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Implementation of a Longitudinal Introduction to Radiology Course During Internship Year Improves Diagnostic Radiology Residents' Academic and Clinical Skills

Posted Jun 30, 2016 Updated Apr 10, 2023
By Kathryn E. Darras , Anne Worthington , David Russell , Daniel J. Hou , Bruce B. Forster , Cameron J. Hague , Colin Mar , Silvia D. Chang
8 min read

Rationale and Objectives

In order to ease the transition from internship to diagnostic radiology residency, a year-long didactic introduction to radiology course was offered to post-graduate year one (PGY-1) diagnostic radiology residents during their internship, which consisted of 27 hours of lecture over 9 months. The purpose of this study was to determine the quantitative and qualitative educational value of this course and its effect with respect to on-call preparedness.

Materials and Methods

Two consecutive cohorts of Diagnostic Radiology residents were included: the first cohort (PGY-1s in 2011–2012) did not participate in the new course (Old Curriculum Residents) and the second cohort (PGY-1s in 2012–2013) completed the new course (New Curriculum Residents). These two cohorts were compared both qualitatively and quantitatively. Scores were compared from the standardized Canadian National Pre-Call Observed Standardized Clinical Examination and American College of Radiology Diagnostic Radiology In-Training examination, which are taken in the PGY-2 year, at months 5 and 7, respectively. In addition, staff observation of on-call resident performance and resident self-reported preparedness were considered. Cohorts were compared using Mann-Whitney U test with significance defined as P value <0.05. P values from 0.05 to 0.10 were noted as possibly significant and further analyzed using a Cohen d test where the difference was determined to be small (0.2), medium (0.5), or large (0.8).

Results

New Curriculum Residents reported that the content of the PGY1 curriculum was more appropriate than the old curriculum to prepare them for call in PGY2 ( P = 0.013). New Curriculum Residents scored better than the Old Curriculum Residents on the Diagnostic Radiology In-Training examination ( P = 0.039) and on the emergency cases of the Canadian National Pre-Call Observed Standardized Clinical Examination ( P = 0.035). Staff radiologists, who were not blinded, reported that the New Curriculum Residents were better prepared for daytime ( P = 0.006) and overnight (P = 0.008) independent call were better prepared to perform common ultrasound examinations alone ( P = 0.049), and required less guidance while on call for nine competency areas. There was, however, no statistical difference between the residents’ self-reported preparedness for independent call.

Conclusions

Participation in a lecture-based introductory radiology curriculum during the PGY-1 internship year improved both radiology residents’ preparedness for call and their performance in PGY-2.

Introduction

The transition from internship to radiology residency is challenging. This adjustment is also made more difficult by the added pressure to prepare for independent call, which has become more demanding over the last decade . While on call, residents are expected to perform a diverse range of examinations from routine cross-sectional imaging to fluoroscopic-guided interventions . Although staff radiologists are available, residents must still be comfortable with clinical scenarios that require imaging, and attendant knowledge of appropriateness criteria, study protocols, and emergent on-call pathologies.

Several solutions have been proposed to ease the transition from internship into radiology residency. These educational initiatives focus primarily on alleviating the anxiety of independent call and include pre-call examinations, simulations, and web-based applications . These solutions, however, primarily emphasize “on-call” pathology (eg, aortic dissection, pulmonary embolism, etc.) and do not address the basics of image interpretation, anatomy, and foundational non-emergent pathology. To ease the transition into radiology residency, the Diagnostic Radiology Residency Program at the University of British Columbia introduced a formal lecture-based course for post-graduate year one (PGY-1) residents to attend during their internship year.

