=.34) the interview season.

CONCLUSIONS

Students desire to learn radiology and often choose to do so when they need to be away from campus during the fall of their 4th year of study to accomplish their residency interviews. Web-based education in radiology allows students' interview traveling and radiology course objectives to be successfully met without adversely affecting the outcomes on a nationally normed examination in radiology. A curriculum that includes online content and live Web-based teleconference access to faculty can accomplish both imperatives.

Smartphone use and schema-based learning in dentomaxillofacial radiology practice: a case report from one College of Dentistry

OBJECTIVES

This study investigates the students' satisfaction and awareness of competency towards smartphone use and schema-based learning in dental radiology practice.

METHODS

Third year students undertaking a dental radiology practicum at a dental school were divided into two groups: one group received traditional clinical training, whereas the other group used smartphones in classes and received new training using schema assignments. At the end of the course, students' satisfaction with the training and self-awareness of their competency were surveyed, and their achievement was assessed.

RESULTS

Although students' satisfaction with smartphone-based training was generally high, it was less than that of students trained by traditional instruction. However, most students that received smartphone-based training had higher self-scored competency before than after training. The smartphone group scored higher on true/false or multiple-choice questions, whereas the traditional group scored higher on short-answer questions.

CONCLUSIONS

Smartphone education with schema based assignment proved to be attractive in dental radiology, but students showed less satisfaction, and need to meet the requirements of evidence-based practice. Although the full use of smartphone education with schema is not recommended in dental education, we think that it could be try to use as a supplementary approach with traditional didactic method to facilitate student's exploration and self-study to cope with rapid change in educational environment.