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Fourth-Year Medical Student Opinions and Basic Knowledge Regarding the Field of Radiology

Posted Feb 28, 2013 Updated Apr 10, 2023
By Charles Prezzia MD , Gregory Vorona MD , Robin Greenspan MD
24 min read

Rationale and Objectives

This study evaluates the opinions and knowledge of fourth-year US medical students regarding radiology and analyzes the influence of a required or nonrequired radiology rotation as a reflection of the effectiveness of radiology medical student education.

Methods and Materials

Our institutional review board granted exempt status. An invitation e-mail was sent to 137 US medical schools. Upon receiving approval a second email was sent containing our voluntary anonymous online survey hyperlink to forward to their fourth-year class. Survey topics included demographics, radiology educational experiences, attitudes toward the field, and basic radiology knowledge. Responses were collected between August 4 and September 26, 2011.

Results

A total of 444 fourth-year medical students from 37 medical schools participated: 89% planned to enter a nonradiology specialty, 10.8% were required to take a dedicated radiology rotation, 34.9% completed one, 77% planned to complete one by graduation, 88.4% thought radiology often changes patient care or is at least as important as physical exam, 91.4% underestimated the cancer risk of an abdomen and pelvis computed tomography by at least one order of magnitude, and 72.9% by at least two orders. Seventy-seven percent had never heard of the American College of Radiology (ACR) Appropriateness Criteria. Respondents underestimated the potential risks of magnetic resonance imaging (MRI); with 58.3% aware intravenous gadolinium can cause nephrogenic systemic fibrosis and 79.4% aware of potential injury from metallic projectiles. 40.4% indicated that non-radiologist clinicians in specific medical specialties interpret their respective imaging studies at least as accurately as corresponding subspecialty radiologists. Other results include student opinions regarding teleradiology, radiologist lifestyle, and compensation.

Conclusions

Fourth-year medical students recognize the importance of radiology but are poorly informed regarding radiation safety, MRI safety, and ACR Appropriateness Criteria, despite 34.9% having a dedicated rotation. This highlights the need for adoption of the Alliance of Medical Student Educators in Radiology curriculum.

Medical student radiology education is a vital part of medical training, both to promote the effective and judicious use of radiology resources and to increase awareness of the field. The effectiveness of such training has been evaluated predominantly in single institution studies and not across multiple US centers. The field of radiology and radiology education has changed since many of these studies were published. We sought to determine if medical student opinions and knowledge of radiology and the influence of a dedicated radiology rotation has changed over the past decade across the United States.

Previous studies have suggested that a radiology clerkship improves both medical student opinion of the role of radiology as well as ability to choose an appropriate workup. A 4-week radiology clerkship increased student desire for a radiologist to be involved in patient care and consultation . Students selected more appropriate imaging in survey scenarios, with projected lower costs after a radiology clerkship than before . Students with some preclinical exposure to radiologists were less likely to hold negative stereotypes of radiologists . In the 10 years or more since most of these studies were published, there have been many changes in the field of radiology. There has been a trend toward integrating radiology into the core curriculum by several different strategies. These include adding half-day web-based independent teaching sessions to each of 10 fourth-year clerkships , adding subspecialty faculty lectures during the internal medicine clerkship , and integrating radiology throughout the third year curriculum with readings, shadowing, didactic sessions, radiology rounds, final exam, and case presentations . There has been an increased public awareness of radiology’s role in US population radiation exposure and a dramatic rise in the cost of health care . During this time the American College of Radiology (ACR) Appropriateness Criteria was converted from text-based guidelines to an on-line database . The effectiveness of radiology medical student education since these changes and trends have occurred has not been evaluated across multiple US medical schools.

