Advertisement

Perspective: Mandatory Radiology Education for Medical Students

Published:November 19, 2022DOI:https://doi.org/10.1016/j.acra.2022.10.023

      Highlights

      • This paper reviews the current state of radiology education in US medical schools and discusses the rationale for a mandatory radiology curriculum taught by radiologists.
      • With increased emphasis on value-based care and patient outcomes, students should learn appropriateness criteria, imaging safety, costs of imaging tests and economic implications of overutilization.
      • Increasing radiologist teaching and engagement with students may improve diversity and inclusivity in radiology by increasing interest in the specialty by underrepresented minorities (URMs).
      Radiology education of medical students is increasingly important given the intersection of radiology with virtually all medical specialties and integral role of imaging in modern patient care. Yet radiology education requirements in US medical schools are variable with only a minority of schools requiring a clerkship in radiology. When required, the radiology curriculum is often limited to anatomy courses in the preclinical years or partially incorporated into required core clerkships and often taught by nonradiologists. Given the growing mandate for value-based care and emphasis on patient outcomes, medical students require better imaging education, both interpretive and non-interpretative skills. They should be taught how to apply appropriateness criteria for exam ordering and the relative costs of different imaging modalities given the economic implications of imaging overutilization. Medical students should also be educated regarding imaging safety considerations. In addition, they must learn the radiologist's role as consultant to assure appropriate ordering of imaging studies, oversight for performance of diagnostic exams and image-guided procedures, interpretation of studies, and communication of results.
      Increasing radiologist teaching and engagement with medical students also has the potential to improve diversity and inclusivity in radiology by increasing interest in the specialty as physicians who identify as underrepresented minorities (URMs) are more likely to practice in underserved areas and with underserved populations thus addressing healthcare disparities and improving access to healthcare for those patient populations.
      Medical schools should support preclinical and clinical curricula that is designed and taught by radiologists.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. AAMC Curriculum Reports: Clerkship requirements by discipline. Available at https://www.aamc.org/data-reports/curriculum-reports/interactive-data/clerkship-requirements-discipline. Accessed February 8, 2021.

      2. AAMC Curriculum Reports: Content documentation as independent course or part of an integrated course. Available athttps://www.aamc.org/data-reports/curriculum-reports/interactive-data/content-documentation-independent-course-or-part-integrated-course. Accessed February 8, 2021.

        • Duffy TP.
        The flexner report–100 years later.
        Yale J Biol and Med. 2011; 84: 269-276
        • Flexner A.
        Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching.
        Merrymount Press, 1910
        • Bradley WG.
        History of medical imaging.
        Amer Philosoph Soc. 2008; 152: 349-361
        • Giardino A
        • Gupta S
        • Olson E
        • et al.
        Role of imaging in the era of precision medicine.
        Acad Radiol. 2017; 24: 639-649
        • Chan S.
        The importance of strategy for the evolving field of radiology.
        Radiol. 2002; 224: 639-648
        • Bardeen CR.
        The use of radiology in teaching anatomy.
        Radiol. 1927; 8: 384-386
        • Phillips AW
        • Smith SG
        • Straus CM.
        The role of radiology in preclinical anatomy: a critical review of the past, present, and future.
        Acad Radiol. 2013; 20: 297-305
      3. AAMC Curriculum Reports: Clerkship week requirements by curriculum year. Available at https://www.aamc.org/data-reports/curriculum-reports/interactive-data/clerkship-week-requirements-curriculum-year. Accessed February 8, 2021.

        • Poot JD
        • Hartman MS
        • Daffner RH.
        Understanding the US medical school requirements and medical students’ attitudes about radiology rotations.
        Acad Radiol. 2012; 19: 369-373
        • Straus CM
        • Webb EM
        • Kondo KL
        • et al.
        Medical student radiology education: summary and recommendations from a national survey of medical school and radiology department leadership.
        J Am Coll Radiol. 2014; 11: 606-610
        • Smith-Bindman R
        • Kwan ML
        • Marlow EC
        • et al.
        Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016.
        JAMA. 2019; 322: 843-856
      4. Centers for Medicare and Medicaid Services. Part B national summary data file (previously known as BESS). Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Part-B-National-Summary-Data-File/Overview. Accessed September 29, 2020.

        • Nadgir R
        • Slanetz PJ.
        Integrating evidence-based imaging into the radiology core clerkship: a proposed teaching tool of imaging strategies.
        J Am Coll Radiol. 2010; 7: 517-521
        • Mettler FA
        • Bhargavan M
        • Faulkner K
        • et al.
        Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources–1950-2007.
        Radiology. 2009; 253: 520-531
        • Prezzia C
        • Vorona G
        • Greenspan R
        Fourth-year medical student opinions and basic knowledge regarding the field of radiology.
        Acad Radiol. 2013; 20: 272-283
      5. American College of Radiology. ACR Appropriateness Criteria®. Available at https://acsearch.acr.org/list. Accessed April 10, 2021.

