Opinion
•
The Who, Why and How of Radiology Teaching Files 1
•
Norman L. Martin, M.D. A variety of teaching files in diagnostic radiology is needed to serve a broad spectrum of purposes and students. A method of acquiring a simplified teaching file to be used for and by medical students, non-radiology house staff, first-year radiology residents and senior staff members is described. The medical student, as a learning experience, acts as the procurer of this file. INDEX TERMS:
•
Education, diagnostic radiology. Opinions • Radiology and radiologists
Radiology 119:745-746, June 1976
Diagnostic radiology has grown rapidly as a consultative service during the past few years. With this increasing expansion has come the awareness of the need for more formal education of medical students and non-radiology house staff in the proper use of this consultative service (2, 3, 4, 8, 10, 11). The ordering of proper examinations in the proper sequence; the time, expense, and patient preparation involved; the indications, contraindications, and limitations of procedures as well as patient experiences and reactions to various examinations have not been taught to our non-radiologist colleagues (6, 12). The recent radiological literature attests to the advisability and capabilities of radiologists being teachers of medical students and house staff in both the basic sciences and clinical medicine (5, 12, 13, 17). Numerous teaching techniques have proved efficacious (1,7,9, 14, 15, 16, 18). One significant problem that arises in teaching medical students, non-radiology house staff, and first year radiology residents is the acquisition of a student radiology teaching file. This file should have radiographs of normal anatomy and physiology and simple, straightforward, classic diseases with characteristic roentgenographic findings. The diagnostic radiology teaching file used by senior radiology staff and residents has many excellent cases, but many are diagnostically difficult, unusual or rare and esoteric. These films have been kept because of personal interests, findings that should be diagnosed by more senior radiology residents, or for use when reviewing for board examinations. Consequently, the very simple fracture or very large pneumothorax may not be found in an otherwise excellent senior staff radiology teaching file. This type of case, however, is very important for the beginning first-year radiology residents, medical students and non-radiology house staff. One very effective way of rapidly accumulating a good student radiology teaching file is to use the medical student as the procurer of the file. This affords the student an excellent learning experience. Six to eight students a month rotate through our Diagnostic Radiolo-
• gy module. One of the requirements while the students are taking the module is to prepare cases for the student teaching file. The student rotates through the areas of general diagnostic radiology, neuroradiology, pediatrics, special procedures, nuclear medicine, GI radiology, GU radiology, ultrasound, thermography, mammography, and bone and joint radiology. He or she is asked to prepare, under the guidance of the senior radiology staff, a case each week that has come through the section in which he is rotating. Such a case must be a c1assic radiographic demonstration of normal anatomy and .physiology or some disease process. Under the supervision of the attending senior staff in the area, the student pulls the diagnostic films from the patient's jacket and these films are copied. The copy films are placed in a separate jacket. The student is then required to write a brief summary on the front of the jacket of the patient's chief complaint and pertinent medical history, the positive physical findings, appropriate laboratory and other diagnostic studies which have been or should be performed, and a differential diagnosis. A brief discussion of the anatomy, physiology and pathological process involved and the roentgenographic findings seen in the particular case are also summarized. This material is then reviewed with the senior staff member for his approval before being placed in the student teaching file. This accomplishes a number of things: first, the student must read a number of texts and consult with the senior staff regarding the disease process under discussion. It causes him to review not just the radiographic findings but the indications, contraindications, and limitations of various radiological examinations. The proper sequence of the radiographic workup for a patient with this disease, and the total scope of the disease process or normal anatomy and physiology in question is identified and studied. Second, the case is presented by the student to his colleagues in the module where he is expected to expound or defend to his peers his findings and conclusions. Third, the case is then placed in the student teaching file to be read and
1 From the Department of Diagnostic Radiology (N. L. M., Assistant Professor), University of Kansas Medical Center, Kansas City, Kansas. shan Accepted for publication in January 1976.
