ACR Bulletin

Covering topics relevant to the practice of radiology

The Right Direction

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The ACR is engaging, mentoring, and educating medical students to keep the specialty moving forward.

The lack of role models, mentorship, and exposure to radiology are barriers for recruitment in medical school.

—Patricia Balthazar, MD
December 20, 2021

“A huge part of how we teach and train medical students comes down to engagement,” says Lori A. Deitte, MD, FACR, chair of the ACR Commission on Publications and Lifelong Learning. “We want to give medical students the opportunity to engage in educational activities that could influence their career path — using a longitudinal curriculum to allow medical students the opportunity to select diagnostic radiology, IR, or radiation oncology early enough as their career preference and be able to match successfully into the corresponding residency program.”

The ACR’s Task Force on Medical Student Education has been investigating avenues for introducing all medical students to diagnostic radiology, IR, and radiation oncology taught by radiologists and radiation oncologists throughout their first through third years. “We think integrating radiology taught by radiologists into an existing curriculum will be the most successful approach,” Deitte says. This allows those seeking a career in other areas of medicine to understand radiology’s central role, she adds.

Medical student education and engagement are important parts of the ACR’s mission. The ACR, in collaboration with the Association of University Radiologists and the Alliance of Medical Student Educators in Radiology, is offering the medical student community a host of educational content in radiology and clinical decision support, free of charge. Learn more.

Targeting Resources

“The ACR offers incredible resources to the medical student community,” says Patricia Balthazar, MD, assistant professor of radiology and imaging sciences at Emory University. These include the Standardized Tool for the Assessment of Radiology Students (STARS), a collaborative effort of the Alliance of Medical Student Educators in Radiology and the ACR that provides medical schools with a national, web-based question-item database and exam-taking system to use in assessing students throughout their radiology courses. Another tool, Radiology-TEACHES™, simulates the process of ordering an imaging exam based on the ACR Appropriateness Criteria®. Radiology-TEACHES addresses the gap in curricula on the Appropriateness Criteria through case vignettes to mirror the process of ordering imaging studies. Learners receive evidence-based feedback to better understand appropriate imaging utilization and reduce waste. More than 58% of medical schools now participate in Radiology-TEACHES, according to Deitte. In addition, medical students are now authoring cases through the program with the assistance of radiology mentors — and health equity modules are now available.

Because radiology is such a diverse specialty, with many career options, it is really important that medical students are introduced to the field early in their training and meet mentors to gain a sense of the breadth within the specialty.

—Sydney Rubin, fourth-year medical student at Michigan State University and aspiring radiologist

On a higher-level scale, the ACR’s medical student curriculum allows students to access a large radiologic education library. The free resource is intended to educate medical students on radiology and provide medical educators with resources to build a radiology curriculum. The medical student curriculum has been popular — with already 1,600 unique page views. 

“The curriculum resource is vital, as many medical students are not exposed to radiology until very late in their training — and sometimes not at all,” Balthazar says. “Some medical schools do not offer a dedicated radiology clerkship, and some don’t have a radiologist involved in the pre-clinical curriculum.”

The Task Force’s findings bear this out, pointing to no national standard regarding imaging education for graduating medical students at accredited schools. In addition, medical student education lacks an evidence-based framework for radiologist-led education. 

Medical students may also miss out on interactions with radiologists during the early years of training, the Task Force concluded. Other findings include a need for increased availability and preparation of radiologists for teaching roles — paired with recommendations to decrease instances of non-radiologists as primary teachers of medical imaging. 

“Radiology can be introduced in the pre-clinical years by including the specialty in anatomy and pathology courses,” Balthazar says. “As students progress to the clinical years, radiology can be integrated into other clerkships.”

This could include recognizing basic surgical findings such as classic appendicitis on CT during surgery or appropriate use criteria for ordering imaging exams, she says.

Introducing Radiology

“Whether students are looking to gain a better understanding of a topic within radiology, contribute to educational projects, or find a mentor to support their career goals, the ACR has many resources available for students,” says Sydney Rubin, a fourth-year medical student at Michigan State University and an aspiring radiologist. “I was fortunate because I had early exposure to radiology in my pre-clerkship curriculum, as well as a required core clerkship course — which allowed me to make an informed decision to pursue a career in this specialty.”

The ACR provides medical students with opportunities to actively contribute to projects. “I am passionate about medical student education and the ACR allowed me to develop case vignettes for Radiology-TEACHES,” says Rubin. “Through participation as a medical student author, I was also connected with a mentor, Arnold C. Friedman, MD, who has supported my pursuit of a career in radiology beyond the completion of our project.”