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Materials and methods

Subjects

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Survey Instrument

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Statistical Analysis

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Institutional Review Board

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Results

Demographics

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Table 1

Demographics

Answered All Questions 84.7% All Opinion Questions 89.0% All knowledge questions 88.5% Gender Male 53.2% Female 46.8% School type Allopathic 73.5% Osteopathic 26.5% US region Northeast Midwest South West 19.5% 29.5% 30.6% 20.4% Career plans Radiology Medical Surgical Other/undecided 11.0% 54.6% 21.2% 13.2% Radiology experience Before medical school Preclinical years (lectures) Core clinical rotations (outside of patient care) Dedicated rotation required Completed dedicated rotation Dedicated rotation by graduation 13.0% 71.1% 56.1% 10.8% 34.9% 77%

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Opinions

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Table 2

Student Opinions

Question Responses Optimal Time for Radiology Rotation Before Clinical Rotations During Clinical Rotations After Clinical Rotations Unnecessary 21.3% 62.0% 7.6% 9.0% How interesting is radiology? Worthless to me Dull but important Interesting relating to clinical medicine Interesting in its own right Downright fascinating 0.2% 18.1% 34.8% 32.5% 14.4% Impact of radiology Minimal impact Occasionally changes patient care Often changes patient care Just as important as physical exam More important than physical exam 0.2% 11.4% 48.7% 30.2% 9.5% Subspecialty clinician accuracy versus subspecialty radiologist interpretation Much more accurate Slightly more accurate As accurate Slightly less accurate Much less accurate 1.9% 8.7% 29.8% 52.6% 7% Teleradiology versus in-house radiologist Teleradiology preferred Equally effective Teleradiology acceptable, in-house preferred Teleradiology not acceptable 0.5% 18.7% 75.4% 5.4% Why in-house radiologist preferred? Not preferred Review cases in person Discuss best next test Knowledge of radiologist’s reputation, abilities Faster report turnaround 4.3% 89% 70.2% 47.4% 37.2% Why teleradiology preferred? Teleradiology not preferred Less expensive Faster report turnaround 24/7 coverage Rural access to subspecialists 71% 14.6% 6% 25.1% 21.5% Radiologist’s lifestyle Much more difficult than clinician’s Slightly more difficult than clinician’s Same difficulty as clinician’s Slightly easier than clinician’s Much easier than clinician’s 0.2% 0.2% 9.9% 34.9% 54.7% Radiologist’s compensation Much less than clinician’s A little less than clinician’s Same as clinician’s A little more than clinician’s Much more than clinician’s 0.7% 1.2% 9.4% 41.3% 47.3%

None Neurologists Orthopedic Surgeons Emergency physicians General Surgeons Internists Which clinicians should provide final interpretations 49% 42.1% 47% 28.1% 33.5% 22.7%

Figure 1, Medical student responses regarding the impact of radiology on patient care.

Figure 2, Medical student responses regarding in-house radiologist versus teleradiology.

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Knowledge

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Table 3

Student Knowledge

Radiology residency length 2 years 3 years 4 years 5 years 0.5% 11.6% 56.7% 31.2% Chest computed tomography radiation dose = [ ] × chest x-ray 10× 100× 1000× 10,000× 10.5% 44.6% 38.3% 6.6% 30-year-old female lifetime cancer risk of computed tomography abdomen/pelvis 1/6 1/60 1/600 1/6000 1/60,000 1/600,000 0.5% 0.7% 8.6% 17.2% 31.5% 41.4% Risks of magnetic resonance imaging None Ionizing radiation Pacemaker, prosthetic valve malfunction Open cerebral aneurysm clips Metal projectile injury Nephrogenic systemic fibrosis with contrast 2% 7.7% 85.4% 59.6% 79.4% 58.3% American College of Radiology appropriateness criteria Seen it used Heard of it, never seen used Never heard of it 8.8% 14.3% 77% Chest x-ray cost $75 $300 $2000 $5000 49.8% 49.8% 0.5% 0% Abdominal computed tomography cost $75 $300 $2000 $5000 0% 28.2% 67.8% 4% Abdominal ultrasound cost $75 $300 $2000 $5000 51.6% 44.3% 4% 0%

Figure 3, Medical student responses regarding how many chest x-rays would give an equivalent radiation dose of a chest computed tomography. Correct response is 100× and outlined (13) .

Figure 4, Medical student responses regarding the increased lifetime cancer risk of an abdomen and pelvis computed tomography in a 30-year-old woman. Correct response is 1/600 and outlined (13) .

Figure 5, Frequency of medical student knowledge of magnetic resonance imaging risks.

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Influence of a Radiology Rotation

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Figure 6, Comparison of medical student responses based on a completed radiology rotation. ACR, American College of Radiology.

