Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective A Comparison of MS-IIs, MS-IIIs, and MS-IVs

Rationale and Objectives

Correct selection of imaging tests is essential for clinicians but until recently has been largely neglected in medical education. How and when students acquire such non-interpretive skills are unknown. This study will assess student knowledge of imaging test selection before and after a general radiology elective.

Materials and Methods

Between 2008 and 2015, an unannounced 13-item test was administered to second, third, and fourth-year students on the first and last days of the Johns Hopkins School of Medicine radiology elective. Scores (0–13) were based on the American College of Radiology Appropriateness Criteria. Pre- and posttest means were compared using paired samples t tests. Whether performance on the pretest and posttest differed by class year was assessed using analysis of variance and Kruskal-Wallis, respectively, and whether year was associated with posttest score after controlling for pretest score was assessed using analysis of covariance.

Results

Posttest means were significantly higher than pretest means for students in all years ( P values <.0001). Pretest scores differed by year (F (2, 360) = 66.85, P <.0001): fourth-year students scored highest (mean = 9.96 of 13) and second-year students scored lowest (mean = 7.01 of 13). Posttest scores did not differ (χ 2 (2, 270) = 0.348, P = .841). Year in school had no independent effect on posttest score (F (2, 239) = 0.45, P = .637).

Conclusion

Knowledge of modality selection increases with clinical training, but room for improvement remains. A general radiology elective increases this knowledge. Second-year students improve most, suggesting that taking radiology early is efficient, but further research to evaluate retention of this knowledge is needed. Medical student education in radiology must increasingly recognize and address non-interpretive skills and intelligent imaging utilization.

Introduction

Correctly choosing imaging tests is an essential skill for physicians in nearly all fields. As we enter the era of value-based health care, it will become even more important to obtain diagnostic imaging efficiently. However, this skill is woefully neglected in preclinical and clinical medical school training: at many institutions, only anatomy courses, if any, address radiology instruction in the preclinical years. Although our institution integrates imaging into all blocks of the preclinical and clinical curriculum, courses usually focus on identification of radiographic findings rather than choice of modalities for diagnosis. According to a 2014 survey by the American College of Radiology Task Force on Medical Student Education , fewer than 40% of schools have dedicated time for teaching imaging algorithms in the first 3 years of their medical school curricula.

Only a minority of schools—estimates from 2012 to 2014 range from 25% to 39% —have a mandatory dedicated radiology clerkship. Thus, the only exposure many students get to the field during their clinical years is through required medicine and surgery (or other) clerkships, in which interpreting computed tomography (CT) scans or chest radiographs is usually deemed more salient than knowing which studies to request. Although radiologists at our institution typically give one to two lectures to all rotating students per required clerkship, non-radiologists provide most of our clinical students’ radiology education.

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Materials and Methods

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Results

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Table 1

Summary of Pretest and Posttest Performance by Student Year a

Year Observations (N) Pretest Minimum Pretest Maximum Pretest Mean ± SD b ANOVA c Result Overall 363 3 13 9.01 ± 1.93 MS-II 42 3 11.5 7.01 ± 2.10 F (2, 363) = 66.85

P <.0001 MS-III 150 4 12.5 8.50 ± 1.74 MS-IV 170 6.33 13 9.96 ± 1.43

Posttest Minimum Posttest Maximum Posttest Mean ± SD Kruskal-Wallis d Result Overall 270 7 13 11.81 ± 1.16 MS-II 42 9 13 11.71 ± 1.19 χ 2 (2, 270) = 0.348

P = .841 MS-III 139 7 13 11.79 ± 1.23 MS-IV 98 8.83 13 11.87 ± 1.05

MS-IIs, MS-IIIs, and MS-IVs scored differently on the pretest ( P <.0001) but not on the posttest ( P = .841).

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Table 2

Paired t Tests: Difference Between Pretest and Posttest Means in MS-II a , MS-III b , and MS-IVs c

Year Observations (N) Pretest Mean ± SD d Posttest Mean ± SD Difference ± SD_t_ Test Result Overall 245 8.81 ± 1.99 11.90 ± 1.08 3.10 ± 2.08t = 23.35

P <.0001 MS-II 41 7.09 ± 2.08 11.70 ± 1.20 4.62 ± 2.33 t = 12.71

P <.0001 MS-III 116 8.51 ± 1.78 11.91 ± 1.11 3.40 ± 1.92t = 19.11

P <.0001 MS-IV 88 9.98 ± 1.42 11.98 ± 0.96 2.00 ± 1.53t = 12.25

P <.0001

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Discussion

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Appendix

Supplementary material

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Table S1

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Table S2

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References

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Assessing Medical Student Knowledge of Imaging Modality Selection Before and After a General Radiology Elective A Comparison of MS-IIs, MS-IIIs, and MS-IVs

Rationale and Objectives

Materials and Methods

Results

Conclusion

Introduction

Materials and Methods

Results

Discussion

Appendix

Supplementary material

References

Further Reading

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