745
746
OPINION
reviewed by upcoming students as part of the requirements of the module. The review of the student teaching file by succeeding student groups occurs at times set aside during the day and during the evenings when they are on call with the radiology resident. This file also provides excellent source material for beginning radiology residents. They are strongly encouraged to review the entire student teaching file early in their training. This has become increasingly important as internships have been deleted and many radiology residents are accepted from medical school without an extra year of medical maturity and experience. A fourth advantage is that a readily accessible flle to be used by students, house staff and senior radiology staff is available when conferences are given in the hospital, and for use by senior staff radiologists for demonstrations in the basic science areas including gross anatomy, physiology, pharmacology, and pathology. Fifth, it is a file which is separate from the main senior diagnostic radiology file or personal files used for teaching more senior diagnostic radiology residents. This keeps loss and misplacement of these films at a minimum. With this system, approximately 400 teaching cases a year are accrued under the supervision of the senior staff radiologists. A wide spectrum of films is obtained covering many aspects of medicine in its broadest sense. The monitoring of the student teaching file by the senior staff assures that all areas of medicine are represented and that there are not 20 cases of renal cell carcinoma and only one case of pyelonephritis present. The medical student teaching file is kept in a room with view-boxes and designated as the "Medical Student Teaching Room." It is convenient for daily use by the medical students taking the module and the first year radiology residents. Films can be taken from the file under the supervision of the individual staff man responsible for guiding the student in a radiology presentation in other areas of the hospital. In summary, it can be stated that indeed there are reasons for different types of radiology teaching files depending on who they are to serve and why they are to be kept. One method of how they can be procured
June
1976
and utilized for the best possible teaching is presented.
Department of Diagnostic Radiology University of Kansas Medical Center 39th and Rainbow Blvd. Kansas City, Kansas 66103
REFERENCES 1. Allman RM: The RPC: a learning set for continuing education in radiology. Radiology 100:189-192, Jul 1971 2. Blotnick VS, Squire LF, BeckerJA: A testing procedure for analyzing methods of teaching diagnostic radiology. Radiology 105: 685-688, Dec 1972 3. Cockshott WP: Radiology in the medical student's program. Radiology 100:197-198, Jul 1971 4. Fischer HW: The objective in diagnostic radiology. Radiology 100:196, Jul 1971 5. Forrester D: Teaching anatomy through radiology. Radiology 100:561-565, Sep 1971 6. Freimanis AK: Successful teaching of radiology to medical students and interns. Radiology 97:669-680, Dec 1970 7. Gold RH, Ross SE, Brown RF, et al: Theradiologic learning file. Radiology 104:27-31,Jul 1972 8. Lalli AF: Radiology a medical schoolrequirement. Radiology 108:217-218, Jul 1973 9. Land RE: Thought-provoking exercises in diagnostic radiology for medical students. Radiology 100:193-195,Jul 1971 10. Langston CS, Squire LF: Onthe structure of the elective in radiology. Radiology 105:435-438, Nov 1972 11. MacEwan DW, Zylak CJ, Walton RJ: Organization of undergraduate radiologic teaching in a small medical centre. J Can AssocRadiol 20:206-209, Sep 1969 12. Pais MJ, Kricun ME, Squire LF: The radiologist as a teacher of medicine. Radiology 116:79-80, Jul 1975 13. Schneider M, Utreich S, Squire LF: Emergency room radiology: a format for instructing house staff. Radiology 116:73-74, Jul 1975 14. Schwarz GS: A view box with a remote-control panel changer as a teaching device. Radiology 97:657-659, Dec 1970 15. Steckel RJ: Daily x-ray rounds in a large teaching hospital using high-resolution closed-circuit television. Radiology 105:319321, Nov 1972 16. Squire LF, Blotnick V, Becker JA: Self-instruction in radiology for medical students. Radiology 105:681-684,Dec 1972 17. Squire LF: On the training of teachers in the preparation and presentation of radiotoqlcal material. Radiology 110:105-1 08, Jan 1974 18. Squire LF, Whitley JE, Robinson T, et al: Teaching the use of diagnostic radiology and other imaging modalities. Radiology 110:575-577, Mar 1974
EDITOR'S NOTE: RADIOLOGY sincerely regrets the printing of the first page of Dr. Martin's Opinion with the second page of Dr. Alfidi's Opinion in the May issue. Each Opinion is presented complete in this issue. W.R.E.
