Rationale and Objectives
To expose students in the premedical years to imaging and its indications, to enhance their understanding of pathologic processes by allowing direct visualization, and to teach physical diagnosis through an integrated, multispecialty approach.
Materials and Methods
A total of 166 second-year medical students participated in a novel imaging session that accompanied the physical diagnosis course they were concurrently enrolled in. Students were provided a didactic orientation to imaging and taught how to use Picture Archiving and Communications System software. The students then participated in interactive imaging sessions in which they were able to scroll through entire imaging cases of real, anonymized patients with accompanying clinical scenarios and physical examination findings.
Results
Of 89 students responding to an online curricular feedback questionnaire, 41% believed that the imaging correlated with the other information taught in the course and 46% found it was helpful to their learning. The majority of students (64%) believed that the sessions helped challenge them to think about physical diagnosis in a different way.
Conclusion
Physical diagnosis on the wards requires a multispecialty approach and the early introduction of this technique through the integrated mode of teaching we present will benefit students in their clinical years and future careers.
Over the past decade, there has been an increasing shift toward the integration of diagnostic radiology into the preclinical curriculum, particularly in gross anatomy. However, the time exclusively devoted to teaching anatomy through imaging remains low, with a recent survey of 60 US and Canadian medical schools indicating that only 5% of time is spent on radiologic anatomy ( ). Most efforts continue to focus on the use of radiology in basic science courses, but few have examined the role of radiology in enhancing the teaching of physical diagnosis to medical students.
As the role of imaging has taken the forefront in all arenas of clinical medicine, it has become imperative to begin the process of introducing radiology earlier in the medical school curricula. It has been documented that early exposure to radiology in problem-based learning modules improves medical students’ impression of radiology as a specialty and increases their interest in radiology as a career ( ).
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Materials and methods
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Course Overview
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Table 1
Imaging Cases
Diagnosis Imaging Provided Physical Exam Correlates Clinical Findings Multilobar PNA CXRs, CT Decreased breath sounds, consolidation Fever, chills, productive cough Pulmonary embolism CXR, CT, lower extremity US Decreased oxygen saturations, tachycardia, tachypnea Shortness of breath, leg pain Metastatic rectal cancer KUB, CT Rectal mass, hepatomegaly Weight loss, abdominal pain, blood in stool Appendicitis KUB, US, CT Tenderness at McBurney’s point RLQ pain, N/V/fevers Kidney stones KUB, CT Left CVA tenderness Flank pain, N/V/fever Tibial plateau fracture Plain film, CT Edema, left lateral knee tenderness Knee pain s/p fall Anterior shoulder dislocation Plain film, MR Decreased ROM, joint tenderness Shoulder pain Acute MCA stroke CT Right hemiparesis Right-sided weakness Ectopic pregnancy US RLQ pain, guarding Abdominal pain, LMP 8 weeks prior
PNA, pneumonia; CXR, chest x-ray; CT, computed tomography; US, ultrasound; KUB, kidney, ureter, and bladder; RLQ, right lower quadrant; N/V, nausea and vomiting; s/p, status post; MR, magnetic resonance; ROM, range of motion; MCA, middle cerebral artery; LMP, last menstrual period.
