Educational Needs of 3rd and 4th Year Medical Students - Literature review Example

Search Strategy A search for studies on methods to address the issue of medical imaging studies as preparation for radiographic specialties, was performed in peer-reviewed journals that were published in English. The data bases that were used were Pubmed, Psychosocial Instruments, British Nursing Index, Cumulative Index to Nursing and Allied Health Library, Psychosocial Instruments, Allied and Alternative Medicine and Sociofile. These databases were used because they are comprehensive and contain a multitude of peer-reviewed journals, and these are the databases commonly used by medical professionals. The initial search terms that were used were medical imaging, radiography, and students. At this time, the search was limited to these words, to see what articles could be found. As I was interested in the evolution of medical image teaching, in that my interest is in what techniques have been used within the last 30 years, the articles that I reviewed and researched were from 1979 to present. The articles were narrowed down to 50 articles by eliminating articles and studies that essentially duplicated other, very similar studies. If a study did not provide a strategy that was novel, it was eliminated. The goal was to find diverse articles that represented slightly different aspects of the issues. Also, in the interest of diversity, articles that examined medical imaging in the context of medical student education were examined as well. Of interest were the most innovative strategies for teaching medical imaging students, including those who are in medical or dental schools, along with those seeking a 4 year degree. Also of interest were articles that focused on radiographers, and the kind of training that makes specialty radiographers competent and well-versed. I was also interested in finding articles that provided a comprehensive look at some of the basics that need to be understood, as well as articles that speak on policy issues surrounding medical imaging education. Combining the focus of these lines of inquiry came up with the best overall view of the question at hand. The articles that were selected were global. Thus, the articles are representative of global strategies. Of interest was whether certain countries are using techniques that are effective and might not be as well-known in this country, and whether these techniques can be imported to this country or whether the techniques would work best because of the culture of the country from where the study originated. When choosing the five articles that would be presented, I first considered that there should be at least one article that dealt with issues about radiography, and one article that dealt with issues about medical imaging. For the radiography article, I looked for an article that went into depth about a study regarding a specific aspect of radiography and a study about a specific aspect of imaging. These were two of the articles that are presented. Then, I wanted to find an article that dealt with policy considerations, so I found an article that deals with the fact that imaging and radiography is not emphasized in medical schools, which has implications for all students of medical imaging technology. I was also interested in finding an article that did not specifically deal with imaging or radiography, but that had a broad approach that is important to the foundation of any medical expertise. This was the article about simulated exercises simulated exercises is a technique that is not just used in imaging, but in medicine in general. As it is a very important one, this article was selected as well. Lastly, I was interested in finding an article that represented a kind of 澱asic skillsarticle for incoming medical imaging students. These are skills that medical imaging technicians must have before they graduate, and, just because these are basic skills, it does not mean that they are always taught correctly. To this end, an article that speaks on the proper basic skills was something that was of great interest as well. This was another of the articles that is presented. What I learned was that most of the articles that handled these subjects handle them from the standpoint of medical students. Few of the articles handled these issues from the standpoint of students who are pursuing bachelors degrees in the subject. Nonetheless, these articles are important, as the issues that present themselves to medical students are the same as the ones that present themselves in other schools. Five Most Important References Gunderman, R.B. and C.D. Stephens. 2009. Teaching medical students about imaging techniques. American Journal of Roentgenology 192: 859-86. Dawes, TJW, S L Vowler, M.C. Allen, and A.K. Dixon. 2004. Training improves medical student performance in image interpretation. British Journal of Radiology 77: 775-776. Eisen, L.A., J.S. Berger, A. Hedge and R.F. Schneider. 2008. Competency in chest radiography. a comparison of medical students, residents, and fellows. Journal of General Internal Medicine 21(5): 460-465. Issenberg, S.B., W.C. McGaghie, E.R. Petrusa, D.L. Gordon & R.J. Scalese. 