Rationale and Objectives
A lecture series aimed at providing new radiology residents a rapid course on the fundamental concepts of professionalism, safety, and interpretation of diagnostic imaging was established. Evaluation of the course’s educational value was attempted through surveys.
Materials and Methods
Twenty-six live 45-minute lectures presented by 16 or 17 faculty members were organized exclusively for the first class of radiology residents, held over a 2-month period at the beginning of certain weekdays. Online surveys were conducted after the course to gather feedback from residents. Average resident rotation evaluation scores were measured over the first semester for the two classes before and after this new course implementation.
Results
The lecture series was successfully organized and implemented. A total of 33 residents sat through the course over three summers. Faculty reported a reasonable number of preparation hours, and 100% of residents indicated they valued the course. Comparison of class average evaluation scores before and after the existence of this 2-month course did not significantly change.
Conclusions
This collection of introductory lectures on professionalism, safety, and diagnostic imaging, delivered early in the first year of the radiology residency, requires a reasonable number of invested preparation hours by the faculty but results in a universal increase in resident confidence. However, we were unable to demonstrate an objective improvement in resident performance on clinical rotations.
Residents beginning a diagnostic radiology residency arrive with highly varying skills and experiences pertinent to diagnostic imaging. Depending on prior medical school curricula and the content of internship training, individuals may have limited exposure to the imaging modalities and indications for appropriate imaging studies . Although novel educational and training modules have been described to prepare junior residents for independent call shifts , there is little literature specifically concerned with addressing the knowledge gaps in new radiology residents.
Before 2010, the first-year diagnostic radiology residents at our institution were provided with some didactic lectures on a limited number of imaging topics, focused mostly on abdominal imaging, which related to the interests of the faculty leading the tutorials. These were presented exclusively to the first-year residents during the first month of training, as a supplement to the remaining standard teaching conferences built into their schedule. The Education Committee recognized this abbreviated lecture series as an underdeveloped opportunity to provide incoming residents with a more comprehensive introduction to the field of diagnostic radiology and to ensure all new residents shared the same fund of knowledge required in the beginning of their residency training. Further, the subjects of professionalism and safety issues in diagnostic imaging, which are core requirements of any training program sponsored by the Accreditation Council for Graduate Medical Education, had not been formally taught to first-year residents prior to 2010. Given the new Accreditation Council for Graduate Medical Education–outlined Milestones intended to ascertain an individual’s progress through residency training, a course designed specifically for the needs of new radiology residents has useful potential for addressing all areas of competency.
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Materials and methods
Course Structure
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Table 1
Tutorial Series Lecture Titles and Objectives
Category and Lecture Number Lecture Title Learning Objectives Professionalism 1 How to Be an Outstanding Resident: The Chief Resident Perspective By the end of the sessions, the residents will be able to (i) process the needs of an efficient reading room and apply their skills to improve communication; (ii) heighten their awareness of how a radiologist can contribute to the mission of the hospital with professional conduct; (iii) reflect on principles of professionalism including ethics, courtesy, and integrity; and (iv) apply the active voice to written statements and produce concise reports following American College of Radiology guidelines for a structured report. 2 How to Be an Outstanding Resident: The Attending Perspective 3 How to Formulate an Effective Radiology Report 4 Professionalism in Radiology Safety and Physics 5 Contrast Media Physiology and Toxicity By the end of the sessions, the resident will be able to (i) list the different types of commonly used contrast agents in diagnostic imaging; (ii) recognize the clinical signs of a contrast reaction; (iii) apply appropriate management steps in caring for the patient with an acute contrast reaction; (iv) list appropriate dosimetry terms for radiography, fluoroscopy, and computed tomography (CT); and (v) discern the x-ray tube from the image intensifier and apply the safety rules to modify fluoroscopic techniques. 6 Treating Contrast Reactions 7 Radiation Units and Dosimetry 8 Radiation Dose Practicalities 9 Radiation Safety and Protection Chest Imaging 10 Chest Radiography: Heart and Mediastinum By the end of the sessions, the residents will be able to (i) identify normal pulmonary architecture and the structures of a normal mediastinum; and (ii) develop a systematic strategy for reviewing a CT scan of the thorax. 11 Chest Radiography: Lungs 12 Chest CT: The Fundamentals Abdominal Imaging 13 Abdominal Radiography I: Fundamentals, Mucosal Thickening, and Pneumoperitoneum By the end of these sessions, the residents will be able to (i) recognize abdominal structures on a radiograph; (ii) distinguish pneumatosis from normal bowel gas patterns; (iii) perceive abnormal air in the portal venous system; (iv) perceive abnormal soft tissue densities such as masses and ascites; (v) formulate the likely etiology of abnormal calcification in the abdomen; (vi) discern correct positions of intravascular and enteric tubes from aberrantly positioned tubes; (vii) identify the solid abdominal organs on a CT study; (viii) recognize simple pathology such as abnormal calcification, inflammation, hemorrhage, and masses in the abdomen and pelvis; (ix) search for pathology using methodical pattern; and (x) list common diagnostic methods used for the evaluation of hematuria and urinary tract infection. 