        • Dillon JE
        • Slanetz PJ.
        Teaching evidence-based imaging in the radiology clerkship using the ACR Appropriateness Criteria.
        Acad Radiol. 2010; 17: 912-916
        • Kozak B
        • Webb EM
        • Khan BK
        • Orozco NM
        • Straus CM
        • Naeger DM.
        Medical student usage of the American College of Radiology appropriateness criteria.
        Acad Radiol. 2015; 22: 1606-1611
        • Bautista AB
        • Burgos A
        • Nickel BJ
        • Yoon JJ
        • Tilara AA
        • Amorosa JK.
        Do clinicians use the American College of Radiology appropriateness criteria in the management of their patients?.
        Amer J Roentgenol. 2009; 192: 1581-1585
        • Gunderman RB
        • Hill DV.
        Student concerns and misconceptions about a career in radiology.
        Acad Radiol. 2012; 19: 366-368
        • Du Cret RP
        • Weinberg EJ
        • Sellers TA
        • Seybolt LM
        • Kuni CC
        • Thompson WM
        Role of radiology in medical education: perspective of nonradiologists.
        Acad Radiol. 1994; 1: 70-74
        • Gunderman RB
        • Gasparis PT
        • Rahman T.
        Educating medical students about radiologists’ contributions to patient care.
        Acad Radiol. 2012; 19: 908-909
        • Branstetter BF
        • Faux LE
        • Humphrey AL
        • Schumann JB.
        Preclinical medical student training in radiology: the effect of early exposure.
        Am J Roentgenol. 2007; 188: W9-W14
        • Branstetter BF
        • Humphrey AL
        • Schumann JB.
        The long-term impact of preclinical education on medical students’ opinions about radiology.
        Acad Radiol. 2008; 15: 1331-1339
        • Scheiner JD
        • Novelline RA.
        Radiology clerkships are necessary for teaching medical students appropriate imaging workups.
        Acad Radiol. 2000; 7: 40-45
        • Islam S
        • Memon A
        • Biren-Fetz J
        • Xie K.
        Introducing the American College of Radiology appropriateness criteria to medical students to increase appropriate imaging selection.
        Curr Prob Diag Radiol. 2022; 51: 737-739
        • Stein MW
        • Frank SJ
        • Roberts JH
        • Finkelstein M
        • Heo M.
        Integrating the ACR appropriateness criteria into the radiology clerkship: comparison of didactic format and group-based learning.
        J Am Coll Radiol. 2016; 13: 566-570
      6. Image Gently. 2021; (Accessed)
      7. Image Wisely. 2021; (Accessed)
        • Scheiner JD
        • Noto RB
        • McCarten KM.
        Importance of radiology clerkships in teaching medical students life-threatening abnormalities on conventional chest radiographs.
        Acad Radiol. 2002; 9: 217-220
        • Gunderman RB
        • Siddiqui AR
        • Heitkamp DE
        • Kipfer HD.
        The vital role of radiology in the medical school curriculum.
        Am J Roentgenol. 2003; 180: 1239-1242
        • Pandharipande PV
        • Mercaldo ND
        • Lietz AP
        • et al.
        Identifying barriers to building a diverse physician workforce: a national survey of the ACR membership.
        J Am Coll Radiol. 2019; 16: 1091-1101
        • Farkas AH
        • Allengaugh J
        • Bonifacino E
        • Turner R
        • Corbelli JA.
        Mentorship of US medical students: a systematic review.
        J Gen Intern Med. 2019; 11: 2602-2609
        • Bhatnagar V
        • Diaz S
        • Bucur PA.
        The need for more mentorship in medical school.
        Cureus. 2020; 5: e7984
        • Nellis JC
        • Eisele DW
        • Francis HW
        • Hillel AT
        • Lin SY.
        Impact of a mentored student clerkship on underrepresented minority diversity in otolaryngology—head and neck surgery.
        Laryngoscope. 2016; 126: 2684-2688
        • Smith SG
        • Nsiah-Kumi PA
        • Jones PR
        • Pamies RJ.
        Pipeline programs in the health professions, part 1: preserving diversity and reducing health disparities.
        J Natl Med Assoc. 2009; 101: 836-840
      8. Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree. Available at: http://lcme.org/publications/. Accessed April 24, 2021.

