Guest Editorial

Radiology Education: Keeping Pace with Changing Times, New Technology, and Increased Challenges Aine Marie Kelly, MD, MS, MA Key Words: Education; teaching; assessment; medical students; residents. ªAUR, 2014

Following upon the outstanding success of the first educational issue of Academic Radiology, the Alliance of Medical Student Educators in Radiology (AMSER) and the Alliance for Clinician Educators in Radiology (ACER) are pleased to bring you another entire issue of the journal dedicated to educational research and scholarship. Thanks again to Dr. Stanley Baum, Dr. Richard Gunderman, and to the leadership of AMSER and ACER for their support and continued encouragement! In this issue, we are pleased to include many articles describing the latest and innovative methods useful in todays’ education of medical students, residents, and trainees. The themes covered in this issue align with the AMSER missions that include encouraging excellence in radiologic education during medical school and establishing radiology as an essential component of medical school education (1). These parallel the ACERs missions that include promoting and developing educational research activities for clinician educators (2). Having an annual issue devoted to educational scholarship will also help the joint AMSER and ACER missions to promote development and dissemination of resources for medical education and to develop and nurture medical student and clinician educators in the field of radiology (1,2). On the theme of trainee engagement, Chen and Lewis (3) describe an innovative and practical scheme for educating and engaging senior medical students, while relieving busy radiology residents of some of the on-call work pressures, which was a valuable clinical experience for the medical students, while at the same time, benefitting workflow for on-call radiology residents. Educational methodology has to evolve with the times, and we are now in the 21st century with the ‘‘Millennials’’ currently undergoing residency training (4). Audience response systems (ARS) in hardware (using physical clickers) and software versions have been around for a couple of decades now. How they are used can influence the educational outcome. Dr. Michael Richardson shares his experience of interactive Acad Radiol 2014; 21:827–828 From the Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical Center, B1 132K Taubman Center/5302, 1500 East Medical Center Drive, Ann Arbor, MI 48109. Received April 15, 2014; accepted April 28, 2014. Address correspondence to: A.M.K. e-mail: [email protected] ªAUR, 2014 http://dx.doi.org/10.1016/j.acra.2014.04.010

lecturing and advice on getting the most out of ARS to improve attentiveness and engagement in the classroom (5). There is pressure from our clinical colleagues for increased hours of in-house coverage by emergency and other radiology attendings, but little is published on the effects of this greater coverage on resident education. Interestingly, in the Whitley Award–winning survey by Dr. Collins et al. (6) of on-call radiology residents, the effects of having 24/7/365 in-house coverage by emergency radiology faculty on resident education resulted in a shorter turnaround time, with greater faculty feedback but with the consequences of a negative effect on autonomy and educational experience. With regard to training residents in noninterpretative skills, the Accreditation Council for Graduate Medical Education has mandated that all the core competencies be taught to residents and assessed. Teaching systems-based practice (SBP) remains a challenge and Choudhery surveyed residents in academic radiology programs who cited the lack of time and difficulty finding a mentor as the main obstacles to completing SBP projects while having a formally organized institutional quality improvement process was essential (7). For residents trying to improve their diagnostic performance, having a systematic approach is helpful and the Memorial award winners Bailey et al. (8) demonstrated increased confidence and greater use of systematic search patterns in cohorts of junior residents following four musculoskeletal magnetic resonance imaging (MRI) sessions using a picture archiving and communication systems (PACS)–based module, compared to cohorts of residents without such a module. Such an initiative could be applied to other modalities and body parts in computed tomography (CT) and MRI, which should help to decrease systematic types of errors in trainees. Part of resident education includes knowledge of ionizing radiation and safety aspects, given that about half of radiation exposure nowadays comes from medical diagnostic radiation. Sadigh et al. (9) surveyed residents in radiology and other specialties to find that knowledge was moderate in radiology residents and lower in other specialties. The findings, although somewhat reassuring, highlight the continued and increased need for continued education regarding appropriate imaging and precautions in our trainees and trainees in specialties that perform procedures using ionizing radiation. We are under increasing constraints, be they financial, time or otherwise, and Naeger et al. (10) share their positive experience 827