14 Abdominal Radiography II: Pneumatosis and Pneumobilia 15 Abdominal Radiography III: Luminal Distention, Masses, and Ascites 16 Abdominal Radiography IV: Calcifications and Foreign Material 17 Abdominal Radiography: Tubes and Lines 18 Introduction to the Fluoroscope 19 How to Interpret Abdominal/Pelvic CT 20 Practical Tutorial: Systematic Review of Abdominal/Pelvic CT 21 Fundamentals of Genitourinary Imaging Neuroradiology 22 How to Read a Head CT and Brain MRI By the end of the sessions, the residents will be able to (i) distinguish a head CT scan from a brain magnetic resonance image; (ii) apply changes in window/levels to visualize subtle densities within the head; (iii) recall the tissue types that are bright or dark on standard magnetic resonance sequences; (iv) identify subdural, epidural, subarachnoid, and intraparenchymal hemorrhage; (v) recognize important skull and facial fractures; and (vi) systematically approach the findings detectable on a spine radiograph, including alignment, fracture, and disc disease. 23 Head Trauma Imaging 24 Fundamentals of Spine Imaging Musculoskeletal Imaging 25 Upper Extremity Fractures By the end of the lectures, the resident will be able to recognize a fracture and the associated soft tissue findings, including joint effusions and soft tissue thickening. 26 Lower Extremity Fractures
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Evaluation
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Results
Faculty Educators
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Table 2
Faculty Perspective: Hours of Preparation Required
0–1 hour, Lecture is repeated from prior year 57.1% ( n = 8) 1–3 hours, Old material is recycled to create a fresh lecture 42.9% ( n = 6) 13–20 hours, Original lecture is made 7.1% ( n = 1)
Table 3
Faculty Perspective: Resident Attendance
Excellent—Full class attends 78.6% ( n = 11) Good—Most of class attends 21.4% ( n = 3) Limited/Poor—Less than half of class attends 0% ( n = 0)
Table 4
Resident and Faculty Perspective: Length of Lectures (45 minutes)
Too Short About Right Resident responses 11.5% ( n = 3) 88.5% ( n = 23) Faculty responses 28.6% ( n = 4) 71.4% ( n = 10)
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Residents’ Impressions
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Table 5
Resident Perspective: Overall Value of Lecture Series
Yes, Definitely Yes, Somewhat No, Not at All Did this course give you more confidence as you started your residency? 50% ( n = 13) 50% ( n = 13) 0% ( n = 0) Did you feel that the lectures were educationally valuable? 84.6% ( n = 22) 15.4% ( n = 4) 0% ( n = 0)
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Department-wide Faculty Evaluation of Resident Rotation Performance
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Table 6
Summary of Average Scores for Each Residency Class, Postgraduate Year–2 Resident Rotation Evaluation Scores (Faculty Evaluations of Residents) in First Half of Each Year
Categories of Evaluation: Medical Knowledge Patient Care Communication Professionalism Practice-Based Radiology Systems-Based Practices 2008 4.19 4.19 4.32 4.44 4.21 4.21 2009 3.81 3.83 4.00 4.10 3.95 3.84 2010 4.08 4.10 4.30 4.36 4.10 4.03 2011 3.76 3.82 4.01 4.07 3.90 3.82
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Objective Test of Knowledge
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Discussion
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References
1. Squire L.F., Novelline R.A.: Radiology should be a required part of the medical school curriculum. Radiology 1985; 156: pp. 243-244.
2. Poot J.D., Hartman M.S., Daffner R.H.: Understanding the US medical school requirements and medical students’ attitudes about radiology rotations. Acad Radiol 2012; 19: pp. 369-373.
3. Trout A.T., Wang P.I., Cohan R.H., et. al.: Apprenticeships ease the transition to independent call: An evaluation of anxiety and confidence among junior radiology residents. Acad Radiol 2011; 18: pp. 1186-1194.
4. Davenport M.S., Ellis J.H., Khalatbari S.H., et. al.: Effect of work hours, caseload, shift type, and experience on resident call performance. Acad Radiol 2010; 17: pp. 921-927.
5. Schumacher D.J., Slovin S.R., Riebschleger M.P., et. al.: Beyond counting hours: the importance of supervision, professionalism, transitions of care, and workload in residency training. Acad Med 2012; 87: pp. 883-888.
6. Borgstede J.P.: Professionalism. J Am Coll Radiol 2005; 2: pp. 873-874.
7. Trout A.T., Cohan R.H., Ellis J.H., et. al.: Teaching management of contrast reactions: does it work and how often do we need to refresh?. Acad Radiol 2012; 19: pp. 498-504.
8. Petscavage J.M., Paladin A.M., Wang C.L., et. al.: Current status of residency training of allergic-like adverse events to contrast media. Acad Radiol 2012; 19: pp. 252-255. Epub 2011 Dec 6. PMID:22153655
9. Richardson M.L., Petscavage J.M., Hunter J.C., et. al.: Running an online radiology teaching conference: why it’s a great idea and how to do it successfully. Acad Radiol 2012; 19: pp. 746-751.
10. Collins J., Hyde C., Gray L., et. al.: Association of Program Directors in Radiology Education Committee. Radiology resident evaluation: a form that addresses the six competencies of the accreditation council for graduate medical education. Acad Radiol 2002; 9: pp. 815-816.
11. D’Alessandro D.M., Kreiter C.D., Erkonen W.E., et. al.: Longitudinal follow-up comparison of educational interventions: multi- media textbook, traditional lecture, and printed textbook. Acad Radiol 1997; 4: pp. 719-723.
12. Phelps A., Naeger D.M., MacKenzie J., et. al.: Educating radiology residents in the new era: Implementation and evaluation of online end-of-rotation examinations. Acad Radiol 2011; 18: pp. 1442-1446.