Learning and Retaining Normal Radiographic Chest Anatomy

Rationale and Objectives

Although most would concur that preclinical exposure to radiology is a desirable goal, specific learning objectives have been more difficult to delineate. It is also important to assess what is learned and to determine how well it is retained or “retrievable.” This study was developed in an attempt to document the extent to which specific measures of preclinically acquired knowledge may be retained and retrieved for later clinical application.

Material and Methods

The Anatomic Structure Identification Quiz (ASIQ, or Quiz), previously described in Feigin et al ( Academic Radiology 2005) was administered to 236 medical students at the conclusion of the required second-year course, as a 10-item written Quiz based on a projected frontal and lateral chest image. The 10-item Quiz was also administered to 555 senior medical students (194 of which had been included in previous work) on the first day of the Uniformed Services University of the Health Sciences basic radiology elective. Finally, the identical Quiz was completed by 74 of these 555 senior medical students at the conclusion of the academic portion of the elective, approximately 3 weeks after the administration of the first quiz.

Results

The second-year students scored a mean of 7.15 points of a possible 10 points with a standard deviation (SD) of 1.42. The senior students completing the quiz at the beginning of the elective scored an average of 4.42 (SD 1.34) compared to a score of 8.65 (SD 1.24) 3 weeks later.

Conclusion

Long-term recall of specific radiologic structures learned in the second year of medical school was poor despite evidence documenting good initial (short-term) retention of tested information. However, after a brief review, consisting of the Quiz itself, followed by 3 weeks of general radiology emphasizing abnormal chest imaging, the senior students demonstrated a near doubling of their ability to correctly identify these structures, as well as an improvement compared with scores obtained during the second year. Thus the value of a preclinical course in radiology may be not only to teach principles of radiology and to stimulate interest in the discipline, but also, by repetition and reinforcement, to facilitate and possibly improve later recall and retention of important radiographic material.

Radiology departments at many training institutions strive to include radiology in the medical curriculum as early as possible ( ). This is done in an effort not only to acquaint medical students with imaging and its role in medicine, but also to stimulate interest in and awareness of radiology as a possible career path ( ). The initial exposure to radiology in many medical schools may occur in the freshman course, with radiology also encountered as part of many other rotations or courses, or as a specific required or elective curriculum item. The content typically focuses on or starts with normal anatomy as it appears on images.

Regardless of the form or depth of radiology involvement in the preclinical curriculum, it is essential that specific goals and objectives be defined ( ), and that several questions be answered: 1) Is the goal of learning specific features of radiographic anatomy in the preclinical years a valid objective? 2) Are students being taught clinically useful information that can later be recalled, and therefore used, in the clerkship years and beyond? Or, 3) Is the value of preclinical radiology teaching primarily limited to the less tangible benefits of “exposure” to radiologists and to imaging as a potential career?

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Materials and methods

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Table 1

Results of Anatomy Quiz

n Mean Score Standard Deviation Second year 36 7.15 1.42 Fourth year—before review 555 4.42 1.34 Fourth year—after review 748 651 24

All pairwise results significant, P < .001, Student t -test.

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Results

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Table 2

Goals—Second-Year Radiologic Interpretation Course

Become an “educated consumer” of radiology consultation and services Learn the basics of chest film review Develop an approach to the radiologic evaluation of skeletal trauma Understand the fundamentals of emergent evaluation of radiographs for the acute abdomen Understand the computed tomography and plain film evaluation of head injury Understand the computed tomography and plain film evaluation of neck injury Learn the Indications for mammographic screening Develop an introductory understanding of radiation medicine and oncology Develop an introductory understanding of nuclear medicine studies

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Discussion

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Table 3

Objectives—Second-Year Radiologic Interpretation Section on Normal Chest Film Analysis

Define the terms used frequently to describe normal and abnormal structures on chest radiographs. Use the “Rules of Visibility” to locate and identify normal structures on chest radiographs. Describe the appearance and components of the normal hilum on both frontal and lateral chest radiographs. Recognize the normal pulmonary markings on chest images. Trace the image of the normal large airways on frontal and lateral radiographs. Locate and identify all the “Required Structures” on frontal and lateral chest radiographs. Demonstrate the ability to completely search the frontal and lateral chest radiographs for abnormalities by using the system described in class and on the handout, “Chest Film Search Pattern.”

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References

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Learning and Retaining Normal Radiographic Chest Anatomy

Rationale and Objectives

Material and Methods

Results

Conclusion

Materials and methods

Results

Discussion

References

Further Reading

Abstracts of Funded National Institutes of Health Grants

Apparent Diffusion Coefficient of Subcutaneous Epidermal Cysts in the Head and Neck

Computer-Assisted Mammography Feedback Program (CAMFP)