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The Radiologist as a Teacher of Medicine
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Education
A Clinical Approach to the Teaching of Undergraduate Radiology 1 M. Joyce Pais, M.D., Morrie E. Kricun, M.D., and Lucy Frank Squire, M.D. Undergraduate medical students entering their clinical years are learning radiology in combined clinical-radiological seminars devoted to the diagnosis of symptoms via case histories and radiographs. Esoteric diseases are avoided and frequent differential problems are stressed and resolved radiographically whenever possible. INDEX TERMS:
Education, diagnostic radiology • Radiology and Radiologists
Radiology 116:79-80, July 1975
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also those involving other anatomic areas such as the neck, esophagus, stomach, etc. We may begin by showing an inspiratory chest film with a questionable pneumothorax and a classical history of pneumothorax. The students are then asked to suggest a diagnosis from the history. In a group of 15 to 20 students, someone can usually volunteer the correct answer-perhaps it was something learned during lectures in pathology, on rounds, or even during lunch with his resident. In this way, students can pool their knowledge and enhance learning. After the diagnosis is suggested, either by the history or from the radiograph, the moderator may develop a discussion of pneumothorax. He may ask questions concerning the etiology, pathophysiology, pleural space pressure, physical findings, and management of patients with pneumothorax. The moderator has tremendous flexibility. He may lead or terminate the discussion in any way he chooses and emphasize facts as they pertain to physical diagnosis and patient care. The student, on the other hand, visualizes the disease on the radiograph. He can, in the case of pneumothorax, see the increase in air in the pleural space and understand why the sounds of percussion are hyper-resonant and the breath sounds distant. We avoid esoteric diseases and stress those which are frequent differential problems. The following list may serve as a guide for arranging a lecture on chest pain: pulmonary embolism and infarction, pneumonia, pneumothorax and tension pneumothorax, pleurisy and pleural effusion, myocardial ischemia and infarction, myo-. carditis and pericarditis, dissecting aorta, esophagitis: hiatal hernia, cholecystitis and degenerative disease of the cervical spine. Examples of other clinically oriented subjects covered in subsequent sessions are cough, hemoptysis, dyspnea, hematemesis and rectal bleeding, diarrhea and constipation, abdominal pain, hematuria, dysuria and pyuria, back pain, bone and joint pain, headache, and the unconscious patient. We do not attempt to cover all symptoms nor all diseases with certain symptoms, of course. We do feel that we help the student appreciate the significance of obtaining a good history, and being able to form a work-
many medical schools, radiologists have taken only a minor role in the teaching of medical students and have thus played a small part in the development and training of future physicians. This has been largely a matter of tradition. The internist teaches internal medicine, the surgeon, surgery, and the anatomist, anatomy. The advent of interdisciplinary teaching has opened a new horizon for radiologists but few have taken advantage of it. In many institutions, radiologists become involved in teaching in only a peripheral way. This usually means several lectures given in the second or third year to large groups of students and consists of little more than a parade of radiographs. One usually remembers little of these lectures except the trauma of being called on in a large darkened auditorium to discuss a slide one can barely see. Of course, most teaching institutions do offer an elective rotation in diagnostic radiology for senior students. These programs may teach the student the principles of radiology no matter what his future plans are. In fact, many future radiology residents come from these programs. Unfortunately, this is usually an elective rotation and therefore not all members of the senior class are able to fit it into their schedules. We as radiologists are an untapped source of teaching potential and can contribute enormously to the education of future physicians. Think of the student's excitement at seeing on the radiograph what was just dissected in the laboratory. There are so many ways in which the radiologist can assist the student in anatomy, pathology, physiology and physical diagnosis. Our course for medical students entering their clinical years has proved to be a significant aid in developing an approach to the history, physical examination, treatment and pathophysiology of disease. This is not a radiologic but rather a clinical approach based upon clinical symptoms and utilizes radiographs as teaching tools, with classes of no more than 20 students. These sessions are discussion periods rather than lectures. Consider an hour devoted to "chest pain." The moderator may begin with a brief discussion of the types, characteristics and dermatome overlap of chest pain and the principles of referred pain. The discussion that follows not only includes entities related to the chest but
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1 From the Department of Diagnostic Radiology (M.J.P., M.E.K., Assistant Professors). Hahnemann Medical College and Hospital. Philadelphia, Pa., and Department of Radiology (L.F.S., Professor), State University of New York. Downstate Medical Center, Brooklyn. N. Y. Presentshan ed at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, III., Dec. 1-6, 1974.
79
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M. JOYCE PAIS AND OTHERS
ing differential diagnosis. We use diagnostic radiology as a tool to analyze medical problems on a clinical level as well as simultaneously reviewing pertinent pathophysiology. We would like to acknowledge Marvin E. Haskin, M.D., Chairman of the Department of Diagnostic ACKNOWLEDGMENT:
July 1975
Radiology at Hahnemann Medical College and Hospital, for his devotion to teaching and support of our teaching endeavors.