2005. Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher 21(1): 10-28. Rogers L.F. 2005. Imaging literacy: a laudable goal in the education of medical students. American Journal of Roentgenology 180(5):1239-1242. The first article was chosen because it 途eviews major themes about imaging techniques with which all educators should be familiar.(Gunderman & Stephens, 2008, p. 859). In other words, this is a basic article about the basic things that imaging students should be aware of and learn, such as physics, history, types of imaging, and clinical applications for each. In this way, this article was akin to a broad survey course at a university, hitting the major points, but not going too much into depth about any one technique. This article was chosen for its broad nature, as an introduction to the basics of image education, and this can serve as a springboard to investigate some of the techniques in more depth. The article is geared towards medical students, but, as the article is about imaging techniques and the study of this, it is appropriate to include in this analysis. It begins by stating that the basis for imaging education is grounded in physics. The basics of imaging are examining x-rays, ultrasound beams and gamma rays. Physics is also necessary to understand 都uch basic imaging parameters as density, acoustic impedence, and T1 relaxation times of human tissues(Gunderman & Stephens, 2008, p. 859). Therefore, a student should have a sound basis in basic physics to effectively understand imaging. The article goes on to state that many physicians do not have the basis to understand ionizing radiation, and that radiation courses need to bring students up to speed on this (Gunderman & Stephens, 2008, pp. 859-860). The article also states that students should grasp the history of radiologic imaging techniques. According to the authors, students would benefit from knowing the contributions of the Curies, Wilhelm Roentgen and others like these individuals, as it brings context to their learning and may help them remember what they study. It also helps prepare them 鍍o become innovators in their own right( Gunderman & Stephens, 2008, pp. 859-860). Further, the article states that students must understand the cost of imaging, how to orient themselves to certain types of imaging, and know the vocabulary of imaging. And, more importantly, according to the researchers, students must be familiar with how each type of imaging is used in clinical practice. The researchers also state that the skill that should be acquired first is that of knowing what tests to order, as opposed to the skill of image interpretation. Another basic skill that imaging students must know is that of contrast agents they should know what these are, and how they affect different images drawn from different techniques (Gunderman & Stephens, 2008, p. 860). The article concludes by stating that students should know the strengths and weaknesses of the various imaging techniques. Included in this is knowledge of what techniques 菟rovide the greatest spatial resolution and which offer the most physiological information. They need to know what sonography is often superb for evaluating superficial soft-tissue lesions but performs poorly in the evaluation of aerated lung and subcortical bone(Gunderman & Stephens, 2008, p. 861). Also necessary is the knowledge that and MRI is preferred for 渡onacute brain imagingand spinal cord issues, but should not be used if the patient has a pacemaker (Gunderman & Stephens, 2008, p. 861). The second article was chosen because it specifically states how training improves medical student performance in image interpretation. This article was especially helpful and relevant, because it produces a study that quantifies how training aids students in imaging practice. Specifically, it studies 鍍he effects of radiological teaching on student performance in interpreting radiological images, and to establish whether training location affects performance(Dawes et al., 2004, p. 775). As the subject of this paper is imaging students, and how education and training will help them become specialize radiographer, this study quantifies how helpful this training is in preparing the students to become experts in their field. In this study, 114 students were divided into two group and asked to interpret 5 images, each image accompanied by the history of the patient and what examinations found. Then, the students went through 26 weeks of training, which included 8 weeks at teaching and general hospitals. During this period, the students were provided with formal and informal teaching. The students, at the end of training, reviewed 10 more radiological cases five that they had seen before, and five new ones. The study found that, after training, the percentage of right answers shot up from a median of 8% to 43%, an improvement that was considered to be 塗ighly significant(Dawes et al., 2004, p. 775). The students also performed significantly better when viewing the images they had seen previously. The limitations