As I have written the history of radiology at now a dozen leading academic departments, I have noted several common challenges that never seemed to get solved or stay that way. One is the chronic underfunding of radiology until the last few decades, when it became clear to hospital administrators and deans that adequate radiology departments were “cash cows” and not drains on the institutional exchequer. Another was the chronic inadequacy of the film files and reporting systems to keep up with the growth of demand for imaging services. The challenge I want to discuss for a few paragraphs is the controversial matter of teaching radiology to medical students and other residents.
In the first decade of radiology, most academic institutions obtained an x-ray machine and designated some member of the staff to learn how to operate the machine and to interpret film and fluoroscopic images. Medical students who were interested could help and, in a few weeks, were as proficient as their mentors. By the second decade, radiology was established as a hospital service, usually within surgery or medicine, and the designated radiologists began to clamor for space in the medical curriculum. Considering that x-ray images were and still are a primary technique of teaching anatomy, there is little documentation that anatomists embraced the new technology or that radiologists had regular roles in anatomy classes.
In Henry Pancoast’s department at the University of Pennsylvania, the dozen hours assigned to radiology in the medical curriculum amounted to lectures and demonstrations of the techniques of x-ray imaging and its application to general categories of disease. One lecture covered radiation treatment for cancers. A few elective hours of observation in the department were offered. That was fairly typical. How much surgeons or internists used images in their teaching was never documented in annual reports or other sources.
That leads to the century-old discussion of the reasons for teaching radiology to medical students. Some of the reasons have not changed.
1 Medical students opting for other medical disciplines are the customers for radiology referrals. They need to know about the capabilities of new radiological techniques to help diagnose their patients.
2 Some medical students need to be attracted to the career opportunities in radiology, else the specialty would have vanished long since.
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