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Influence of a Radiology Requirement

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Influence Type of Medical School

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Table 4

Allopathic versus Osteopathic Student Responses

Allopathic Osteopathic_P_ Value Should clinicians provide final interpretations of imaging studies they order? (Check all that apply.) None 50.5% 44.7% Neurologists 39.8% 48.5% Orthopedic surgeons 45.3% 51.5% Emergency room physicians 27.0% 30.1% General surgeons 31.8% 37.9% Internists 22.5% 22.3% <.001 What is the lifetime cancer risk of a single phase abdomen and pelvis computed tomography in a 30-year-old woman? 1/6 0.7% 0.0% 1/60 0.7% 0.0% 1/600 8.3% 9.6% 1/6,000 15.9% 18.3% 1/60,000 33.6% 27.9% 1/600,000 40.8% 44.2% <.001

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Influence of Career Plans

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Table 5

Influence of Career Plans on Opinions

Career Plans Radiology Medical Surgical Other/Undecided Non-Radiology_P_ Value How interesting is the subject matter of radiology? <.001 Worthless 0.0% 0.5% 0.0% 0.0% 0.3% Dull, but important 2.4% 20.9% 16.7% 25.5% 20.6% Interesting clinically 2.4% 42.7% 33.3% 33.3% 39.3% Interesting in own right 14.6% 30.9% 46.2% 29.4% 34.1% Downright fascinating 80.5% 5.0% 3.8% 11.8% 5.7% Impact of radiology on patient care .012 Minimal 0.0% 0.5% 0.0% 0.0% 0.3% Occasional 2.4% 13.2% 14.1% 11.8% 13.2% Often 34.1% 50.2% 42.3% 52.9% 48.9% Importance = physical exam 36.6% 28.3% 34.6% 33.3% 30.5% Importance > physical exam 26.8% 7.8% 9.0% 2.0% 7.2% Subspecialty clinician interpretation accuracy compared to subspecialty radiologists <.001 Much higher 0.0% 2.3% 3.8% 0.0% 2.3% Little higher 0.0% 9.3% 11.5% 9.8% 9.9% Equal 17.1% 29.8% 35.9% 35.3% 32.0% Little lower 56.1% 54.9% 47.4% 49.0% 52.3% Much lower 26.8% 3.7% 1.3% 5.9% 3.5% Radiologist’s professional lifestyle compared to medical and surgical clinicians <.001 Much harder 0.0% 0.0% 0.0% 2.1% 0.3% Little harder 2.4% 0.0% 0.0% 0.0% 0.0% Similar 26.8% 6.2% 6.7% 10.6% 6.9% Little easier 51.2% 35.9% 22.7% 34.0% 32.6% Much easier 19.5% 57.9% 70.7% 53.2% 60.1% Radiologist’s compensation compared to medical and surgical clinicians <.001 Much less 2.4% 0.5% 0.0% 0.0% 0.3% Little less 2.4% 1.0% 2.7% 0.0% 1.2% Similar 17.1% 8.6% 13.3% 0.0% 8.4% Little more 68.3% 35.7% 44.0% 38.3% 38.0% Much more 9.8% 54.3% 40.0% 61.7% 52.1% Should subspecialty clinicians provide final interpretations on studies? (Check all that apply.) <.001 None 85.4% 42.4% 45.2% 51.1% 44.3% Neurologists 12.2% 50.7% 39.7% 36.2% 46.2% Orthopedic surgeons 14.6% 52.2% 52.1% 44.7% 51.1% Emergency room physicians 7.3% 34.1% 23.3% 34.0% 31.7% General surgeons 7.3% 37.1% 38.4% 34.0% 36.9% Internists 7.3% 30.2% 16.4% 17.0% 25.5%

Table 6

Influence of Career Plans on Knowledge

Career Plans Radiology Non-Radiology_P_ Value Nephrogenic systemic fibrosis risk of magnetic resonance imaging contrast .003 Aware of risk 80.5% 56.4% Unaware 19.5% 43.6% American College of Radiology Appropriateness Criteria <.001 Heard of it; seen it used 22.5% 6.6% Heard of it; not seen it used 22.5% 12.9% Never heard of it 55.0% 80.6%

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Discussion

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Appendix 1

Survey instrument

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Academic Radiology, Volume 20, Issue 3
Journals General Radiology
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