Outside the reading room: Field trips expose medical students to patient-centered radiology

Integrating structured field trips to the imaging department during a four-week radiology clerkship could help expose medical students to the patient-centered, team-based aspects of the specialty, according to a review published this July in Academic Radiology.

The radiology elective, though important for teaching medical students the basics of radiologic interpretation, tends to lean on passive teaching methods like didactic lectures and observational shadowing of radiologists in the reading room, Matthew Hartman, MD, and co-authors wrote in the journal. And while traditional teaching techniques have their advantages, some worry students are gaining too shallow an understanding of the field.

“The importance of noninterpretive skills and active learning has been minimized,” Hartman, an associate professor with Allegheny Health Network in Pittsburgh, Pennsylvania, and his colleagues wrote. “With the emphasis on value-focused, team-based, patient-centered care, it is important to expand the focus of radiology education beyond interpretive skills alone such that these future physicians can most effectively utilize imaging to care for patients.”

Medical students need those skills for future patient counseling, appropriate ordering of imaging studies, patient safety and professionalism, the authors said, but their education is typically limited to observation with few expectations in return.

To target noninterpretive skills in the student population, Hartman et al. devised a month-long radiology program that employed active learning to expose students to different areas of imaging. Students from two organizations, Allegheny Health Network and the University of Kentucky, were given a worksheet at the beginning of their clerkship that they were expected to turn in by the end of their rotation. 

The worksheet outlined nine radiology “field trips”—interactive tasks around the radiology department that students could complete at any time—accompanied by questions designed to reinforce their knowledge.

Students were asked to observe a chest radiograph for one section, while in another they were expected to watch a contrast-enhanced body CT scan and observe the administration of an intravenous contrast. In the MRI suite they were asked to follow a patient through the process of an arthrogram, and in ultrasound they were to observe an image-guided biopsy and interpret the specimen with a cytopathologist. Other field trips took the students to fluoroscopy neuroradiology, mammography, interventional radiology and nuclear medicine.

“Most field trip experiences are completed within one to two hours,” Hartman and his team said. “By design, these observations require the student to leave the reading room to interact with technologists and patients.”

Classroom learning, independent study time and traditional reading room observation were all still parts of the curriculum, they wrote, but the field trips allowed students to see the more interactive—and often underplayed—side of radiology.

“It was a good experience to see the various imaging tests,” one student wrote of the program. “It was good to see the process involved with certain tests that I will order next year.”

The field trip model was successfully integrated into the four-week program, according to the study, with positive learning outcomes similar to those reported by the student above. Another student said they wished there were more field trips to look forward to.

“The field trips model uses active learning principles to promote teaching noninterpretive skills as they relate to radiology-specific medical student education,” Hartman and colleagues wrote. “It is expected that the practical information gained during these targeted field trips will be valuable to the future practice of the majority of medical students, regardless of their chosen specialty.”