of this study were that it could not be determined how much of the improvement was due to radiological teaching, and how much was due to clinical practice. It goes on to recommend a 菟rovision of extra radiology teaching in one group of students, or gathering the same data sets in another medical school with less radiological teachingto help clear this question up (Dawes et al., 2004, p. 776). The article also stated that there seemed to be no difference in the site and training manner, as 妬t would be difficult to provide identical training opportunities for students (Dawes et al., 2004, p. 776). While this article was helpful, in that it demonstrated the dramatic way that training helps in image interpretation, it also seems rather self-evident that this would be so. Moreover, it did not really distinguish between training and formal education. Therefore, it is not clear which of these modalities would be the most helpful in assisting students in interpreting images. Nevertheless, the dramatic results achieved by the researchers in this article deserve another look, and the techniques that were used should be used in medical imaging training facilities. The third article was about chest radiography, and this one was chosen because it focused on radiography, as opposed to image reading. Since the question that must be answered in this paper is how imaging students may be prepared to become radiographers, I found it interesting to focus on at least one article that talks about radiography and states what makes a person a good chest radiographer, and what makes for competency in this area. This article, combined with the others that focus on medical imaging, ties both aspects of the question together, so that it may be answered as a whole. In the study, three authors were given 10 chest radiographs (CXR) from a training program for internal medicine. These CXRs were representative of common chest ailments that these students would be called upon to diagnose when they became practitioners. Each one had only one correct diagnosis. Each CXR was also examined by 2 experts, who were blind about what the study was about. These experts agreed about each CXR. All the participants had, prior to the study, gone through CXR training and a 2 week diagnostic radiology clerkship. The clerkship consisted of 2 introductory lectures, as well as monthly interactive sessions with IM interns and residents. Each participant was given a survey about their basic background. Then, they were asked to review CXR and write what they found most important. Then, the experts blindly rated the participants. What the researchers found was that there were certain CXRs that the participants were 殿bsolutely certainthat they were correct about the diagnosis, but that these students were often wrong. They also found that radiology residents scored higher than internal medicine residents. The article goes on to explain that CXR interpretation is not stressed enough in medical school, and that it is not mandated in undergraduate medical school. Also, the American Board of Medicine does not require competency in CXR interpretation, although it does require competency in electrocardiogram interpretation. CXR interpretation also is not required for pulmonary exams, such as for boards such as for pulmonary medicine, cardiology and critical care (Eisen et al., 2008, p. 463). This is a problem, as house officers are often required to examine CXR before a radiologist does, and that this is particularly important in pulmonary emergencies (Eisen et al., 2008, p. 463). Considering that the subjects in this study had problems interpreting any CXR, even the normal one, and that this can lead to inappropriate diagnoses and care, there should be more emphasis on CXR. This is what this study concludes. The study also states remedies, such as using computers to aid diagnosis and using a picture archiving and communication system, as opposed to standard film, to also aid diagnosis. It also advocates formal training in CXR interpretation, with an emphasis on computer training, as this aids in CXR interpretation more than traditional methods (Eisen et al., 2008, p. 464). Other methods to improve CXR interpretation include encouraging IM house staff to enroll in radiological electives and to review the results of their interpretation with a physician who is trained in CXR interpretation. The strengths of this study were that it was one of the largest study of its kind, the participants came from multiple fields of medicine, and that this study was the only one to correlate confidence on a reading with success. The weaknesses were that a small number of CXRs were chosen, there was no house staff provided with clinical competence in CXR, and that even experienced radiologists have had differing interpretations of CXR, therefore their evaluation of the films might not have been accurate (Eisen et al., 2008, p. 464). The fourth article was chosen because it dealt with medical simulations (Issenberg, 2005, p. 10). This was an interesting article, as simulations have been used for many years in a successful manner. Simulations