Radiology teaching within the undergraduate medical curriculum: medical students’ perspective

Dear Editor,

We would like to thank Chew et al for their article titled, ‘Radiology for medical students: Do we teach enough? A national study’, which we found to offer great insight into the current state of undergraduate radiology teaching within the UK. ¹ As final year medical students at King’s College London, having experienced both pre-clinical and clinical radiology teaching within an undergraduate curriculum, we would like to offer our contribution to this article.

Whilst we agree with Chew et al regarding the need to improve radiology teaching within the undergraduate medical curriculum, we believe that further discussion is required regarding the delivery of radiology teaching to ensure competent clinical practice. Unfortunately, the quality of radiology teaching within UK undergraduate medical curricula has been a long-standing issue, with a study performed in 2010 surveying UK medical students highlighting that 68% of fifth-year medical students reported inadequate pre-clinical radiology teaching. ² Therefore, we believe it is imperative to address the delivery of radiology teaching within the undergraduate medical curriculum, in order to improve learning outcomes for medical students and to optimize patient management.

One of the numerous barriers in achieving a high standard of radiology teaching is the limited time available for radiologists to participate in hospital-based teaching, regardless of their enthusiasm or eagerness to teach medical students. ³ In order to maintain high quality teaching without increasing the burden on radiologists, we believe the use of radiology trainees or hospital-based clinicians for bedside teaching could be beneficial. 100% of fifth-year medical students and 93% of third-year medical students felt that there were no differences in the quality of radiology teaching delivered by radiologists when compared to other clinicians. ² Through the utilization of radiology trainees for teaching, more radiology teaching can be allocated to medical students within their curriculum whilst also offering trainees the opportunity to gain not only academic teaching experience early in their career, but also revision of key radiological aspects that will aid them in their future specialty examinations. Hospital-based clinicians may also offer an alternative approach to teaching for medical students, highlighting the wider application of radiology across all specialties of medicine, and exposing medical students to greater utilization of cross-sectional imaging. This will increase medical students’ confidence in imaging interpretation, improving their clinical judgement and diagnostic accuracy, providing great benefit for their OSCE examinations. ⁴

In order to further the training of diagnostic reasoning, integration of diagnostic grand rounds into the undergraduate medical curriculum may provide an essential resource in meeting the GMC expectations of medical students at graduation. The diagnostic grand round is a subform of the grand round, which provides medical students with opportunities to present cases from either patients they have seen themselves or from patient notes, offering their opinions on which investigations are required and their interpretation of test results. ⁵ Stieger et al investigated the use of diagnostic grand rounds in undergraduate medical education and reported that attendance of diagnostic grand rounds among fifth-year medical students significantly improved their ability of diagnostic reasoning. ⁶ Attendance of these rounds provided medical students with greater flexibility in thinking and the ability to restructure knowledge in memory, both key factors contributing to improved overall diagnostic reasoning and accuracy. ⁶ Diagnostic grand rounds can also effectively be incorporated into the medical curriculum, through use of lecture theatres, classrooms or virtual platforms, providing interactive and interdisciplinary modes of teaching with a greater degree of flexibility for clinicians running the sessions.

Utilization of radiological literature publications reviewing diagnostic errors can also provide an effective mode of teaching for medical students. Pinto et al evaluated the use of literature evaluating radiological diagnostic errors, as a method for improving education in radiology, reporting that errors can provide educational value if considered learning opportunities, rather than failures. ⁷ Reviewing diagnostic errors through literature can lead to improved knowledge and clinical reasoning, through greater awareness of patient history, selection of clinical investigations and through comparison with alternative case studies. ⁸ This mode of teaching can be implemented through provision of relevant literature to medical students for independent review by department leads within medical schools, in line with medical schools’ learning outcomes, the Royal College of Radiologists undergraduate curriculum and GMC outcomes for graduates.

To improve radiology education within the undergraduate medical curriculum, effective communication is required between medical schools and their teaching hospitals in order to improve the delivery of radiological teaching and provide medical students with adequate training to further clinical competency.