KELLY

of engaging medical students and using medical student capital, in an innovative scheme involving medical student–created independent learning modules to supplement the radiology clerkship. For educators training residents in mammography interpretation/diagnostic performance, Grimm et al. (11) found that resident sensitivity decreased for cases that experts deemed difficult, whereas resident specificity dropped for cases that residents themselves determined to be difficult. The latter finding is surprising and suggests that educators would need to include a mix of cases that are found difficult by residents and experts to maximize the effect of training on diagnostic performance (11). The radiology profession is under pressure to show our added value to patients, providers, insurance companies, and society, and we continue to be under threat from outsourcing and commoditization. We can learn from the initiatives of Webb et al. (12) who illustrate how radiology should take its rightful place in the teaching of ultrasound to the first-year medical students through a practical hands-on module embedded within their anatomy teaching. Simulation has become a very useful (and practical) alternative to the traditional apprenticeship in medical education, allowing trainees’ confidence to increase and alleviating anxiety. Sekhar et al. (13) share their experience using an inexpensive phantom to teach residents the technique of percutaneous liver biopsy, which will be applicable and useful to residency programs everywhere. It is a reality that diagnostic imaging examinations (particularly radiography) are often reviewed by nonradiology residents, particularly out of hours. What is not documented is how well trained or competent these residents are to interpret these studies, the findings of which may be acted on in the oncall situation. An accurate, valid, and reproducible assessment tool is needed, and Seagull et al. (14) from the Medical Education Department of the University of Michigan have developed and validated an assessment tool using an iterative process and discriminative indices. Such an assessment method will go toward ensuring that patient care and safety are maintained to the highest standards. Since the advent of PACS, image storage and capture for teaching purposes and sharing have become possible. It is important that such a process fits into the increasing daily workflow of the busy radiologist. Rowe et al. (15) describe their use of radiology software, which is free and interacts with all PACS systems and which uses some of the functionality of social networking sites. Such an application should be very useful to all radiology teaching programs, to enable digital teaching file collection and image sharing without interrupting workflow. Every radiology program wants to recruit the very best residents, so it is important to be aware of what factors will increase the likelihood for candidates to come to interview. Deloney and colleagues have surveyed residents regarding this and found that the overall “personality” of the program and geographical factors were very important factors (16). Very low discrepancy rates between residents’ overnight interpretations and final attending reports have been repeatedly documented in the literature, supporting the currently popular on-call arrangements. Garrett et al. (17) 828

Academic Radiology, Vol 21, No 7, July 2014

have extended this work to assess discrepancy rates in the increasingly prevalent ‘‘triple-rule-out’’ CT, done to evaluate for pulmonary embolism, myocardial infarction, and acute aortic pathology concurrently. It is reassuring to find that the rates of major discrepancy were similar and low as for non–ECG-gated CT, although minor discrepancies (which were not clinically significant) were increased. This issue of Academic Radiology illustrates the interest and growth in the area of radiologic education, and we hope that you will enjoy reading these and other articles in this issue. We look forward to welcoming contributions that will illustrate the cutting edge technology and advances in modern day medical education and educational research and place it in the position it so well deserves alongside noneducational research! Last but not least, a big thanks to Flora Cauley, Editorial Coordinator for Academic Radiology for her constant support, patience, and efficiency in this endeavor! REFERENCES 1. Alliance of Medical Student Educators in Radiology (AMSER) website. Accessed on April 30, 2014 at: http://www.aur.org/Secondary-Alliances. aspx?id=453. 2. Alliance for Clinician Educators in Radiology (ACER) website. Accessed on April 30, 2014 at: http://www.aur.org/Secondary-Alliances.aspx?id=135. 3. Chen JY, Lewis PJ. The value of a medical student radiology triage program in enhancing clinical education and skills. Academic Radiology 2014; 21(7):829–833. 4. Slanetz PJ, Kung J, Eisenberg RL. Teaching Radiology in the Millennial Era? Academic Radiology 2013; 20(3):387–389. 5. Richardson ML. Audience response techniques for 21st century radiology education. Academic Radiology 2014; 21(7):834–841. 6. Collins J, Gruppen LD, Bailey JE, et al. 24/7/365 In-house radiologist coverage: effect on resident education. Academic Radiology 2014; 21(7):842–850. 7. Choudhery S, Richter M, Anene A, et al. Practice quality improvement during residency: where do we stand and where can we improve? Academic Radiology 2014; 21(7):851–858. 8. Bailey J, Roth T, Heitkamp D. Real view radiology—impact on search patterns and confidence in radiology education. Academic Radiology 2014; 21(7):859–868. 9. Sadigh G, Khan R, Kassin M, et al. Radiation safety knowledge and perceptions among residents: a potential improvement opportunity for graduate medical education in the United States. Academic Radiology 2014; 21(7): 869–878. 10. Naeger DM, Straus CM, Phelps A, et al. Student-created independent learning modules: an easy high-value addition to radiology clerkships. Academic Radiology 2014; 21(7):879–887. 11. Grimm L, Kuzmiak CM, Ghate SV, et al. Radiology resident mammography training: interpretation difficulty and error making patterns. Academic Radiology 2014; 21(7):888–892. 12. Webb EM, Cotton JB, Kane K, et al. Teaching point of care ultrasound skills in medical school: keeping radiology in the driver’s seat. Academic Radiology 2014; 21(7):893–901. 13. Sekhar A, Sun MR, Siewert B. A tissue phantom model for training residents in ultrasound guided liver biopsy. Academic Radiology 2014; 21(7):902–908. 14. Seagull FJ, Bailey J, Trout A, et al. Residents’ ability to interpret radiology images: development and improvement of an assessment tool. Academic Radiology 2014; 21(7):909–915. 15. Rowe SP, Siddiqui A, Bonekamp D. The key image and case log application: a new radiology software for teaching file creation and case logging that incorporates elements of a social network. Academic Radiology 2014; 21(7):916–930. 16. Deloney LA, Perrot LJ, Lensing SY, Jambhekar K. Radiology resident recruitment: A study of the impact of web-based information and interview day activities. Academic Radiology 2014; 21(7):931–937. 17. Garrett KG, De Cecco CN, Schoepf UJ, et al. Residents performance in the interpretation of on-call ‘‘triple-rule-out’’ CT studies in patients with acute chest pain. Academic Radiology 2014; 21(7):938–944.

Radiology education: keeping pace with changing times, new technology, and increased challenges.

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