•
The Who, Why and How of Radiology Teaching Files 1
•
Norman L. Martin, M.D. A variety of teaching files in diagnostic radiology is needed to serve a broad spectrum of purposes and students. A method of acquiring a simplified teaching file to be used for and by medical students, non-radiology house staff, first-year radiology residents and senior staff members is described. The medical student, as a learning experience, acts as the procurer of this file. INDEX TERMS:
•
Education, diagnostic radiology. Opinions • Radiology and radiologists
Radiology 119:745-746, June 1976
Diagnostic radiology has grown rapidly as a consultative service during the past few years. With this increasing expansion has come the awareness of the need for more formal education of medical students and non-radiology house staff in the proper use of this consultative service (2, 3, 4, 8, 10, 11). The ordering of proper examinations in the proper sequence; the time, expense, and patient preparation involved; the indications, contraindications, and limitations of procedures as well as patient experiences and reactions to various examinations have not been taught to our non-radiologist colleagues (6, 12). The recent radiological literature attests to the advisability and capabilities of radiologists being teachers of medical students and house staff in both the basic sciences and clinical medicine (5, 12, 13, 17). Numerous teaching techniques have proved efficacious (1,7,9, 14, 15, 16, 18). One significant problem that arises in teaching medical students, non-radiology house staff, and first year radiology residents is the acquisition of a student radiology teaching file. This file should have radiographs of normal anatomy and physiology and simple, straightforward, classic diseases with characteristic roentgenographic findings. The diagnostic radiology teaching file used by senior radiology staff and residents has many excellent cases, but many are diagnostically difficult, unusual or rare and esoteric. These films have been kept because of personal interests, findings that should be diagnosed by more senior radiology residents, or for use when reviewing for board examinations. Consequently, the very simple fracture or very large pneumothorax may not be found in an otherwise excellent senior staff radiology teaching file. This type of case, however, is very important for the beginning first-year radiology residents, medical students and non-radiology house staff. One very effective way of rapidly accumulating a good student radiology teaching file is to use the medical student as the procurer of the file. This affords the student an excellent learning experience. Six to eight students a month rotate through our Diagnostic Radiolo-
• gy module. One of the requirements while the students are taking the module is to prepare cases for the student teaching file. The student rotates through the areas of general diagnostic radiology, neuroradiology, pediatrics, special procedures, nuclear medicine, GI radiology, GU radiology, ultrasound, thermography, mammography, and bone and joint radiology. He or she is asked to prepare, under the guidance of the senior radiology staff, a case each week that has come through the section in which he is rotating. Such a case must be a c1assic radiographic demonstration of normal anatomy and .physiology or some disease process. Under the supervision of the attending senior staff in the area, the student pulls the diagnostic films from the patient's jacket and these films are copied. The copy films are placed in a separate jacket. The student is then required to write a brief summary on the front of the jacket of the patient's chief complaint and pertinent medical history, the positive physical findings, appropriate laboratory and other diagnostic studies which have been or should be performed, and a differential diagnosis. A brief discussion of the anatomy, physiology and pathological process involved and the roentgenographic findings seen in the particular case are also summarized. This material is then reviewed with the senior staff member for his approval before being placed in the student teaching file. This accomplishes a number of things: first, the student must read a number of texts and consult with the senior staff regarding the disease process under discussion. It causes him to review not just the radiographic findings but the indications, contraindications, and limitations of various radiological examinations. The proper sequence of the radiographic workup for a patient with this disease, and the total scope of the disease process or normal anatomy and physiology in question is identified and studied. Second, the case is presented by the student to his colleagues in the module where he is expected to expound or defend to his peers his findings and conclusions. Third, the case is then placed in the student teaching file to be read and
1 From the Department of Diagnostic Radiology (N. L. M., Assistant Professor), University of Kansas Medical Center, Kansas City, Kansas. shan Accepted for publication in January 1976.
