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Development of a Competency-Based Radiology Clerkship Using Categorical and Statistical Analysis of Assessment
Abstract
Purpose
The purpose was to create and analyze a competency-based model of educating medical students in a radiology clerkship that can be used to guide curricular reform.
Methods
During the 2019 to 2020 academic year, 326 fourth-year medical students were enrolled in a 2-week required clerkship. An online testing platform, ExamSoft (Dallas, Texas), was used to test pre- and postinstruction knowledge on “must see” diagnoses, as outlined in the National Medical Student Curriculum in Radiology. Assessment analysis was used to compare the frequency with which the correct diagnosis was identified on the pretest to that on the posttest. At the end of the academic year, in addition to statistical analysis, categorical analysis was used to classify the degree of this change to uncover topics that students found most challenging.
Results
For 23 of the 27 topics (85%), there was a significant improvement in diagnostic accuracy after instruction in the test curriculum. Categorical analysis further demonstrated that the clerkship had a high impact in teaching 13 of the 27 topics (48%), had a lower impact for 6 topics (22%), and identified the remaining 8 topics (30%) as gaps in teaching and learning.
Conclusions
For medical students, our instructional program significantly increased competency for most critical radiologic diagnoses. Categorical analysis adds value beyond statistical analysis and allows dynamic tailoring of teaching to address gaps in student learning.
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Background
Currently, no national standard exists for educating medical students regarding radiography or formal research indicating the level of improvement regarding computed tomography (CT) interpretation of medical students during clinical rotations.
Methods
Students were evaluated based on their response to twenty-two open-ended questions regarding diagnosis and treatment of eleven de-identified CT images of life-threatening injuries. The number of incorrect answers was compared with correct or partially correct answers between students starting third-year clinical rotations and those starting their fourth year.
Results
Survey results were collected from 65 of 65 (100%) beginning third-year students and 9 of 60 (15%) beginning fourth-year students. Students in their fourth-year had less incorrect answers compared to third-year students, with five questions reflecting a statistically significant reduction in incorrect responses. The image with the least incorrect for both groups was epidural hemorrhage, 33.9% and 18.5% incorrect for third-year students for diagnosis and treatment, respectively, and 11.1% and 0% incorrect for fourth-year students. Outside of this image, the range of incorrect answers for third-year students was 75.4% to 100% and 44.4% to 100% for fourth-year students.
Conclusion
Baseline CT knowledge of medical students, regardless of clinical experience, indicated a strong deficit, as more students were incorrect than correct for the majority of CT images.
The ACR Task Force on Medical Student Education in Radiology, in partnership with the Alliance of Medical Student Educators in Radiology, investigated the current status of how and to what extent medical imaging was being taught in medical schools. The task force executed a 3-part survey of medical school deans, radiology department chairs, and intern physicians. The results provided an updated understanding of the status of radiology education in medical schools in the United States. This summary includes recommendations about how individual radiology departments and ACR members can assist in advancing the specialty of diagnostic radiology through medical student education.
Purpose:
An unmet need for radiology education exists even in this era of medical school curricular renewal. The authors examined the radiology clerkship requirements in Canadian and US medical schools to interpret radiology residency applicant trends.
Methods:
The curricula of Canadian and US medical schools were reviewed for radiology rotation requirements. The radiology residency applicant trends for 2010 to 2019 were analyzed using linear regression. The number of radiology electives taken by matched radiology applicants was examined. Regression analysis was performed to assess the impact of radiology rotation requirements on residency application.
Results:
Only 1 of 17 Canadian medical schools required a radiology rotation despite major curricular renewal at the majority of medical schools. Approximately 20% of US medical schools required radiology rotations, without a significant change from 2011 to 2018, whereas the duration of required radiology rotations increased significantly. The numbers of total and first-choice radiology applicants showed significant decreases from 2010 to 2019 in Canada but not in the United States. Nearly all matched radiology applicants took electives in radiology, the majority of whom took three or more electives. Both the presence and duration of radiology rotation requirements showed significant, positive relationships with the number of radiology applicants.
Conclusions:
Only a minority of medical schools in North America have radiology clerkship requirements, both the presence and duration of which significantly affect students' choice of radiology as a career. Radiology clerkship requirements can be a solution to meet the expanding demand for diagnostic imaging in modern medicine.
The purpose of the present study is to describe how undergraduate radiology teaching is organized in Europe and to identify important characteristics of undergraduate radiology curriculum.
An electronic survey on undergraduate teaching was distributed by the European Society of Radiology (ESR) to 38 national delegates of the ESR Education Committee.
The "classic type" of radiology teaching method is more frequent than the "modular type". In 38% of medical training centres the first experience with radiology is in pre-clinical years. The students enrolled in the fourth medical year experience the largest involvement in radiology education. The total number of teaching hours (mean 89 h, median 76 h) varies across the countries and differs depending on the radiological topic (mean across all topics 14.8h, median 13). Written tests and oral exams were the most frequently used examination modes. Clerkships are reported as a key part of training.
This first international comparative study of undergraduate radiological curriculum in Europe identifies a large number of differences in curriculum content and teaching methods throughout Europe. More research is needed to establish the radiological educational competences resulting from these differing curricula's to improve and to standardize the teaching according to (inter)national and institutional needs.
