Rationale and Objectives
Medical imaging education often has limited representation in formal medical student curricula. Although the need for greater inclusion of radiology material is generally agreed on, the exact skillset that should be taught is less clear. The purpose of our study was to perform a needs assessment for a national radiology curriculum for medical students.
Materials and Methods
We analyzed data from previous unpublished portions of the American College of Radiology/Alliance of Medical Student Educators in Radiology survey of Deans and Radiology Chairs regarding prevalence of radiology curricular revisions, assessment tools, use of the American College of Radiology Appropriateness Criteria, and resources used in curriculum revision. We also performed a literature search through both PubMED and a general search engine (Google) to identify available resources for designing and implementing imaging curricula and curricular revisions.
Results
Medical school deans and chairs reported a need for more overall radiology content; one of every six programs (15%) reported they had no recognized imaging curriculum. Of schools currently with imaging curricula, 82% have undergone revision in the last 10 years using a variety of different resources, but there is no universally agreed on guide or standard curriculum. The PubMED and Google searches identified only 23 and eight resources, respectively, suggesting a sizable deficit in available guidance; however, a single published medical student radiology curriculum is available through the Alliance of Medical Student Educators in Radiology.
Conclusions
There is a need, but few available resources, to guide educators in adding imaging content to medical school curricula. We postulate that a standardized national curriculum directed by a focused skillset may be useful to educators and could result in greater uniformity of imaging skills among graduating US medical students. A proposed skillset to guide a national curriculum in radiology is described.
Medical imaging has become a critical component of modern medical practice and diagnosis; however, imaging curricula in medical school education have not evolved at an equivalent pace. Medical imaging education, especially that emphasizing appropriate use of examinations has barely penetrated student training, raising the question as to whether US medical schools are adequately preparing students to be safe and efficient practitioners of evidence-based imaging . The recent American College of Radiology (ACR)/Alliance of Medical School Educators in Radiology (AMSER) white paper on the status of medical imaging education in the US and numerous prior studies have shown the relatively poor penetration and incorporation of imaging instruction into medical school curricula across the country. These studies have suggested that more, and better integrated, imaging education is desired by US medical school leadership.
Although there is some consensus that more imaging content is needed, the exact skillset that should be taught is less clear. The type of content currently being taught has only been described in a limited fashion in both the radiology and education literature. Of the information available, much of it has been just recently published; the ACR/AMSER survey showed large variability across 4-year medical school curricula in terms of subjects addressed. For example, 20% of Department Chairs stated that radiation safety was not taught in their medical school at any point in the curriculum. Eleven percent stated that diagnostic imaging algorithms (or “what should be ordered when”) were not covered. A surprising number of programs taught only about radiographs (21% did not cover computed tomography, 25% taught no ultrasound, 32% did not cover fluoroscopy, and 36% taught no magnetic resonance imaging) . Some authors have suggested that teaching medical students how to interpret advanced imaging modalities is unnecessary; however, students do need to understand when and why these modalities should be ordered to provide appropriate care for their patients as future practitioners , and for adequate United States Medical Licensing Examination (USMLE) preparation in the near term.
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Materials and methods
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Survey
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Literature Search and Internet Search
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Results
Survey Results
Formal Imaging Curriculum
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Resources Used in Curriculum Development
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Table 1
Deans and Chairs Responses to “In Your Most Recent Revision of the Medical Imaging Curriculum, What Resources Were Employed?”
The AMSER ∗ curriculum was consulted 24% (17/70) The AMSER ∗ curriculum was modified 11% (8/70) Other curricular resources were used 9% (6/70) Another standardized curriculum was used 3% (92/70) The AMSER ∗ curriculum was used verbatim 0% (0/70) Has never been revised 1% (1/70) Do not know 19% (13/70) No answer 41% (29/70)
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Table 2
Chairs Responses to “What Resources for Teaching Medical Imaging to Medical Students are Developed/Maintained within Your Radiology Department (if any)?”
Lectures 86% (49/57) Textbooks 79% (45/57) Tests 67% (38/570 Curricula 65% (37/57) Case databases 56% (32/57) Website(s) 51% (29/57) Interactive digital resources 51% (29/57) Quizzes 39% (22/57) Other 11% (6/57) None 2% (1/57) No answer 9% (5/57)
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Assessment of Imaging Skills
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Table 3
Chairs Responses to “How are Imaging Skills Assessed in Preclinical Courses?”
Assessment Method Preclinical Curriculum Clinical Curriculum Imaging questions on examination(s) in radiology courses (elective or required) 26% (15/57) 60% (34/57) Imaging questions on examination(s) in nonradiology courses 51% (29/57) 35% (20/57) OSCE 4% (2/57) 5% (3/57) Other 4% (2/57) 9% (5/57) Imaging not formally assessed 9% (5/57) 5% (3/57) Do not know 26% (15/57) 19% (11/57) No answer 7% (4/57) 7% (4/57)
OSCE, Objective Structured Clinical Examination.
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PubMED Search
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Table 4
Number of Curricular Resources Identified by PubMED and Google Searches
Content Subject PubMED Search Results Google Search Results Standardized medical school radiology curriculum 1 [Ref. ] 1 [Ref. ] Structure of curriculum 6 [Refs. ] 0 Suggested content 7 [Refs. ] 0 Curricular materials 1 [Ref. ] 3 [Refs. ] Guidelines for curriculum development 4 [Refs. ] 1 [Ref. ] Learning objectives 2 [Refs. ] 1 [Ref. ] Current practices 2 [Refs. ] 0 Assessment 0 2 [Refs. ]
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Google Search
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Discussion
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Proposed student skillset to guide a national curriculum
Communication and Test Selection
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Role of Imaging in the Health Care System
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Risks and Benefits of Imaging Studies
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Interpretation Basics
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Patient-Centered Imaging
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Demonstrate Proficiency in Core Basic Imaging Content
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Supplementary Concepts Targeted to Specialty of Choice
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Conclusions
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Supplementary data
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Appendix A
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