On teaching radiology to medical students: a commentary.

The article by Scheiner and colleagues of Brown Medical School (Providence, RI) (1) and the correspondence from Afaq of the Imperial College School of Medicine (London, England) (2) in this issue of Academic Radiology reiterate an old problem. In fact, Afaq cites 30 years of references on the difficulty of gaining access to medical students to teach them radiology. The senior author’s experience at four medical schools confirms this impression. Although we found radiology course electives to be popular, they were never required until we reached the University of Rochester. However, development of our “double helix” curriculum with emphasis on problem-based learning and small-group discussions led to the demise of this short radiology lecture series for preclinical medical students. Scheiner et al (1) most ably present the problem that currently exists. Medical students now receive most of their initial exposure to radiographic images through daily patient rounds on their clinical services. Although the clinicians who lead these rounds are most knowledgeable about basic radiographic findings within their specialty, there is a tendency for the clinicians to overread the images when influenced by physical findings and clinical history. In addition, these rounds are held in large groups, and the medical student rarely obtains an optimal position for viewing the images and hearing the discussion. This is now further compromised by workstation reviews in the filmless environment. When viewed from an off-center location, many monitor screens lack full fidelity and in fact obscure detail for everyone except those few within direct vision. Let us reemphasize that our clinical colleagues are not always uncomfortable reviewing radiologic images of disorders in their specialty or subspecialty. When our ultrasound (US) section converted to a filmless system, we did not anticipate the objection and inconvenience expressed by some of our colleagues, most notably pediatric urologists and pediatric orthopedists. Although US images in many cases are static representations of dynamic evaluations (similar to fluoroscopy), these clinicians used the film images (and now paper copies that we presently supply) to discuss patient care issues with the children’s families. However, even though clinicians may be knowledgeable and comfortable viewing images, they usually teach imaging as a correlative adjunct to physical diagnosis and clinical history rather than as a scientific depiction of the pathophysiology of disease. The emphasis of the new curriculum on problem-based learning and small-group discussions is an opportunity for radiologists to be more effective as consultants. However, participation in this new curriculum is extremely labor intensive. Since only a few medical students can be taught at a time, multiple groups of students must be taught; thus it is difficult to find enough radiologists to teach all of these groups because it impinges on their limited clinical and academic time. Medical student teaching is too often considered a distraction from the perceived primary goal of resident education. Radiology clinical clerkships are still a ready opportunity for teaching and medical student contact. They are also more effective when available in the 3rd or 4th year of medical school. If special attention is to be paid to medical student education, it may become difficult to find enough space to accommodate all students that are interested. However, observation of image interpretation sesAcad Radiol 2002; 9:224–225