Rationale and Objectives
The purpose of this study was to identify radiology topics considered essential by residency program directors who will be working with our graduates. Secondary goals were to survey their satisfaction with incoming residents’ radiology knowledge, inquire if radiology training was provided in their programs, and identify differences among specialties.
Materials and Methods
A questionnaire was mailed to all residency program directors in emergency medicine, family medicine, internal medicine, pediatrics, and general surgery programs that accepted our graduates between 2005 and 2010. Program directors were asked to rate a list of radiology knowledge and skills topics as essential or nonessential and to answer several questions regarding their residents and programs.
Results
Ninety-nine surveys were completed (51.3% response rate). Seven skills were considered essential by 90% or more of all respondents. On average, program directors identified 18/28 topics as essential prior to beginning their residency. The mean number identified as essential did not differ by program (F 4, 93 = 0.732, P = .572). Based on analyses of variance comparing each topic by program, the importance of six topics differed significantly. Program directors generally agreed that incoming residents had adequate radiology skills and knowledge when they started their residencies. One hundred percent of the responding emergency medicine, family medicine, and pediatrics programs and 70% to 80% of the general surgery and internal medicine programs provide radiology training.
Conclusion
There is high agreement among program directors regarding imaging topics they consider essential. Topics considered essential by more than 60% should comprise our core curriculum for all students while less essential topics can be included in elective or program specific curricula.
The use of imaging in clinical care has substantially increased in recent years , and radiology’s role continues to expand as fast as new technologies grow. In the past decade, diagnostic imaging services grew at about twice the rate of other health care technologies, including laboratory procedures and pharmaceuticals . Because of these technological advances in medical imaging, radiology has become integral to patient care and clinical management. Radiological studies help clinicians visualize their patient’s internal anatomy and narrow differential diagnoses. In addition, minimally invasive image-guided procedures offer definitive therapy. Most medical specialties routinely use medical imaging; thus, medical students need at least a basic understanding of radiological concepts including appropriate imaging utilization and image interpretation.
The Liaison Committee on Medical Education, in the accreditation standards for medical schools, states, “Educational opportunities must be available…in the disciplines that support general medical practice (eg, diagnostic imaging)” . The Liaison Committee on Medical Education does not specify curricular content, how or when this training should occur, by whom it should be taught, or how these opportunities should be achieved or assessed. The Alliance of Medical Student Educators in Radiology (AMSER) has published a National Medical Student Curriculum in Radiology that provides an overarching compendium of possible radiology topics. A valuable educational resource, this document is intended to be used as a resource guide by programs to develop their own curriculum. It will help standardize medical student education in radiology, but is not itself a standardized curriculum.
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Method and materials
Sample and Design
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Questionnaire
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Analysis
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Results
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Table 1
Distribution of Program Directors by Specialty and National Residency Match Program Geographic Regions
Specialty Western Region, n (%) Central Region, n (%) Southern Region, n (%) North Eastern Region, n (%) Emergency medicine 5 (31.3) 3 (18.8) 3 (18.8) 5 (31.3) Family medicine 14 (73.7) 1 (5.3) 3 (15.8) 1 (5.3) Internal medicine 8 (28.6) 9 (32.1) 5 (17.9) 6 (21.4) Pediatrics 6 (27.3) 9 (40.9) 2 (9.1) 5 (22.7) General Surgery 7 (50) 2 (14.3) 3 (21.4) 2 (14.3) Total 40 (40.4) 24 (24.2) 16 (16.2) 19 (19.2)
Table 2
