Educational Infrastructure for Radiology Residency Programs
Article Outline
- Libraries
- Computer Network
- Teaching Files
- Conference Rooms
- Digital Educational Media Laboratory
- Web Site
- References
- Copyright
A radiology residency program cannot exist without an educational infrastructure. In this article, educational infrastructure refers not to the clinical resources of a department (eg, magnetic resonance imagers, radiographic rooms, interpretation areas) but rather to the educational resources shared by faculty and residents for teaching and learning. These include libraries, computer and network resources, teaching files, conference rooms, digital media laboratory, and Web sites. This article describes these resources not only in relation to Accreditation Council for Graduate Medical Education (ACGME) requirements Fig 1(1, 2) but also in relation to best practices. Educational infrastructure may also refer to the organizational features of a department or institution that support education, such as leadership positions or committee structure (3, 4), but these aspects of infrastructure are not discussed herein.
Figure 1.
ACGME requirements for educational infrastructure (2)
Libraries
No educational program in any field should be without books. An institutional library is required by the ACGME for radiology residency programs and will typically be the medical school library, for a university-based residency program, or the hospital library, for a community-based program. The importance of physical access to the institutional library has diminished as reference resources have become available via the Internet. The ACGME program information form inquires about the distance of the radiology department to the institutional library Fig 2 but does not ask about the size or resources of the library.
Figure 2.
ACGME educational infrastructure as specified on the program information form (1)
Although radiologists cannot affect the location of the library, they should take an active role in recommending relevant books and journals for the library's collections. The number of such books and journals depends on the size and resources of the institution. Medical school and hospital libraries have been under the same financial pressures as academic medical centers in general, with rising costs, increasing demands, and decreasing budgets. As a cost-saving measure, institutional libraries may seek to reduce the duplication of books and journal subscriptions by coordinating their purchases with departmental libraries. An absolutely minimal list of recommended radiology journal subscriptions would include Academic Radiology, American Journal of Roentgenology, RadioGraphics, and Radiology. Multispecialty radiology journals with full text and illustrations are also available on the Web. As a general rule, if the necessary volumes are not owned by the institutional library, the radiology department should recommend them for purchase or acquire them for the department library. The typical reading room in an academic setting has reference books and at least one computer with Internet access. ACGME requirements still specify the physical existence of institutional and departmental libraries.
Many radiology departments are spread over multiple locations. The ACGME is concerned with access to books and other library materials, rather than specific criteria for number of volumes, distance from the department, and hours open. With the increasing availability of educational resources via the Internet and intranet, access to a networked personal computer is assuming the role of the traditional library. The ACGME requires 24-hour access to an on-site department library or collection of journals, references, and resource materials at each institution participating in the residency program (2). Given the amount of materials available via the Internet, providing appropriate Internet access may satisfy the requirement for availability.
In general, the availability of teaching materials (eg, books) is one important difference between a service rotation and an educational rotation. Areas such as the emergency room and other on-call reading rooms should have the latest books. Sometimes it is necessary to secure them physically to ensure their continued availability. The departmental educational budget should include money for maintaining the library collection. Each reading room should have its own collection of reference books. A system should be in place to ensure that books are available and circulate. Each section or rotation can be responsible for one or two books that are issued to residents as they rotate on the service and that are turned in at the end of the rotation, available for the next resident.
At Wake Forest University, Winston-Salem, NC, the institutional library handles the high-demand radiology books. The library takes responsibility for checking books out, retrieving them, sending overdue notices, and collecting fines. Books circulate better because there is no underground passing around of books among residents without checking them out or returning them to the library. Also, through the computerized card catalog, one can check the status of any individual book and reserve it for when it is returned. Library fines of $1 per day seem to provide a deterrent to keeping books past the due date. The radiology department has in effect become the purchaser of new radiology textbooks for the library, and in exchange the library provides cataloging and circulation services. The department decides what to buy, buys it, and then sends it over to the institutional library for cataloging and placement into circulation. The department, however, retains the option to retrieve the book for reshelving in the departmental library.
Computer Network
Clinical computer systems such as the hospital information system, the radiology information system, and the picture archiving and communication system (PACS) have educational value. The presence of a PACS makes every clinical case a potential teaching case, because the images are widely and simultaneously available (5, 6). Conferences can be simplified by maintaining lists of cases rather than having to pull cases physically out of the stream of patient care. The radiology or hospital information system can become a key component in maintaining individual logs of case experience. These systems also have the potential to monitor the case experience of all residents (7) and allow a program to make adjustments in rotations and resident deployment.
Internet connectivity is important for bringing library-type resources to the reading stations so that residents have ready access to information. Key sites include the institutional library and PubMed at the National Library of Medicine (www.ncbi.nih.gov/entrez/query/fcgi). A search engine such as Google (www.google.com) can be invaluable in locating other resources, and the RSNALink (www.rsna.org) and journal sites also are helpful. Educational resources accessed over the Internet are generally available at all times to all users, unlike nondigital books, which may become lost or misplaced.
Teaching Files
The ACGME requirements for teaching files are as follows: Teaching files (electronic or film) of cases related to all aspects of diagnostic radiology must be available for use by residents. Aggregates of these files should contain a minimum of 1,000 cases that are actively maintained and continually enhanced with new cases. The American College of Radiology (ACR) learning file or an equivalent should be available to residents but only partially meets the teaching file requirements (2). The requirement for teaching files in addition to the ACR learning file can be met through a combination of departmentally created files, purchase of commercial files, and files available online free of charge at numerous Internet sites (8).