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Materials and Methods

Study Population

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New Curriculum Course Design

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Figure 1, Post-graduate year 1 (PGY-1) Course Design and Assessment Schedule. An introduction to radiology didactic curriculum was offered to PGY-1 residents during their rotating internship year. The course consisted of 9 monthly 3-hour lectures. Resident self-assessment of their clinical performance and the course evaluation occurred 3 months into their PGY-2 year. The New and Old Curriculum residents completed this survey 1 year apart. The New and Old Curriculum residents took the National Pre-Call Observed Standardized Clinical Examination (OSCE) and American College of Radiology Diagnostic Radiology In-Training (ACR DXIT) Examination during their PGY-2 year. The New and Old Curriculum residents took these examinations 1 year apart. After the New Curriculum PGY-2 residents had completed 2 months of independent call, faculty assessment of resident clinical performance occurred. In the Canadian training system, the PGY-1 internship year is called a basic clinical training year.

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New Curriculum Course Evaluation

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Resident Academic Performance Assessment

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Resident Self-Assessment of Clinical Performance

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Faculty Assessment of Resident Clinical Performance

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Statistical Analysis

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Results

Study Population

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Figure 2, Hours of didactic radiology teaching which radiology residents received prior to residency in years 1 to 4 of medical school.

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New Curriculum Course Evaluation

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Resident Academic Performance Assessment

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Figure 3, Canadian National Pre-Call Observed Standardized Clinical Examination (OSCE). Overall, the New Curriculum Residents scored better than the Old Curriculum Residents; however, this difference did not reach statistical significance ( P = 0.366). When compared by OSCE station, the New Curriculum Residents performed significantly better on the emergency cases ( P = 0.035) but worse on the ultrasound cases ( P = 0.013). These statistically significant differences are indicated with an asterisk.

Figure 4, American College of Radiology Diagnostic Radiology In-Training (ACR DXIT) Examination Scores. Overall, the New Curriculum Residents scored significantly better on this examination when compared to the Old Curriculum Residents ( P = 0.039). This statistically significant difference is indicated with an asterisk.

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Resident Self-Assessment of Clinical Performance

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Figure 5, Resident Self-Assessment of Clinical Performance. The New Curriculum and Old Curriculum residents were asked to self-report their readiness for independent call. A survey with a 5-point scoring system was used where 1 = not at all prepared and 5 = completely prepared (Appendix 1). There was no statistical difference between the self-reported readiness of the New Curriculum Residents and the Old Curriculum Residents.

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Faculty Assessment of Resident Clinical Performance

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Figure 6, Faculty Clinical Assessment of Resident Clinical Performance. After the New Curriculum PGY-2 residents had completed 2 months of independent call, faculty assessment of resident clinical performance occurred. A survey with 5-point scoring system was used where 1 = not at all prepared and 5 = completely prepared (Appendix 2). The staff radiologists reported that the New Curriculum Residents were overall better prepared than the Old Curriculum Residents to take independent overnight call ( P = 0.008), independent daytime call ( P = 0.006), and to perform common on-call ultrasound examinations ( P = 0.049). These statistically significant differences are indicated with an asterisk.

Figure 7, Faculty Clinical Assessment of Resident Clinical Performance. After the New Curriculum PGY-2 residents had completed 2 months of independent call, faculty assessment of resident clinical performance occurred. A survey with a 5-point scoring system was used where 1 = almost always required guidance, 2 = frequently required guidance, 3 = sometimes required guidance, 2 = rarely required guidance, and 1 = almost never required guidance. The New Curriculum Residents were superior in detecting chest radiography abnormalities ( P = 0.008), detecting pulmonary emboli on computed tomography (CT) ( P = 0.036), interpreting chest radiography findings ( P = 0.055), recognizing thoracic anatomy ( P = 0.098), recognizing abdominopelvic anatomy ( P = 0.091), detecting abdominopelvic pathology on CT ( P = 0.059), detecting CT abdominal radiography abnormalities ( P = 0.059), and detecting noncontrast CT head abnormalities ( P = 0.088). These statistically significant and possibly statistically significant differences are indicated with an asterisk.

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Discussion

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Acknowledgements

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Appendix 1

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Appendix 2

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Academic Radiology, Volume 23, Issue 7
Journals General Radiology
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