Refining your skills as a medical student hinges upon acknowledging the patients behind the images — and is crucial for building patient relationships.
Hannah Johnson, M4
By Hannah Johnson, M4, Southern Illinois University School of Medicine, Springfield
Regardless of what specialty you plan on entering after medical school, one of the best ways to learn and improve throughout your clinical years is to be present with the patient. Be there for the patient when they ask follow-up questions about scans or test results and engage in patient-centric care.
Across most clinical clerkships and specialties, your patients will undergo imaging. It’s important to make the time to acknowledge the power of imaging — both in clinical decision making and in its impact on patients. While it can be incredibly educational and instill in students that there is always a patient behind the image, we never make clinical, interpretive decisions without the supervision and approval of a qualified radiologist.
Many areas of medicine afford opportunities to improve your understanding of imaging. Obstetrics and gynecology deals with prenatal ultrasounds (same goes in pediatrics), amniotic fluid index, endometrial hyperplasia, ectopic pregnancy and mammography. In surgery, as a preceptor of mine once said, “Ordering a scan is deciding where to cut.” Family medicine has follow-up X-rays and head CTs, among others. In emergency medicine, imaging coupled with an EKG can allow you to recognize or rule out some “cannot-miss diagnoses,” such as aortic dissection, pulmonary embolus and esophageal rupture.
Following a patient’s examination, make a differential diagnosis. Attempt to determine which are best diagnosed by imaging. Use all tools and resources at your disposal — such as the ACR Appropriateness Criteria® — to support the most appropriate scan for diagnosis, and discuss with your supervisors whether that should be X-ray, ultrasound, CT with contrast, CT without contrast, MRI, PET, etc. Try to determine whether the scan can and should be performed in your current setting (hospital or clinic, for example) and whether follow-up imaging will be needed.
Make a point of reviewing your patients’ scans as you go through daily lab results. Challenge yourself to make a preliminary interpretation. Begin by recognizing anatomy and always specify left or right. Look up images of “normal” and compare them to those of your patients.
As you progress, describe structures and findings as appropriate to the imaging modality. Eventually, you will begin to recognize that some things don’t seem right. Read the radiologist’s interpretation to check yourself. Always ask for help along the way; experienced physicians are your go-to resource for invaluable insight throughout your training.
With permission from a supervisor, you may discuss the results of the images with your patients during your clinical rotations. Take these opportunities to apply what you have learned. Explain basic anatomy and the pathology in simple terms. Acknowledge what you do and do not know. Often, patients will appreciate your personal attention and frank conversation.
It would be wise to familiarize yourself with ACR Commission on Patient- and Family-Centered Care. Giving patients and their families a say in their own clinical care and the decision-making process that is driving it can lead to better patient health outcomes, higher satisfaction with care for patients and clinicians alike and the opportunity to share resources and to encourage follow-up care.
Never let what you have learned stop with you. Offer to give brief presentations to your team on imaging. These talks don’t have to take the form of presenting interpretations but may address the current protocols for workup and diagnosis of pathologies. As applicable, incorporate pathology staging (TI-RADS®, BI-RADS®, LI-RADS®, PI-RADS®) and follow-up frequency into your presentations. You will learn and improve by doing this, as will your team members and fellow medical students.
Finally, sign up for a radiology elective. As a student, you will be in awe of radiologists’ diagnostic speed and breadth of knowledge — they are the experts. As appropriate, ask for tips about interpreting the imaging you’ve seen and about what prompts a radiologist to call the clinician. Accompany patients to their scans when and if you can.
Meet the patient, meet the scan and your patients and team will benefit.
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