The role of radiology in medical student education

Introduction: Radiologists have been espousing the merit of Radiology in teaching medical students for almost a hundred years. Yet, despite all the above, the role of radiology in medical student education is poorly defined and understood. With technological advances in CT, MRI, ultrasound and interventional radiology, Radiology not only details human anatomy and pathology, but is central to the practice of modern clinical medicine. The aims of this thesis were to (1) Perform a literature review of the role of radiology in teaching medical students and its evolution through time. (2) Assess the current role of Radiologists in undergraduate medical education. (3) Evaluate and quantify the hours allocated to Radiology teaching in medical schools and to determine if they can fulfil the requirements expected of Clinician Teachers of other disciplines and the upcoming GMC Medical Licensing Assessment. (4) Examine how frequently radiologic images features in summative assessments in Medical Schools. (5) Determine if small group teaching in Radiology impacted Anatomy scores in summative end of year assessment. (6) Explore the potential role of Radiology in teaching Clinical Reasoning to Medical Students. Methods: MEDLINE (Ovid), Embase (Ovid), the Cochrane Database of Systematic Reviews and CENTRAL (Wiley Interscience) and the Education Resources Information Centre and British Education Index (EBSCOhost) databases were searched up to 2018 for relevant articles for the literature review to evaluate the role of Radiology in undergraduate medical education. A national online survey of Consultant Radiologists was performed in November 2019. Raw data from Analysis of Teaching of Medical Schools survey (2020) was evaluated to determine the hours allocated to radiology. A survey evaluating what University Lead Clinician Teachers consider essential Radiology knowledge for medical students was performed in 2020. Data (up to 2019) from all Scottish medical schools’ summative written and clinical assessments was collected and analysed to determine how frequently Radiologic images appeared in written and OSCE examinations. Anonymised end of year summative total and anatomy scores over 5 years were retrospectively collected and analysed to determine if small group teaching improved Anatomy scores. Interactive online learning resource was produced together with a student. The materials were built around radiology images, to teach students’ clinical reasoning as well as the central role of radiology in acute clinical scenarios through gamification of learning. Results: 377 records were included in the review spanning 1925 – 2019. There was a 100 fold increase in rate of publication over time. The vast majority (60%) of publications were expositions (“how we teach”) and surveys, with few truly experimental articles. Radiology was involved in both clinical (63%) and pre-clinical (Anatomy) teaching, but almost half of Anatomic Radiology teaching was conducted without a Radiologist’s input. Compulsory Radiology blocks / clerkships were offered infrequently (35%). 102 responses were collected from the online survey, representing 34% of Consultant Radiologists in Scotland. All agreed Radiology should be taught to medical students, with over 70% currently teaching. The most common barrier cited to teaching was the lack of time, with 76% of those who do not teach expressing a desire to do so. Median time spent teaching medical students was 10 hours/year. Medical students in Scottish Universities were allocated 59 hours in Radiology (0.3%) out of a total 19,325 hours of time tabled teaching. Hospital based radiology teaching was variable and ranged from 0 – 31 hours. Almost half (15/31) of University Lead Clinician Teachers felt there was insufficient radiology teaching in their specialty. Of the 30 conditions included in the GMC MLA under Clinical Imaging, 13 were cited as important by Clinician Teacher, while 23 other conditions listed by them were not included in the GMC MLA. 10, 534 MCQ and 1083 OSCE stations were included in the evaluation of Radiologic inclusion in medical schools. There was a wide variation in the number, type and timing of assessments across Scottish medical schools. There were significant differences in the number of OSCE stations and the number of MCQs set over the study period (p<0.001). Radiologic images were used on average 0.6 times (0 – 1.1) in each OSCE examination and 2.4 times (range 0.1 -3.7) for written assessments. Student numbers ranged 238-290 per year. Mean Anatomy scores ranged 62-74%, compared to mean Total examination score of 62-65%. Anatomy scores were significantly higher than Total examination scores for the study period of 2017 and 2018 [68.97 (17.32) vs 63.12(11.51) and 73.77 (17.85) vs 64.99 (10.31); p< 0.001]. Combined Anatomy scores 2017 and 2018 were significantly higher than base line years 2015 and 2016, difference of 5.50 (95% C.I 3.31-7.70; p