A questionnaire was administered to 238 students at four institutions before and after a radiology clerkship to evaluate student attitudes regarding radiology as a career, radiologist expertise, and clerkship expectations. There was no statistically significant difference among the clerkships, although they varied in types of experience, geographic location, and size. After the clerkship, the students agreed more strongly that the radiologist should be involved in patient workup, screening of requests, interpretation of emergency room films, and consultations. A significant change in attitude could be identified after the four-week experience, indicating a desire for the radiologist to have a more active role as imaging consultant.
We asked our nonradiologist colleagues to evaluate and comment on the most desirable format for radiology education.
Questionnaires were distributed to 631 nonradiologist physicians affiliated with the University of Minnesota and representing all medical specialties and academic ranks. Three hundred twenty-seven surveys were returned after one mailing.
Residency was retrospectively noted to be indispensable for consolidating knowledge of radiology. The overwhelming majority of clinicians in all specialties believed that formal radiologic instruction should be mandatory for medical students (279 of 322; 87%). Film interpretation was believed to be an indispensable part of a medical student radiology rotation (226 of 321; 70%), but many clinicians indicated a need for additional training. A marked disparity in the perceived level of confidence in interpreting radiologic tests during medical school and residency between those who had and those who had not received formal radiologic instruction during medical school was evident. This difference in perceived level of confidence was present even among the most experienced clinicians.
Collectively, the nonradiologist clinicians emphasized the need for a mandatory and clinically oriented radiology curriculum during medical school.
The purpose of this study was to adapt the technology of the World Wide Web to the teaching and evaluation of medical students participating in the radiology clerkship at our institution.
Teaching modules were placed on a local intranet site. One hundred two student evaluations were conducted online as a standardized, written- and image-based test that was administered both before and after the clerkship. The computer-delivered test consisted of 40 standardized questions that were sorted by category (based on American College of Radiology code criteria) and randomly administered from a pool of 200 potential questions. Scores from before and after the clerkship were analyzed statistically to evaluate the effectiveness of the educational program and the student performance. Student case presentation scoring and clerkship administration tasks were also evaluated both before and after implementation of the modules during the first 12 months of this project (July 1997 to July 1998).
A statistically significant (P < .001) improvement in test performance was found in 102 consecutive students, and all 102 students (100%) preferred the digital-testing format. The amount of time needed to tabulate the teacher evaluation, grade the test, and score the oral presentations decreased substantially with the digital system.
An intranet-based method of evaluating students in an ongoing fashion allows for additional growth in content and ease of use during the radiology clerkship.
The competency of medical students in radiology clerkships is traditionally evaluated with film images, projected slides of photographed films, or printed reproductions of films. As radiology departments switch to filmless imaging, it seemed appropriate to determine the feasibility of an electronic evaluation prepared directly from digital images.
The image-based portion of a multiple-choice final examination was prepared as a PowerPoint presentation that included images downloaded from the departmental picture archiving and communication system (PACS) or digital teaching collections. The images were downloaded as bitmap files, imported to Adobe Photoshop for image editing, converted to tagged image file format, and finally imported to PowerPoint, where they were combined with text to create 50 questions. A liquid crystal diode projector displayed the questions, with a timer set to advance them automatically.
The examination was easy and inexpensive to prepare (no photography costs). In an initial survey of 25 students, 17 (71%) of 24 students rated the resolution of images as excellent and five (21%) as good. No student gave an image a poor rating. Students preferred that images cover at least 40%-50% of the slides, and most approved of a blue background. An original allowance of 30 seconds per slide was reported to be too fast; the interval was increased to 45 seconds.
An electronic final examination for medical students, prepared with images downloaded from PACS or digital teaching collections, is feasible, easy to prepare, and cost-effective, and it provides an excellent display of test images.
The purpose of this study was to investigate the ability of medical students who had already completed medicine and surgery clerkships to identify life-threatening abnormalities on conventional chest radiographs.
From May 2000 to August 2001, 72 consecutive 3rd- and 4th-year medical students enrolled in the radiology clerkship at Rhode Island Hospital completed examinations before and after the radiology clerkship. During the examination, they were asked to identify acute abnormalities on five conventional chest radiographs. Only students who had already completed both medicine and surgery clerkships were included in this prospective study.
Before the radiology clerkship, the frequency of correct diagnoses of pneumothorax, pneumoperitoneum, congestive heart failure, misplaced endotracheal tube, and misplaced feeding tube were 40%, 61%, 57%, 6%, and 6%, respectively. After the radiology clerkship, these findings were correctly identified more than 94% of the time (P < .001).
Learning to identify life-threatening abnormalities on conventional chest radiographs through medicine and surgery clerkships is insufficient. The radiology clerkship provides a unique educational experience that significantly improves these abilities.
Students need to be taught radiology in a systematic and appropriate manner that differs from radiology resident education. There are multiple paths to achieve this, through integrated 4-year programs, required courses, and elective clerkships (or some combination thereof). It is hoped that the first version of the National Student Curriculum in Radiology will provide a valuable resource to both clerkship directors and students regardless of program format and will help standardize medical student education in radiology across the country.
A survey of radiology clerkships at teaching hospitals in the United States
- Barlev