Distribution of Program Directors by Specialty and Program Setting
Specialty University Programs, n (%) Community Programs—University Affiliated, n (%) Community Programs, n (%) Military Programs, n (%) Emergency medicine 7 (43.8) 8 (50.0) 1 (6.7) 0 (0.0) Family medicine 1 (5.3) 7 (36.8) 8 (34.2) 3 (15.8) Internal medicine 20 (71.4) 6 (21.4) 0 (0.0) 2 (7.1) Pediatrics 15 (68.2) 7 (31.8) 0 (0.0) 0 (0.0) General surgery 6 (42.9) 5 (35.7) 3 (21.4) 0 (0.0) Total 49 (49.5) 33 (33.3) 12 (12.1) 5 (5.1)
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Table 3
Percent of Program Directors Rating Skills as Essential, by Program and Overall
Skill Percent Essential ∗ EM FM IM Peds GS All Recognize common abnormal findings on: chest x-rays93.8 100.0 100.0 100.0 100.0 99.0 A systematic approach to viewing: chest x-rays87.5 100.0 100.0 100.0 100.0 98.0 Communicate relevant clinical history when ordering a radiologic study80.0 100.0 96.4 95.5 92.9 93.8 Ability to choose the most appropriate radiologic study for workup of common clinical situations in your field81.3 94.7 100.081.0 100.0 91.8 Basic knowledge of the limitations of radiologic studies86.7100.0 89.3 90.9 92.9 91.8 Recognize common abnormal findings on: abdominal x-rays81.3 94.7 89.3 90.9100.0 90.9 A systematic approach to viewing: abdominal x-rays66.7 100.0 89.3 95.5 100.0 90.7 Ability to effectively communicate with patients about radiologic studies and procedures93.8 88.9 82.1 81.878.6 84.7 Basic knowledge of radiologic anatomy93.8 78.9 85.776.2 78.6 82.7 Ability to interpret a radiologist’s report86.7 78.9 78.686.4 78.6 81.6 Ability to use radiologic findings to narrow a differential diagnosis 86.794.7 75.068.2 78.6 79.6 Recognize common abnormal findings on: bone and joint x-rays 93.894.757.1 68.2 85.7 76.8 Basic knowledge of the indications for use of contrast media53.3 84.2 82.1 63.692.9 75.5 Basic knowledge of the radiation risks of imaging studies 80.0 72.2 71.490.957.1 75.3 A systematic approach to viewing: bone and joint x-rays 81.3 83.357.1 71.485.7 73.2 Ability to choose cost effective radiologic studies for clinical situations 64.378.953.6 59.1 71.4 63.9 Basic knowledge of radiation safety 64.3 61.1 60.768.250.0 61.5 Recognize common abnormal findings on: head CT71.452.9 64.3 57.1 57.1 60.6 A systematic approach to viewing: head CT 46.7 47.164.366.7 50.0 56.8 Understanding of the approximate costs of common radiographic studies 60.061.1 57.1 54.550.0 56.7 A systematic approach to viewing: abdomen/pelvis CT 40.025.0 46.4 38.178.6 44.7 Recognize common abnormal findings on: abdomen/pelvis CT 35.723.5 53.6 38.164.3 43.6 A systematic approach to viewing: chest CT 33.318.8 51.9 40.064.3 42.4 Recognize common abnormal findings on: chest CT 35.717.657.1 23.8 50.0 38.3 Recognize common abnormal findings on: abdomen US40.0 17.6 21.49.5 21.4 21.1 A systematic approach to viewing: abdomen US31.3 20.011.1 19.0 28.6 20.4 Recognize common abnormal findings on: pelvis US40.0 17.6 18.59.5 23.1 20.4 A systematic approach to viewing: pelvic US31.3 20.011.1 14.3 28.6 19.4
CT, computed tomography; EM, emergency medicine; FM, family medicine; GS, general surgery; IM, internal medicine; Peds, pediatrics; US, ultrasound.
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Table 4
Means and Standard Deviations for Number of Core Topics, Overall and by Program
Program_n_ Mean Standard Deviation Emergency medicine 16 17.56 4.98 Family medicine 19 17.53 5.06 Internal medicine 28 18.21 5.32 Pediatrics 22 17.32 4.79 General surgery 14 19.57 3.94 Overall total 99 17.97 4.88
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Table 5
Means and Standard Deviations for Core Topics that Differ by Program
Program Topic Emergency Medicine Family Medicine Internal Medicine Pediatrics General Surgery ANOVA M SD M SD M SD M SD M SD F_P_ Ability to choose the most appropriate radiologic study for workup of common clinical situations in Your field0.81 0.400.95 0.231.00 0.000.81 0.401.00 0.002.491 .049 A systematic approach to viewing: Chest x-rays0.88 0.341.00 0.001.00 0.001.00 0.001.00 0.002.744 .033 Abdominal x-rays0.67 0.491.00 0.000.89 0.320.95 0.211.00 0.003.885 .006 Abdomen/pelvis CT0.40 0.510.25 0.450.46 0.510.38 0.500.85 0.383.073 .020 Recognize common abnormal findings on: Bone and joint x-rays0.94 0.250.95 0.230.57 0.500.68 0.480.85 0.383.662 .008 Abdomen/pelvis CT0.36 0.500.18 0.390.57 0.500.24 0.440.54 0.522.789 .031
ANOVA, analysis of variance; CT, computed tomography; M, mean; SD, standard deviation.