“I believe most students approach the later years of their education with an open mind, but many already have a sense of what specialty they will likely choose,” Rubin says. “Because radiology is such a diverse specialty, with many career options, it is really important that medical students are introduced to the field early in their training and meet mentors to gain a sense of the breadth within the specialty.” 

“The lack of role models, mentorship, and exposure to radiology are barriers for recruitment in medical school,” Balthazar says. “Even when we review the residency applications of students who ended up finding their best fit in radiology, we often see students making a last-minute decision in their fourth year due to the late exposure.” This is due in no small part to misinformation about the current state and future of the field, she adds. 

“I would like to dispel the myth that radiologists don’t have patient contact,” Balthazar says. “Many radiology subspecialties have direct patient contact for procedures — for example, IRs, breast imagers, and some MSK and abdominal imagers. Radiology is a wonderful career choice that allows you to make a direct impact on the care of multiple patients in a single day. Your interpretation of the imaging findings can completely change the course of someone’s condition.” 

Defining Work

“In my experience, medical education is changing for the better when it comes to connecting students with radiology,” says Neil K. Jain, DO, IR resident at MedStar Georgetown University Hospital and chair of the ACR Medical Student Subcommittee. “Why would you not want to be on the frontline of medicine?”

“This year, we aim to form additional subcommittees within the RFS that will be a part of the ACR’s overall mission,” Jain says. “One example would be the recently launched bioethics subcommittee. The idea came actually from a medical student who is very passionate about bioethics.” The subcommittee looks at the interconnection of ethics and radiology, a topic vital to radiologists at all career stages but particularly important for physicians-in-training, Jain says.

The Medical Student Subcommittee is part of the ACR RFS and by extension, the Commission on Membership and Communications. Subcommittee members work to develop resources for medical students and provide input to ACR committees on issues related to membership retention and medical student outreach.

The RFS also facilitates two journal clubs — one on the topic of AI and one on economics. The journal clubs let trainees interact directly with ACR leaders to gain their unique perspectives. The RFS AI Journal Club also has its own YouTube channel.

“Medical students must understand that AI and machine learning are here to stay but not here to necessarily take away jobs from radiologists,” Jain says. “Instead, new technologies will complement our worklist so radiologists can focus more on interesting cases.” Another myth is that radiologists do not perform procedures, Jain says. “There are so many different subspecialties within radiology that provide procedural experience, interventional radiology being at the extreme. You definitely leave the dark room and interact with patients, colleagues, and other clinical staff,” he says. 

Jain adds, “I like to think about radiology this way — you are at the center of disease management. Your findings dictate a patient’s care management or treatment plan. When you throw radiology at medical students in their third year without a proper introduction in the preclinical years, they don’t have the time to truly consider and appreciate the specialty.”

“When it comes to patient-centered care, many students believe that radiology isn’t involved. However, some can argue that radiology is at the center of it,” Jain says. “And if radiology was taught during the pre-clinical years, there would be an opportunity to show how interconnected radiology is to their other coursework.” 

Pushing Forward

“I would strongly suggest that medical students who are interested in radiology take the initiative to get involved with the ACR early,” Rubin says. “There are many diverse opportunities to engage by contributing to Case in Point®, getting involved with an ACR state chapter, or participating in one of the ACR’s programs.”

“When we put the Task Force together, it was formed with an intentionally diverse representation,” Deitte says. The group includes a dean of a medical school, medical students, a radiation oncologist, members of the RFS and YPS, and so on, she notes. This is critical to achieving next steps based on Task Force findings, representing all voices.

Current goals of the Task Force include early engagement of radiologists with medical students through teaching, mentoring, and outreach programs. The Task Force plans to conduct a needs assessment of faculty and medical students and then share best practices for radiologist-led imaging education that is integrated into schools’ curricula. 

The Task Force also wants to develop a graduation standard, which would include a curriculum of core topics (imaging utilization, safety, etc.) that is expected of all graduating medical students. The group plans to collect case studies on value-added, radiologist-led activities, such as teaching, tumor boards, and workshops.

“We want to increase the use of social media and employ other online platforms to engage medical students,” Deitte says. “And we will engage with the Society of Chairs of Academic Radiology Departments to identify a faculty leader in individual medical school departments to lead the charge and act as a liaison between medical schools and radiology educators.” This will facilitate inclusion of the radiologist on undergraduate curriculum committees, Deitte asserts. The Task Force also plans to build a network of educators using a webinar series designed for faculty teaching. 

“There is nothing more rewarding than mentoring, educating, and developing our future leaders,” Deitte says. “We are developing our pipeline of future members — and we’ve got to engage, mentor, and educate to keep the specialty moving in the right direction.”

Author Chad Hudnall  Senior Writer, ACR Press