745
746
OPINION
reviewed by upcoming students as part of the requirements of the module. The review of the student teaching file by succeeding student groups occurs at times set aside during the day and during the evenings when they are on call with the radiology resident. This file also provides excellent source material for beginning radiology residents. They are strongly encouraged to review the entire student teaching file early in their training. This has become increasingly important as internships have been deleted and many radiology residents are accepted from medical school without an extra year of medical maturity and experience. A fourth advantage is that a readily accessible flle to be used by students, house staff and senior radiology staff is available when conferences are given in the hospital, and for use by senior staff radiologists for demonstrations in the basic science areas including gross anatomy, physiology, pharmacology, and pathology. Fifth, it is a file which is separate from the main senior diagnostic radiology file or personal files used for teaching more senior diagnostic radiology residents. This keeps loss and misplacement of these films at a minimum. With this system, approximately 400 teaching cases a year are accrued under the supervision of the senior staff radiologists. A wide spectrum of films is obtained covering many aspects of medicine in its broadest sense. The monitoring of the student teaching file by the senior staff assures that all areas of medicine are represented and that there are not 20 cases of renal cell carcinoma and only one case of pyelonephritis present. The medical student teaching file is kept in a room with view-boxes and designated as the "Medical Student Teaching Room." It is convenient for daily use by the medical students taking the module and the first year radiology residents. Films can be taken from the file under the supervision of the individual staff man responsible for guiding the student in a radiology presentation in other areas of the hospital. In summary, it can be stated that indeed there are reasons for different types of radiology teaching files depending on who they are to serve and why they are to be kept. One method of how they can be procured
June
1976
and utilized for the best possible teaching is presented.
Department of Diagnostic Radiology University of Kansas Medical Center 39th and Rainbow Blvd. Kansas City, Kansas 66103
REFERENCES 1. Allman RM: The RPC: a learning set for continuing education in radiology. Radiology 100:189-192, Jul 1971 2. Blotnick VS, Squire LF, BeckerJA: A testing procedure for analyzing methods of teaching diagnostic radiology. Radiology 105: 685-688, Dec 1972 3. Cockshott WP: Radiology in the medical student's program. Radiology 100:197-198, Jul 1971 4. Fischer HW: The objective in diagnostic radiology. Radiology 100:196, Jul 1971 5. Forrester D: Teaching anatomy through radiology. Radiology 100:561-565, Sep 1971 6. Freimanis AK: Successful teaching of radiology to medical students and interns. Radiology 97:669-680, Dec 1970 7. Gold RH, Ross SE, Brown RF, et al: Theradiologic learning file. Radiology 104:27-31,Jul 1972 8. Lalli AF: Radiology a medical schoolrequirement. Radiology 108:217-218, Jul 1973 9. Land RE: Thought-provoking exercises in diagnostic radiology for medical students. Radiology 100:193-195,Jul 1971 10. Langston CS, Squire LF: Onthe structure of the elective in radiology. Radiology 105:435-438, Nov 1972 11. MacEwan DW, Zylak CJ, Walton RJ: Organization of undergraduate radiologic teaching in a small medical centre. J Can AssocRadiol 20:206-209, Sep 1969 12. Pais MJ, Kricun ME, Squire LF: The radiologist as a teacher of medicine. Radiology 116:79-80, Jul 1975 13. Schneider M, Utreich S, Squire LF: Emergency room radiology: a format for instructing house staff. Radiology 116:73-74, Jul 1975 14. Schwarz GS: A view box with a remote-control panel changer as a teaching device. Radiology 97:657-659, Dec 1970 15. Steckel RJ: Daily x-ray rounds in a large teaching hospital using high-resolution closed-circuit television. Radiology 105:319321, Nov 1972 16. Squire LF, Blotnick V, Becker JA: Self-instruction in radiology for medical students. Radiology 105:681-684,Dec 1972 17. Squire LF: On the training of teachers in the preparation and presentation of radiotoqlcal material. Radiology 110:105-1 08, Jan 1974 18. Squire LF, Whitley JE, Robinson T, et al: Teaching the use of diagnostic radiology and other imaging modalities. Radiology 110:575-577, Mar 1974
EDITOR'S NOTE: RADIOLOGY sincerely regrets the printing of the first page of Dr. Martin's Opinion with the second page of Dr. Alfidi's Opinion in the May issue. Each Opinion is presented complete in this issue. W.R.E.