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Feedback Survey
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Results
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Table 2
Responses to Structured Questions
5 (Excellent) 4 3 (Average) 2 1 (Poor) N/A Questions related to format and content: How well did you feel prepared to look at the different modalities presented in each of the sessions prior to and following the didactic lectures ( n = 89) 4 (4%) 20 (22%) 36 (40%) 14 (16%) 15 (17%) Did the worksheets provide adequate direction for the case reviews? ( n = 89) 6 (7%) 28 (31%) 28 (31%) 16 (18%) 11 (12%) Too Much Too Little Balanced Did the sessions cover too much or too little material? ( n = 88) 32 (36%) 6 (7%) 50 (56%) 1 Questions related to your study of physical diagnosis: How well did the images match what you were learning in physical diagnosis? ( n = 87) 8 (9%) 28 (32%) 37 (43%) 6 (7%) 8 (9%) 2 How did these images help you correlate physical examination findings with imaging findings? ( n = 86) 7 (8%) 34 (38%) 29 (34%) 9 (14%) 5 (6%) 3 Yes No N/A Did these sessions challenge you to think in a different way about physical diagnosis? ( n = 83) 57 (64%) 26 (29%) 6 (7%)
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Table 3
Excerpts from Surveys
Positive Evaluations Negative Evaluations “The entire image view was helpful, and I liked how the software let us see different cuts and showed where on the body the coronal sections were.” “Consider having radiology residents/more attendings to help us through cases.” “Having spent 2 years in a Neuro-ICU helping coordinate a research study that followed SAH survivors, my knowledge of MRI and CT as yet very basic … this tutorial helped me learn more about how the rest of the body looks when imaged, and also introduced me to the fun part- playing with the screen controls and imaging parameters on the viewing program online. I loved that!” “Radiology should be spread out over the year when relevant to ongoing coursework.” “This was very helpful … it is good to start integrating material that we will need to know on wards and also to help us actually understand pathology rather than just memorize it.” “… I feel like smaller groups would work better to provide for adequate interaction between faculty and students when discussing the cases.” “It helped to see radiologic images in the context of an illness.” “I had radiology for the first time in this course and felt overwhelmed because we hadn’t yet learned any pathology.” “Since in class we only see one or two images per case, it was good to see the entire MRI or CT, not only the most important view.” “I think it would be better if there was some outside reference on reserve in the library we could just look at before going to a session.”
ICU: intensive care unit; SAH: subarachoid hemorrhage; MRI: magnetic resonance imaging; CT: computed tomography.
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Discussion
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Acknowledgments
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Appendix A
Sample Case
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Appendix B
Feedback Questionnaire
Radiology Session Thank you for your thoughtful, truthful answers to the following questions. Note that some of the questions relate to the format and content of the sessions and others relate to the impact of the material on your study of physical diagnosis. Please be as specific as you can with your answers and provide examples to support your comments when applicable. Questions related to format and content: Excellent 4 Average 2 Poor N/ A How well did you feel prepared to look at the different modalities presented in each of the sessions prior to and following the didactic lectures? Did the worksheets provide adequate direction for the case reviews? Did the sessions cover too much or too little material? Too much Too little Balanced In what way did viewing entire imaging cases help or hinder your learning of radiology and physical diagnosis? Any other comments/suggestions for improvement? Questions related to your study of physical diagnosis: Excellent 4 Average 2 Poor N/A How well did the images match what you were learning in physical diagnosis? How did these images help you correlate physical exam findings with imaging findings? Did these sessions challenge you to think in a different way about physical diagnosis? Yes No N/A In what way(s) did you benefit from/find useless the focus on image interpretation and imaging strategies? What is your overall impression of these sessions? Any other comments/suggestions for improvement?
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References
1. Ganske I., Su T., Loukas M., et. al.: Teaching methods in anatomy courses in North American medical schools: the role of radiology. Acad Radiol 2006; 13: pp. 1038-1046.
2. Branstetter B.F., Faix L.F., Humphrey A.L., et. al.: Preclinical medical student training in radiology: the effect of early exposure. AJR Am J Roentgen 2007; 188: pp. W9-W14.
3. Erinjeri J.P., Bhalla S.: Redefining radiology education for first-year medical students: shifting from a passive to an active case-based approach. Acad Radiol 2006; 13: pp. 789-796.
4. Schneider J.D., Noto R.B., McCarten K.M.: Importance of radiology clerkships in teaching medical students life-threatening abnormalities on conventional chest radiographs. Acad Radiol 2002; 9: pp. 217-220.
5. Bui-Mansfield L.T., Chew F.S.: Radiologists as clinical tutors in a problem-based medical school curriculum. Acad Radiol 2001; 8: pp. 657-663.
6. Shaffer K., Small J.E.: Blended learning in medical education: use of an integrated approach with web-based small group modules and didactic instruction for teaching radiologic anatomy. Acad Radiol 2004; 11: pp. 1059-1070.
7. Maleck M., Fischer M.R., Kammer B., et. al.: Do computers teach better: a media comparison study for case-based teaching in radiology. Radiographics 2001; 21: pp. 1025-1032.