would naturally be helpful in the area of medical imaging. The previous article dealing with CXRs is an example of a simulation that was successfully used. Since this article went into depth about different medical simulations, and how these simulations contribute to effective medical learning, this article was an excellent foundational article for the topic at hand. In particular, the article focused on high fidelity simulations, and how these lead to the most effective learning. Therefore, it is focused on an innovative strategy for learning, and this made this article valuable. The article begins by stating that simulations are they include 電evices, trained persons, lifelike virtual environments, and contrived social situations that mimic problems(Issenberg, 2005, p. 11). The advantages for simulations are that they are like a real environment, therefore the participants acts as if they are also in the real environment, and they can be in complex situations. They are also advantageous, as medical students may not get the chance to examine real- life patients, due to different factors. Also, simulations are valuable because technology is constantly changing, and using brand-new technology on a real patient often increases the complication rate. Therefore, it is safer to use a simulation when dealing with new technology. Another value to simulated situations is that they encourage teamwork, and safe systems in which to learn. This is important to cut down on medical errors, as medical errors are often a result the systems of care (Issenberg, 2005). The researchers study found that high- fidelity simulations 吐acilitate learning among trainees when used under the right conditions(Issenberg et al., 2008, p. 20). The conditions include giving feedback to learners, and 菟roviding opportunities for repetitive practice to curriculum integration, individualized learning and simulator validityIssenberg et al., 2008, p. 20). Other conditions included repetitive practice, in which the learner repetitively learns skills in a controlled environment; curriculum integration, in which simulated situations are integrated into the coursework of students, as opposed to be a stand-alone curricula; range of difficulty level, where learners are engaged in simulations that are different degrees of difficulty; multiple learning strategies, where different learning strategies are incorporated to facilitate learning; capturing clinical variation, in which the simulations capture a wide variety of problems; controlled environment, in which students are able to make assessments without adverse consequences; and individualized learning, where learners are active participants, not passive by-standers. Their study also found that simulation-based learning complements, but not duplicates, learning with real patients in genuine settings. In this way, simulation based learning should be used to prepare students for real-life contact with real-life patients. The limitations of their study was that 鍍he quality and utility of the review stem directly from the quality of the primary research it covers(Issenberg et al., 2008, p. 20). Their study, and this is generalized to simulation-based learning as a whole, is that 都imulation-based medical education prohibits strong inference and generalizable claims about efficacy(Issenberg et al., 2008, p. 20). The fifth and final article was chosen because it was a general statement on why imaging literacy is a good goal for educating medical students (Rogers, 2003). This article provides a general explanation on why imaging education is valuable. This is important, as instructors and course curriculum designers might forget how important imaging is to developing students. If this occurs, then education on this aspect of medicine would go by the wayside and innovations will be slow to develop. This would affect all students who are interested in imaging or radiography, as innovations are what drives the industry and makes quality better. This article provides a sound basis for the continuance of imaging literacy. The article states that all medical students need to have sound knowledge of imaging, and this is the cornerstone for good patient care. According to Rogers, 鍍his knowledge should include the indications, contraindications, and limitations of each imaging technology, and the need for proper sequencing of examinations. Physicians should also have a basic understanding of radiologic physics, including an awareness of the harmful effects of radiation, the time-distance-dose relationship, and the implications of this relationship for those who use fluoroscopy.(Rogers, 2003). Additionally, practitioners should have a sound basis in the use of contrast medial, which, according to Rogers, physicians tend to know little about. Rogers feels that imaging education is spotty at the moment, and that medical students currently receive 努oefully little formal training in radiology and fewer still...receive mandated and required courses in imaging for which students must show proficiency by passing a test in the subject.