From an educational viewpoint, the ideal teaching file is complete, comprehensive, and universally available at all times, with multiple points of access (9). To meet these criteria, a teaching file must be electronic and available over a computer network. The simplest way of providing such a resource is to purchase the ACR Learning Files on CD-ROM (institutional or multiuser network version) and place the CD-ROMs on a jukebox with network access Fig 3. In this way, everyone has access, even dial-in (now being replaced by virtual private network) access from remote sites or home. It is only necessary to purchase one copy of each CD, and there is no loss of the materials. Although it is easy to make unauthorized copies of copyrighted CD-ROMs by using CD-R technology, the department can prevent this illegal activity by retaining physical control of the CDs.
Figure 3.
Screen shot of access dialog for teaching materials maintained on CD-ROM server (Metaframe Server, Citrix Systems, Ft Lauderdale, Fla)
Locally created teaching files also should be made available in digital format. In addition to providing easier access and greater availability, digital files are ultimately less expensive than copying, cataloging, and storing radiographic films. How many cases are necessary? Beyond the ACGME required minimum of 1,000 cases, the appropriate number is a judgment for the faculty, based on what they deem necessary to cover each area and on their resources for compiling a teaching file. Ten areas of radiology are recognized by the American Board of Radiology, and one can estimate that each area would require 200–600 cases for reasonably complete coverage, so the total teaching file might need at least 2,000 cases. To create such a teaching file quickly, one can ask the faculty in each area to contribute cases. Most experienced faculty will have extensive teaching files. It is also a good idea to involve the residents and clinical fellows and require them to prepare and submit a minimum number of teaching file cases per year. One can also have a periodic teaching file case conference in which cases are presented before being added to the teaching file. Medical students rotating through radiology can also be required to submit teaching file cases. Through all of these strategies, a substantial teaching file can be accumulated within a very short time.
What about purchasing teaching files? The ACR Learning Files have been available on CD-ROM for several years. The initial editions were digitized versions of the original film files or videodiscs, which compromised image quality. However, the updated editions contain mostly new material. I recommend that a network license be purchased for each module. Making the ACR Learning Files available to all residents over a computer network has been shown to be educationally useful (10), and this approach prevents theft or loss while providing equal access. Teaching files are also available from commercial publishers in a variety of subspecialty areas. Multiuser network licenses are generally available for commercial products. Teaching files in book form are also available and highly popular with residents. In addition, there are a variety of software tools for creating digital teaching files (11).
Conference Rooms
A good radiology conference room comfortably provides the technology necessary to display radiologic images for teaching (12). The ideal conference room has sufficient space and seating but is not so large that it becomes difficult to see and hear or to foster discussion. Digital projection has become standard, and a built-in ceiling-mounted liquid crystal display projector has become a necessity. Connections for a laptop computer are essential; it is better yet to have both laptop connections and a permanently sited computer with network and Internet access. Network access should include PACS, so that the conference room can be used for clinical conferences in which patient imaging studies can be displayed and reviewed.
Facilities for projecting radiographic film images have become much less important and can be expected to become irrelevant for most departments over the next few years. These have often been expensive optical or video systems that are challenging to use. A simple overhead projector of reasonable quality is sufficient for the needs of most departments in the process of converting to fully digital classrooms. There should also be facilities for displaying digital videodiscs, videotapes, and Web casts. Many faculty members still maintain extensive teaching materials on 35-mm slides, and for now the requisite projectors should be kept. Laser pointers are often difficult to keep, but fortunately their price has been decreasing dramatically.
Digital Educational Media Laboratory
Every academic department should have facilities for creating digital teaching materials. In the past, a photography laboratory was required in order to make 35-mm slides for teaching and photographic prints for publication. Although this sort of laboratory is no longer necessary, a digital laboratory is now required. A separate physical space is highly desirable but not absolutely necessary, as computer networking enables the efficient creation of a virtual digital educational laboratory. Recommended peripheral computer equipment for the digital imaging laboratory is listed in Figure 4. The equipment needed for the transition from analog to digital imaging includes equipment for digitizing radiographic film images (film scanner) and for digitizing 35-mm slide images (slide scanner). Computers that can support these peripherals are needed, and they should be equipped with photo-editing software. Also necessary are a flatbed scanner, a high-quality photographic printer for preparing illustrations for publication, and access to a large-format printer for creating educational exhibits. Large-format printing services are commonly available from commercial establishments. It is critical to have someone who knows how to use the equipment and who is knowledgeable about digital imaging. Most of this equipment is easy to use, and secretaries can learn the skills necessary to create digital materials. Network storage is critical for moving large image files from computer to computer.
Figure 4.
Peripheral computer equipment recommended for digital educational media laboratory
Web Site
Many radiology departments have their own Web site. The Web site should reflect the manner in which the department wishes to present itself to the outside world. Departmental Web sites commonly include descriptions of the clinical services offered, descriptions of the educational programs, lists of faculty, a table of organization, personnel directory, descriptions of research programs, and links to the institution and city. The radiology department Web site for Wake Forest University is shown in Figure 5 and can be found atwww.rad.wfubmc.edu.
Figure 5.
Radiology department Web site for Wake Forest University School of Medicine (www.rad.wfubmc.edu)
A prominent part of the Web site should be a Web page for the residency program. Prospective applicants for training at all levels commonly learn about a department from its Web site. The Web page for the residency program should contain specific information about educational programs and facilities, including the application process and the selection criteria. A full-text version of a residency manual can be placed on the Web site, eliminating the need for hard-copy versions. Many institutions have already replaced hard-copy recruitment and application materials with Web-based versions. The Web site should also include contact information (e-mail, fax, and voice) for the person responsible for receiving applications.
References
- References
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PII: S1076-6332(03)80158-7
doi:10.1016/S1076-6332(03)80158-7
© 2003 Acad Radiol. Published by Elsevier Inc. All rights reserved.
