Page 7 - Kansas Journal of Medicine, Volume 10 Issue 3
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KANSAS JOURNAL of M E D I C I N E                                    gram directors reported the ability to read abdominal x-rays and
                                                                     computed tomography (CT) imaging, among other radiologic-
	                                                                    related tasks, as essential capabilities for incoming residents.3,4

        Comparisons of Medical Student                                  Introduction to radiology in the clinical or hospital setting,
   Knowledge Regarding Life-Threatening                              even in the early phases of a student’s medical education, can in-
                                                                     fluence their perception of imaging interpretation.3,5,6 However,
     CT Images Before and After Clinical                             institutions vary with regard to incorporation of radiology train-
                        Experience                                   ing. One approach that has shown success is the integration of
                                                                     medical imaging with an anatomy course.6-10 A study at Boston
            Barbara Nguyen, M.D.1, Brady Werth, M.D.1,               University School of Medicine evaluated the impact of CT scans
       Nicholas Brewer, M.D.1,2, Jeanette G. Ward, MSCR3,            of cadavers on students’ anatomy education and spatial relation-
                                                                     ships, with positive results.6 Two similar studies also found that
          R. Joseph Nold, M.D.1,2, James M. Haan, M.D.1,2            inclusion of CT images in cadaver labs yields positive student
       1University of Kansas School of Medicine-Wichita,             perspectives and significant improvement in radiology skills.9,10

                        Department of Surgery                           Although the literature provides numerous examples of studies
         2Via Christi Hospital Saint Francis, Wichita, KS            related to medical student interpretation of radiographs, no formal
        3Chandler Regional Medical Center, Chandler, AZ              study specifically has indicated the level of improvement of CT knowl-
                                                                     edge after one year of clinical rotation for U.S. medical students.11-14
ABSTRACT                                                             Therefore, the purpose of this study was to observe and compare the
Introduction. Currently, no national standard exists for educat-     baseline knowledge regarding CT interpretation of traumatic inju-
ing medical students regarding radiography or formal research in-    ries for medical students starting clinical rotations to those complet-
dicating the level of improvement regarding computed tomography      ing their required rotations. Evaluating the extent of radiographic
(CT) interpretation of medical students during clinical rotations.   knowledge gained from clinical rotations alone in a setting lacking
                                                                     an emphasis on radiology education would provide the impacting
Methods. Students were evaluated based on their response to          factor. From this analysis, improvements and future discussion can
twenty-two open-ended questions regarding diagnosis and treat-       be made regarding basic radiologic knowledge for medical students.
ment of eleven de-identified CT images of life-threatening in-
juries. The number of incorrect answers was compared with            METHODS
correct or partially correct answers between students starting          All volunteer medical students tested were from the University
third-year clinical rotations and those starting their fourth year.
                                                                     of Kansas School of Medicine-Wichita (KUSM-W). The medical
Results. Survey results were collected from 65 of 65 (100%) be-      student curriculum at KUSM-W incorporates two years of didactic
ginning third-year students and 9 of 60 (15%) beginning fourth-      learning, followed by two years of clinical rotations. Radiology-spe-
year students. Students in their fourth-year had less incorrect      cific education is not integrated into the core curriculum. However,
answers compared to third-year students, with five questions         during the surgical clinical rotation students partake in overnight
reflecting a statistically significant reduction in incorrect re-    trauma. Surgery residents are to involve medical students as appro-
sponses. The image with the least incorrect for both groups was      priate; introduction to and education of CT imaging are expected.
epidural hemorrhage, 33.9% and 18.5% incorrect for third-year
students for diagnosis and treatment, respectively, and 11.1%           Two separate groups were utilized for comparison: medi-
and 0% incorrect for fourth-year students. Outside of this im-       cal students beginning their third-year of clinical rotations
age, the range of incorrect answers for third-year students was      (MS3), and medical students who recently had completed their
75.4% to 100% and 44.4% to 100% for fourth-year students.            third-year and were beginning their fourth-year of clinical ro-
                                                                     tations (MS4). Following informed consent, both groups par-
Conclusion. Baseline CT knowledge of medical students,               ticipated in a timed, open-ended survey to evaluate their abil-
regardless of clinical experience, indicated a strong defi-          ity to interpret CT images typical of high-risk trauma situations.
cit, as more students were incorrect than correct for the
majority of CT images. KS J Med 2017;10(3):55-58.                       De-identified single images of 11 different CT scans representing
                                                                     potential life-threatening injuries were identified by a board-certi-
INTRODUCTION                                                         fied trauma surgeon (Table 1). There were two questions per CT, for
    Currently, there are no national standards for educating medi-   a total of 22 questions. Students were asked to identify: 1) the cor-
                                                                     rect diagnosis, and 2) the correct treatment for the correct diagnosis.
cal students regarding radiography interpretation in the trauma      The students were instructed that each CT scan represented a life-
population. Radiology clinical rotations were required in only       threatening injury, as determined by two trauma surgeons, each hav-
a quarter of U.S. medical schools as recently as 2009 to 2010.1      ing completed a fellowship in trauma and critical care surgery. Both
Among U.S. medical students surveyed, over three-fourths planned     groups were exposed to the same images in a controlled setting and
to take a radiology elective before residency.2 The majority of      were given a maximum of two minutes to view each image and record
these students believed radiology changes patient care or was as     their interpretation of the image regarding diagnosis and treatment.
important as a physical exam.2 In addition, general surgery pro-
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