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Table 6
Incoming Residents (PGY1) to My Program Have Adequate Radiology Skills and Knowledge When They Start the Program
Specialty Strongly Disagree (%) Disagree (%) Agree (%) Strongly Agree (%)n Median Mean Standard Deviation Emergency medicine 0 (0) 5 (31.3) 10 (62.5) 1 (6.3) 16 3 2.75 0.58 Family medicine 0 (0) 2 (11.1) 13 (72.2) 3 (16.7) 18 3 3.06 0.54 Internal medicine 0 (0) 16 (57.1) 12 (42.9) 0 (0) 28 2 2.43 0.50 Pediatrics 0 (0) 7 (31.8) 15 (68.2) 0 (0) 22 3 2.68 0.48 General surgery 0 (0) 5 (41.7) 7 (58.3) 0 (0) 12 3 2.58 0.51 Total 0 (0) 35 (36.5) 57 (59.4) 4 (4.2) 96 3 2.68 0.55
1, strongly disagree; 2, disagree; 3, agree; 4, strongly agree.
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Table 7
Type of Physician Who Provides Radiology or Image Interpretation Instruction during Residency
Radiologist (%) Non-radiologist (%) Both (%) Emergency medicine ( n = 16) 2 (12.5) 8 (50.0) 6 (37.5) Family medicine ( n = 19) 6 (31.6) 1 (5.3) 12 (63.2) Internal medicine ( n = 22) 8 (36.4) 5 (22.7) 9 (40.9) Pediatrics ( n = 22) 10 (45.5) 0 (0) 12 (54.5) General surgery ( n = 10) 2 (20.0) 3 (30) 5 (50.0) Total ( n = 89) 28 (31.5) 17 (19.1) 44 (49.4)
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Discussion
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Acknowledgments
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Appendix 1
Questionnaire
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I. If you were to design a medical school curriculum, what RADIOLOGY topics do you think should be CORE knowledge and skills PRIOR to graduation from medical school? Your answers should reflect the knowledge and skills that you believe all interns who enter your program should have prior to arriving.
Essential Nonessential1. Ability to choose the most appropriate radiologic study for workup of common clinical situations in your field 1 22. Basic knowledge of the limitations of radiologic studies 1 23. Communicate relevant clinical history when ordering a radiologic study 1 24. Basic knowledge of the radiation risks of imaging studies 1 25. Ability to use radiologic findings to narrow a differential diagnosis 1 26. Basic knowledge of the indications for use of contrast media 1 27. Ability to choose cost effective radiologic studies for clinical situations 1 28. Basic knowledge of radiologic anatomy 1 29. Ability to interpret a radiologist’s report 1 210. Understanding of the approximate costs of common radiographic studies 1 211. Ability to effectively communicate with patients about radiologic studies and procedures. 1 212. Basic knowledge of radiation safety 1 213. A systematic approach to viewing: a) Chest x-rays 1 2 b) Abdominal x-rays 1 2 c) Bone and joint x-rays 1 2 d) Chest computed tomography (CT) 1 2 e) Abdomen/pelvis CT 1 2 f) Head CT 1 2 g) Abdomen ultrasound (US) 1 2 h) Pelvic US 1 214. Recognize common abnormal findings on: a) Chest x-rays 1 2 b) Abdominal x-rays 1 2 c) Bone and joint x-rays 1 2 d) Chest CT 1 2 e) Abdomen/pelvis CT 1 2 f) Head CT 1 2 g) Abdomen US 1 2 h) Pelvis US 1 215. Other essential content you would recommend?
II. Incoming residents (PGY 1) to my program have adequate radiology skills and knowledge when they start the program. Please select one. Strongly Disagree Disagree Agree Strongly Agree
III. Do residents receive training in radiology or image interpretation in your program? Yes No N/A If yes, who provides this instruction? Radiologist Non-radiologist Both
IV. Please list the specialty of your program: ____________________________________________________
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