        • Xierali IM
        • Castillo-Page L
        • Conrad S
        • Nivet MA.
        Analyzing physician workforce racial and ethnic composition associations: geographic distribution (part II).
        AAMC Anal Brief. 2014; 14: 1-2
        • Garcia AN
        • Kuo T
        • Arangua L
        • Pérez-Stable EJ.
        Factors associated with medical school graduates’ intention to work with underserved populations: policy implications for advancing workforce diversity.
        Acad Med. 2018; 93: 82-89
      9. AAMC Diversity in Medicine: Facts and figures 2019. Available at https://www.aamc.org/data-reports/workforce/report/diversity-medicine-facts-and-figures-2019. Accessed February 22, 2021.

        • Chapman CH
        • Hwang W
        • Both S
        • Thomas CR
        • Deville C.
        Current status of diversity by race, hispanic ethnicity, and sex in diagnostic radiology.
        Radiology. 2014; 270: 232-240
        • Potterton VK
        • Ruan S
        • Sunshine JH
        • Applegate K
        • Cypel Y
        • Forman HP.
        Why don't female medical students choose diagnostic radiology? A review of the current literature.
        J Am Coll Radiol. 2004; 1: 583-590
        • Grimm LJ
        • Lowell DA
        • Cater SW
        • Yoon SC.
        Differential motivations for pursuing diagnostic radiology by gender: implications for residency recruitment.
        Acad Radiol. 2017; 24: 1312-1317
      10. AMSER Curriculum, Competencies, and Learning Objectives. Available at: https://www.aur.org/affinity-groups/amser/curriculum. Accessed June 15, 2022.

        • Naeger DM
        • Webb EM
        • Zimmerman L
        • Elicker BM
        Strategies for incorporating radiology into early medical school curricula.
        J Am Coll of Radiol. 2014; 11: 74-79
        • Chorney ET
        • Lewis PJ.
        Integrating a radiology curriculum into clinical clerkships using case-oriented radiology education.
        J Am Coll Radiol. 2011; 8: 58-64
      11. Aquifer Radiology. https://aquifer.org/courses/aquifer-radiology/. Accessed 14 September 2021.

      12. American college of radiology standardized tool for the assessment of radiology students (ACR STARS). Available at https://www.acr.org/Lifelong-Learning-and-CME/Learning-Activities/Medical-Student-Activities/Radiology-Student-Assessment-Tool. Accessed February 22, 2021.

        • Willis MH
        • Newell AD
        • Fotos J
        • et al.
        Multisite implementation of Radiology-TEACHES (Technology-enhanced appropriateness criteria home for education simulation).
        J Am Coll Radiol. 2020; 17: 652-661
        • Hilmes MA
        • Hyatt E
        • Penrod CH
        • Fleming AE
        • Singh SP.
        Radiology in medical education: a pediatric radiology elective as a template for other radiology courses.
        J Am Coll Radiol. 2016; 13: 320-325
      13. The Image Gently Alliance. https://www.imagegently.org/Home/Pledge-Certificate. Accessed 14 September 2021

        • Tigges S
        • Lewis PJ
        • McNulty NJ
        • Mullins ME.
        Medical student performance after a vertically integrated radiology clerkship.
        J Am Coll Radiol. 2016; 13: 67-71
        • Restauri N
        • Lind KE
        • Webb N
        • Ariefdjohan M
        • Kondo K
        • Dodd G.
        Medical student satisfaction and performance using an innovative radiology education laboratory.
        J Am Coll Radiol. 2016; 14: 404-408
      14. Long, H. B. Adult learning: Research and practice. New York: Cambridge., 1983. (p. 47)

        • Hartman M
        • Thomas S
        • Ayoob A
        Radiology field trips–a list of “must sees” in the radiology department for medical students: how we do it.
        Acad Radiol. 2018; 25: 1646-1652
        • Elsayes KM
        • Khan ZA
        • Kamel S
        • et al.
        Multidisciplinary approach in teaching diagnostic radiology to medical students: the development, implementation, and evaluation of a virtual educational model.
        J Am Coll Radiol. 2021; 18: 1179-1187
        • Mauro DM
        • Ellis JA
        • Lilly JF
        • Dallaghan GLB
        • Jordan SG.
        Creating an open-access educational radiology website for medical students: a guide for radiology educators.
        Acad Radiol. 2021; 28: 1631-1636
        • Oancea L
        • Gunderman R
        • Carrico C
        • Straus C.
        Teaching radiology in medical school: an association for medical student educators in radiology survey.
        Acad Radiol. 2013; 20: 255-256
      15. American College of Radiology. ACR appropriateness criteria. Suspected Appendicitis—Child. Available at https://acsearch.acr.org/docs/3105874/Narrative/. Accessed July 14, 2021.