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January 22, 2021
Given the state of medical school curricula, many medical students are learning more about radiology from non-radiologists, who often perpetuate many misconceptions that deter students from entering our field,” says Yasha Gupta, MD, chief resident at Mount Auburn Hospital in Cambridge, Mass., and education liaison for the ACR RFS Executive Committee. “There are a lot of misconceptions, and students need more knowledge — an early introduction to the specialty — to dispel myths and misinformation that threaten our strongest future.”
Connecting with medical students to impart the value of the specialty — through outreach, education, revised curricula, and straightforward resources — will ensure a diverse pipeline toward coordinated, collegial healthcare to ensure the best patient outcomes. Radiology is frequently underrepresented in the formal curricula of medical schools — and taught by non-radiologists. Often the educational materials do not cover technological advances, the current scope of radiological practices, or the role radiologists play in the patient care continuum.1
“Physicians are charged with ordering the most appropriate studies for their patients throughout their careers,” says Lori Deitte, MD, FACR, chair of the ACR Commission on Publications and Lifelong Learning and vice chair of education at Vanderbilt University Medical Center. “In our role as expert consultants, we are the source for our colleagues with questions about imaging.” To that end, better understanding the central role of the radiologist and how imaging helps direct patient care is important for medical students, Deitte says.
Stressing the value of radiology for medical students goes beyond showcasing the latest imaging capabilities. In addition to learning about the technology behind the images, medical students need more information about the radiologists day-to-day, their central role in a patient’s care journey, and the various subspecialties that make up the profession.
The specialty also needs to counteract misinformation students may encounter. They may be told that AI will decimate the specialty or that radiologists are shut away reading images in a dark room. Medical students may also be misinformed about how much patient interaction radiologists have or the changing demographics of the specialty. Whether or not medical students decide to go into radiology, it’s integral that these future clinicians understand the specialty and how imaging impacts patient care.
Deitte co-chairs the ACR Task Force on Medical Student Education, formed as a result of a Council-passed resolution from the 2020 ACR annual meeting. The Task Force is investigating more avenues for introducing medical students to imaging — including diagnostic radiology, IR, and radiation oncology. “The idea is to have radiologists and radiation oncologists teaching and interacting with students throughout their first through fourth years,” she says. “We want to be represented early
in medical schools’ curricula.”
The task force is divided into three teams, each working on specific activities related to medical student education and engagement. These groups will report out by the end of this month, providing perspectives from diverse stakeholders, ranging from medical students to a medical school dean. The group will aggregate the findings and make recommendations for ways to accelerate medical students’ understanding of radiology and add value to their educational experiences. The Task Force will present a report on the group’s work at ACR 2021.
“We want to give medical students an opportunity to engage in educational activities that could influence their career path — using a longitudinal curriculum that can assist with better matches to corresponding residency programs,” Deitte says. “We think integrating radiology taught by radiologists into an existing curriculum will be the most successful approach,” she adds.
A failure to teach the fundamentals of radiology will have huge long-term effects on the profession, says Christopher M. Straus, MD, professor of radiology and director of medical education at University of Chicago Pritzker School of Medicine and co-chair of the Task Force with Deitte. At his institution, Straus is expanding a radiology interest group, with a fundamental goal of integrating radiology into first-year coursework.
“We are operational with first-year activities here, and we are networking in the Chicago area with medical schools of different types, sizes, and philosophies to share and formalize what we’re doing,” Straus says. “After testing the radiology interest group, we plan to approach the ACR later this year to use our strategy on a national scale.” The group is building out from an existing effort to encourage students interested in imaging or a career in radiology to meet with radiologists from Pritzker to learn more about the specialty. “We’re moving this project up in the queue in part because of COVID-19 and the increased readiness and willingness to establish remote education experiences,” Straus says.
In response to the COVID-19 pandemic reducing medical student presence on clinical services and in classrooms, academic institutions are using virtual formats to continue medical student education.2
“We had to terminate a clerkship when COVID-19 began,” says Christopher F. Beaulieu, MD, PhD, professor of radiology and associate chair of education at Stanford University. “Medical students were sent home and everyone was sort of left out in the cold.”
Beaulieu says his institution quickly recognized that virtual radiology education was an option. “We put together a two-week online clerkship. Instead of the usual 8 or 10 students we typically get, we got 80,” Beaulieu says. “It went quite well. It was time well spent for faculty and residents who taught — and the feedback was tremendous.” A little more than half of the students surveyed at the end of the course said they would consider radiology as a career choice.
“Our residents are quite proactive and enthusiastic about participating,” Beaulieu says. “Teaching is a benefit for them. They learn what they know and what they don’t know when they teach.” There is evidence that involving radiology residents in medical student teaching — giving lectures — may benefit residents and students alike.3
The clerkship aimed to teach students some very basic image interpretation skills for things like chest X-ray and abdominal CT, which are good to know for any physician, Beaulieu says. “Then we want them to learn to be a good clinician consumer of radiology. They need to learn how they can collaborate with radiologists,” he says. “I hope that social piece of it is going to be ingrained in them.”
“One of my concerns about going virtual was the loss of face time and the in-person experience,” Beaulieu admits. “But to be honest, a lot of students who visit a reading room see the experience as some kind of downtime. They can get bored and don’t feel engaged. If you do something virtually, it can be much more concentrated and effective.”
Pre-pandemic, Stanford Radiology had been planning to host informal radiology-themed lunch seminars for medical students once per week for one credit. Last fall, the school instituted an imaging seminar online (minus the lunch) and paralleled it with gross anatomy. “We called it ‘Imaging for Human Anatomy.’ There is an anatomy schedule in their curriculum already, so we added 10 seminars to go along with that coursework. We had a great turnout, with 26 students enrolled,” Beaulieu says. “A first-quarter introduction will be a huge plus for radiology down the road.”
