RSNA: Appropriate image ordering isn't being taught in med school

CHICAGO—Overcoming the barriers of faculty time and suboptimal radiology clerkship structure may allow implementation of a national imaging utilization curriculum that may lead to substantial healthcare savings, surmised the researchers of a study presented Nov. 26 at the annual meeting of the Radiological Society of North America (RSNA).

With the study, Hansel J. Otero, MD, a fifth-year post-graduate resident at Tufts Medical Center in Boston, and colleagues sought to identify perceived barriers to the establishment of an appropriate imaging utilization education in medical school by surveying radiology clerkship directors.

The cross-sectional study included a 13-question web-based survey sent nationwide via email to all radiology clerkship directors from the 134 allopathic medical schools in the U.S. A 34 percent response rate was achieved following two reminders. The researchers calculated descriptive statistics and correlations using chi-square or Fisher's exact test as appropriate.

A radiology clerkship is mandatory in eight of 32 schools that responded to the survey. The respondents ranked lower priority compared with other clinical areas and lack of interest/support from the medical school as the first and second most important reasons for radiology not being a mandatory clerkship.

According to the surveys, image interpretation consumes 50 percent of the students’ allotted time in 14 of the 32 programs, with 10 to 50 percent of the time allotted devoted to teach utilization in 21 of the 32 programs.

“It’s clear that image interpretation is given the greatest importance, with students [spending] half or more than half of their time dedicated to this learning process,” said Otero.

Similarly, they ranked appropriate ordering and utilization second in the overall objective of the radiology clerkship; critical findings in common tests was ranked first while advanced imaging interpretation, imaging economics and medical physics were ranked lower.

In terms of the mechanisms by which the students learned, the respondents said that lectures and open discussion are used by the vast majority of the programs to teach appropriate utilization. “Some of the respondents also said they conducted a chart review, and reviewed ACR’s appropriate use criteria with the students,” Otero said.  “Of note, a couple programs reported that they don’t discuss appropriate utilization at all.”  

The final question, according to Otero, focused on the barriers that prohibited teaching imaging utilization in a more organized, structured manner. The majority of surveyed clerkship directors believes that appropriate imaging utilization is very important during the training of medical students to reduce inappropriate test ordering in the future and improve communication between the referring physician and the radiologist. However, they identified limited faculty time and short clerkships as the main barriers for implementing an imaging utilization curriculum.

The radiology clerkship directors also said that additional training for the radiology staff was lacking, and they would appreciate more guidelines in this area from the radiology professional societies.

“We believe that if medical schools can address the barriers of limited faculty time and length of the clerkships, then it could reduce inappropriate image utilization in the future,” Otero concluded.