Department of Radiology Hahnemann Medical College Philadelphia, Pa. 19102
The Radiologist as a Teacher of Medicine
•
Education
A Clinical Approach to the Teaching of Undergraduate Radiology 1 M. Joyce Pais, M.D., Morrie E. Kricun, M.D., and Lucy Frank Squire, M.D. Undergraduate medical students entering their clinical years are learning radiology in combined clinical-radiological seminars devoted to the diagnosis of symptoms via case histories and radiographs. Esoteric diseases are avoided and frequent differential problems are stressed and resolved radiographically whenever possible. INDEX TERMS:
Education, diagnostic radiology • Radiology and Radiologists
Radiology 116:79-80, July 1975
•
•
also those involving other anatomic areas such as the neck, esophagus, stomach, etc. We may begin by showing an inspiratory chest film with a questionable pneumothorax and a classical history of pneumothorax. The students are then asked to suggest a diagnosis from the history. In a group of 15 to 20 students, someone can usually volunteer the correct answer-perhaps it was something learned during lectures in pathology, on rounds, or even during lunch with his resident. In this way, students can pool their knowledge and enhance learning. After the diagnosis is suggested, either by the history or from the radiograph, the moderator may develop a discussion of pneumothorax. He may ask questions concerning the etiology, pathophysiology, pleural space pressure, physical findings, and management of patients with pneumothorax. The moderator has tremendous flexibility. He may lead or terminate the discussion in any way he chooses and emphasize facts as they pertain to physical diagnosis and patient care. The student, on the other hand, visualizes the disease on the radiograph. He can, in the case of pneumothorax, see the increase in air in the pleural space and understand why the sounds of percussion are hyper-resonant and the breath sounds distant. We avoid esoteric diseases and stress those which are frequent differential problems. The following list may serve as a guide for arranging a lecture on chest pain: pulmonary embolism and infarction, pneumonia, pneumothorax and tension pneumothorax, pleurisy and pleural effusion, myocardial ischemia and infarction, myo-. carditis and pericarditis, dissecting aorta, esophagitis: hiatal hernia, cholecystitis and degenerative disease of the cervical spine. Examples of other clinically oriented subjects covered in subsequent sessions are cough, hemoptysis, dyspnea, hematemesis and rectal bleeding, diarrhea and constipation, abdominal pain, hematuria, dysuria and pyuria, back pain, bone and joint pain, headache, and the unconscious patient. We do not attempt to cover all symptoms nor all diseases with certain symptoms, of course. We do feel that we help the student appreciate the significance of obtaining a good history, and being able to form a work-
many medical schools, radiologists have taken only a minor role in the teaching of medical students and have thus played a small part in the development and training of future physicians. This has been largely a matter of tradition. The internist teaches internal medicine, the surgeon, surgery, and the anatomist, anatomy. The advent of interdisciplinary teaching has opened a new horizon for radiologists but few have taken advantage of it. In many institutions, radiologists become involved in teaching in only a peripheral way. This usually means several lectures given in the second or third year to large groups of students and consists of little more than a parade of radiographs. One usually remembers little of these lectures except the trauma of being called on in a large darkened auditorium to discuss a slide one can barely see. Of course, most teaching institutions do offer an elective rotation in diagnostic radiology for senior students. These programs may teach the student the principles of radiology no matter what his future plans are. In fact, many future radiology residents come from these programs. Unfortunately, this is usually an elective rotation and therefore not all members of the senior class are able to fit it into their schedules. We as radiologists are an untapped source of teaching potential and can contribute enormously to the education of future physicians. Think of the student's excitement at seeing on the radiograph what was just dissected in the laboratory. There are so many ways in which the radiologist can assist the student in anatomy, pathology, physiology and physical diagnosis. Our course for medical students entering their clinical years has proved to be a significant aid in developing an approach to the history, physical examination, treatment and pathophysiology of disease. This is not a radiologic but rather a clinical approach based upon clinical symptoms and utilizes radiographs as teaching tools, with classes of no more than 20 students. These sessions are discussion periods rather than lectures. Consider an hour devoted to "chest pain." The moderator may begin with a brief discussion of the types, characteristics and dermatome overlap of chest pain and the principles of referred pain. The discussion that follows not only includes entities related to the chest but
I
N
1 From the Department of Diagnostic Radiology (M.J.P., M.E.K., Assistant Professors). Hahnemann Medical College and Hospital. Philadelphia, Pa., and Department of Radiology (L.F.S., Professor), State University of New York. Downstate Medical Center, Brooklyn. N. Y. Presentshan ed at the Sixtieth Scientific Assembly and Annual Meeting of the Radiological Society of North America. Chicago, III., Dec. 1-6, 1974.
79
80
M. JOYCE PAIS AND OTHERS
ing differential diagnosis. We use diagnostic radiology as a tool to analyze medical problems on a clinical level as well as simultaneously reviewing pertinent pathophysiology. We would like to acknowledge Marvin E. Haskin, M.D., Chairman of the Department of Diagnostic ACKNOWLEDGMENT:
July 1975
Radiology at Hahnemann Medical College and Hospital, for his devotion to teaching and support of our teaching endeavors.
Department of Radiology Hahnemann Medical College Philadelphia, Pa. 19102