In a way, COVID-19 has leveled the playing field among medical schools, where big and small programs essentially have the same virtual platform at their disposal. It is an opportunity to connect with potential future radiologists — establishing mentoring and education resources through familiar social media outlets, for instance. This approach could be more successful than mandatory courses that come too late to spark interest.
To capture some of these opportunities, Gupta has spearheaded a number of efforts at her institution around education, mentoring, and a future career in radiology. “We’re working on a variety of things,” she says. “We just did a ‘How-to-nail-your-virtual-interview’ webinar — a COVID-19-borne response to the new virtual interview scene for radiology residencies.” Gupta was involved in a JACR® tweet chat on the same subject.
Social media platforms promote webinars and national radiology conferences — often with specific educational content and service opportunities for medical students. Twitter, in particular, has become an effective way for students to collect and share the accounts of program directors, residents, educators, and institutional training programs.4 “I also created a future radiology residents group (@futureradres) on Twitter,” Gupta says. “It has basically evolved into its own mini-organization.”
An @futureradres virtual mentorship program last summer, with support from the ACR, was a tremendous success, with around 500 students interested in radiology signing up. The ACR’s Medical Student Subcommittee, of which Gupta is a member, has a keen interest in developing a mentorship program, and members of all ages and experience are ready to participate. “Recently, the ACR Senior and/or Retired Section reached out to me with interest in doing a similar virtual mentorship program with medical students and younger residents,” Gupta says.
It is heartening to see more senior and retired radiologists stepping forward to share leadership experience and serve as mentors, Gupta says. “Connecting early is the best way to ensure a strong future for radiology — and hopefully with a more diverse pipeline,” she says.
More diversity in radiology is definitely something we need to be working on, says David M. Naeger, MD, director of radiology at Denver Health, professor and vice chair at the University of Colorado School of Medicine, and immediate past president of the Alliance of Medical Student Educators in Radiology (AMSER). “It is mission critical. We are one of the least diverse fields in medicine, and it hinders our field and the care we provide to our patients. It’s hard to get the best and brightest when students may feel like they don’t belong,” he says.
Getting the best students interested also hinges on changing their perceptions of a longstanding misunderstanding of what radiologists actually do. “They may have concerns about collegiality and respect between radiology and our referring colleagues,” Naeger says. “We operate a little bit behind the scenes. If you don’t understand what the job is, you may get a skewed view. If radiology is invisible to students and trainees, quality communication and respect might be lacking downstream once students and trainees graduate.”
To build a solid foundation, medical students need to be exposed to the role radiology plays in clinical medicine, ideally as part of their pre-clinical curricula and in their early clinical experiences. “We just proposed and got accepted for a full, hands-on IR course for third-year students, right as students are experiencing their first in-depth clinical rotations,” Naeger says. “It’s an important time to engage students — to show the significance of radiology in a clinical setting.”
“Students mostly see patients bedside and think all the action is happening there,” Naeger says. “They don’t realize the care started sometimes well before that point, when a highly trained physician read the images that made the diagnosis or changed the course of care for that patient,” he says.
“The message that AI is not going to replace radiologists, for example, has not permeated medical schools,” Naeger says. “That’s an area where we need to set the record straight and quell the hysteria.”
It is the perfect example of the kind of misinformation that causes some medical students to shy away, Straus agrees. “If we let AI fundamentally change our role in the eyes of the general public, referring providers, and patients, we are really hurting ourselves,” he says. “AI can be used as a tool, but that messaging is not getting through. And those who control the education of medical students may cast AI as another reason not to become a radiologist.”
“This is a misunderstanding on all fronts — among medical students and the general public alike,” Straus says. Until relatively recently, reaching medical students has not been top of mind. “We’re finally beginning to realize that we need to change our attitude and focus — to target our efforts and put a face on radiologists for students. We need to teach them properly, so they understand the role of imaging — which, in turn, may motivate them to pursue a career in radiology,” he says.
“The ACR has been extremely good in its efforts to reach medical students,” Straus says. “With so many issues around referring physicians and reimbursement battles on the Hill, it is clear that we need to start this outreach early on in medical school training.”
“While radiology is integral to the physician experience, medical students largely do not have a basic understanding of how imaging works and can be used,” says Joan Lynch, coordinator of the ACR’s Medical Education & Student Outreach (MESO) program. “Of course, we would like more students to pursue radiology, but our objective with MESO is for every medical student to understand at least some basic imaging.”
ACR membership is free to medical students — and comes with a host of resources and education opportunities. Educating medical students on the true role radiologists play in patient care is critical to attracting more students to the profession and ensuring appropriate imaging for all patients.
Although radiology may be a more highly compensated specialty, this alone is not enough to attract the best and brightest to the specialty. “There is a high level of idealism among medical students,” Naeger says. “They won’t pursue radiology for material or lifestyle reasons.” A sense of belonging, appreciation, and being of service to their community is more likely to drive the career decisions of many. Plus, medical students are nowhere near sending out resumes. “They aren’t really paying attention to the job market eight years down the road,” he adds.
"Medical students want to know that radiologists will have a seat at the table with other specialists,” Straus says. “They see and hear snippets about the field — maybe something about one component of it. They hear the easy-to-repeat sentence and that’s what gets spread.”
Radiology is not a supplemental element of patient care or the learning process, Straus says. “Educating medical students early about the value of radiologists in healthcare may not only create a more robust pipeline to the future, it also validates the central role of imaging in patient care today,” he says. “That education needs to start on day one for students. The only thing worse than not learning about radiology is learning the wrong things.”