(Rogers, 2008). Thus, medical imaging is overlooked in most medical school training. Moreover, the classes that offered in imaging are not rigorous they often do not have tests, and are taken on a pass/fail basis. The result of imaging being overlooked by medical school curricula is that image illiteracy is the norm, as opposed to image literacy. And this problem is not rectified by the fact that students have a passing exposure to imaging through their rounds and conferences. This is because the teaching of imaging through these means are not structured, and not tested, therefore are not taken seriously. They are thus 努oefully short of the structured educational experience required to prepare students for the proper use of imaging(Rogers, 2008). Thus, this article calls the fact that imaging is neglected out on the carpet. As stated above, this underutilization of imaging training courses at the medical school level will possibly have a chilling effect on the entire industry, which would extend to those studying medical imaging as a four year degree. This is because neglect of imaging at the highest level of medical training will necessarily result in a lack of innovation in this area. This will affect all students who are studying medical imaging, as it is necessary to keep up with technology. This probably will not happen until medical school curricula wake up and realize how important imaging is, and teaching all students at least the basic of this skill. Bibliography Adler A.M. and S. Baker. 1990. Recruiting radiography students. Administrative Radiology 9(5) :36-8. Aitken V. and S. Tabakov. 2005. Evaluation of the e-learning material developed by emerald and emit for diagnostic imaging and radiotherapy. Medical Engineering & Physics 27(7):633-9. Dikshit, A., D. Wu, C. Wu and W. Zhao, 2005. An online interactive simulation system for medical imaging education. Computerized Medical Imaging and Graphics 29(6): 395-404. Cao, X. and HK Huang. 2000. Current status and future advances of digital radiography and pacs. IEEE Engineering in Medicine and Biology Magazine 19(5): 80-88. Choi HK, SM Park, JH Kang, SK Kim and HM Choi. 2002. Tele-medical imaging conference system based on the web. Computer Methods and Programs in Biomedicine 68(3): 223-31. Conway A., S. Lewis and J. Robinson. 2008. Final-year diagnostic radiography students perception of role models within the profession. Journal of Allied Health 37(4):214-20. Corrigan M., M. Reardon, C. Shields and H. Redmond. 2008. "SURGENT" -- Student e-learning for reality: the application of interactive visual images to problem-based learning in undergraduate surgery. Journal of Surgical Education 65(2):120-125. Dawes, TJW, S L Vowler, M.C. Allen, and A.K. Dixon. 2004. Training improves medical student performance in image interpretation. British Journal of Radiology 77: 775-776. Doi, K.. 2005. Current status and future potential of computer-aided diagnosis in medical imaging. British Journal of Radiology 78: 3-19. Doi, K. 2000. Computer-aided diagnosis in medical imaging: historical review, current status and future potential. Computer Medical Imaging Graphics 31(4-5): 198-211. Eisen, L.A., J.S. Berger, A. Hedge and R.F. Schneider. 2008. Competency in chest radiography. a comparison of medical students, residents, and fellows. Journal of General Internal Medicine 21(5): 460-465. Giger, M.L., H.P. Chan and J. Boone. 2010. Anniversary paper: history and status of cad and quantitative image analysis: the role of medical physics and AAPM. Medical Physics 35(12): 5799-5820. Gunderman, R.B. and C.D. Stephens. 2009. Teaching medical students about imaging techniques. American Journal of Roentgenology 192: 859-86. Harris T.R. and S.P. Brophy. 2005. Challenge-based instruction in biomedical engineering: a scalable method to increase the efficiency and effectiveness of teaching and learning in biomedical engineering. Medical Engineering and Physics 27(7): 617-24. Hellen-Halme, K., and G.H. Petersson. 2010. Influence of education level and experience on detection of approximal caries in digital dental radiographs. an in vitro study. Swedish Dental Journal, 34(2):63-9. Herrlin, K., G. Svahn, C. Olsson, H. Pettersson, C. Tillman, A. Persson, C.G. Wahlstrom and S. Svanberg. 1993. Generation of X-Rays for Medical Imaging by High-Power Lasers: Preliminary Results. Radiology 189: 65-68. Hutten H., W. Stiegmaier, G. Rauchegger. 2005. KISS--A new approach to self-controlled e-learning of selected chapters in medical engineering and other fields at bachelor and master course level. Medical Engineering and Physics 27(7): 611-6. Iglehart, J.K.. 2006. The new era of medical imaging progress and pitfalls. New England Journal of Medicine 354: 2822-2828. Issenberg S.B., W.C. McGaghie, E.R. Petrusa, G.D. Lee and R.J. Scalese,. 2008. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher 27(1): 10-28. Jonsson, B.A. 2008. A case study of successful e-learning: a web-based distance course in medical physics held for school teachers of the upper secondary level. Medical Engineering and Physics 27(7): 571-581. Kennedy S., D.B. Knibutat, S.L. DelBasso, S.A. Bokhari and H.P. Forman. 2010. The educational and career impact of using medical students for triaging off-hour diagnostic imaging requests at a major academic medical center. American Journal of Roentgenology 194(4):1027-33. Kerfoot, B.P. 2008. Interactive spaced education versus web-based modules for teaching urology to medical students: a randomized controlled trial. The Journal of Urology 179(6):2351-6. Lindner, J. 2004. Microbubbles in medical imaging: Current applications and future directions. Nature Reviews Drug Discovery 3: 527-533 Marker, D.R., Anshuman K.B., Krishna J., and D. Magid. 2010. Developing a radiology-based teaching approach for gross anatomy in the digital era. Academic Radiology 3(8): 1057-1065. Miles, K.A. 2005. Diagnostic imaging in undergraduate education: an expanding role. Clinical Radiology 60: 742-745. Metcalf K.L., R. Terrass, M.P. Watkins. 2006. New hybrid online graduate program in medical imaging graduates its first class of students. Radiology Management 28(4): 32-40 Metz, Charles E., Kunio Doi, and Robert M. Nishikawa. 1995. Toward consensus on quantitative assessment of medical imaging systems. Medical Engineering & Physics 22: 1057-1062. Morin, R.L. 2009. Physics education in medical imaging. Journal of the American College of Radiology 3(10): 812-813. Ng C.K., P. White and J.C. McKay. 2009. Development of a web database portfolio system with pacs connectivity for undergraduate health education and continuing professional development. Computer Methods and Programs in Biomedicine 94(1):26-38. Pallikarakis N. 2005. Development and evaluation of an ODL course on medical image processing. Medical Engineering & Physics 27(7):549-54. Petersson H, D. Sinkvist, C. Wang C and O. Smedby. 2009. Web-based interactive 3d visualization as a tool for improved anatomy learning. Anatomical Sciences Education 2(2): 61-8. Makely S. 1990. Methods for teaching effective patient communication techniques to radiography students. Radiography Today, 56(638):14-5. Mubuuke A.G., Kiguli-Malwadde E, Byanyima R. and Businge F. 2008. Evaluation of community- based education and service courses for undergraduate radiography students at Makeree University, Uganda. Rural Remote Health, 8(4):976 Robb, R.A., D. P. Hanson, R. A. Karwoski, A. G. Larson, E. L. Workman and M. C. Stacy. 1989. Analyze: A comprehensive, operator-interactive software package for multidimensional medical image display and analysis. Computerized Medical Imaging and Graphic 13(6): 433- 454 . Rogers L.F. 2005. Imaging literacy: a laudable goal in the education of medical students. American Journal of Roentgenology 180(5):1239-1242. Scheiner, J.D. and Novelline, R.A. 2000. Radiology clerkships are necessary for teaching medical students appropriate imaging work-ups. Academic Radiology 7(1): 40-45. Spiers, L. 1991. Multi-professional education of health personnel: the role of the radiographer in promotion and research of MPE. Radiography Today. 57(644):13-5. Sprawls, P. 2008. Re-engineering the process of medical imaging physics and technology education and training. Medical Engineering Physics 27(7): 625-632. Squire L.F., J.E. Whitley, T. Robinson, N. Twersky. 1974. Teaching the use of diagnostic radiology and other imaging modalities: an exercise designed for fourth-year medical students. Radiology 110(3): 575-577. Subramaniam, R. 2005. Response to editorial--teaching imaging to medical students: strategies and expectations. New Zealand Medical Journal 118(1226):U1766. Tabakov S, V.C. Roberts, B.A. Jonsson, M. Ljungberg, C.A. Lewis, R. Wirestam, S.E. Strand, I.L. Lamm, F. Milano, A. Simmons, C. Deane, D. Goss, V. Aitken, A. Noel, J.Y. Giraud, S. Sherriff P. Smith, G. Clarke, M. Almqvist and T. Jansson. 2005. Development of educational image databases and e-books for medical physics training. Medical Engineering Physics 27(7): 591-598. Tabakov S. 2005. E-Learning in Medical Engineering and Physics. Medical Engineering & Physics 27(7):543-7 Turner-Smith, A.and A. Devlin. 2005. E-learning for assistive technology professionals--a review of the telemate project. Medical Engineering Physics 27(7): 561-570. Valaitis R., N. Akhtar-Danesh, K. Eva, A. Levinson and B. Wainman. 2007. Pragmatists, positive communicators, and shy enthusiasts: three viewpoints on web conferencing in health sciences education. Journal of Medical Internet Research 9(5): 39. Ward P. and C. Makela. 2010. Radiography students clinical learning styles,radiology technology 81(6):527-37. Wilson, N. 1990. A method of practically assessing students in diagnostic radiography. Radiography Today, 56(643): 9-11 Wu, D., A. Dikshit, W. Zhao. 2004. Medical imaging curriculum development: an interactive simulation system for different modalities. Conf. Proc IEEE Eng. Med. Biol. Soc. 7: 5172- 5275. Yokohama N., T. Tsuchimoto, M. Oishi and K. Itou. 2007. Development and valuation of the medical imaging distribution system with dynamic web application and clustering technology. Nippon Hoshasen Gijutsu Gakkai Zasshi 63(1): 75-84. Zary N., U.G. Fors. 2006. WASP--A generic web-based, interactive, patient simulation system. Student Health Technology Information 95: 756-61. Read More