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lrogers{at}ajroffice.org
But then every year or so there is a "much-to-do" over the results of the students' standardized test scores: "Reading test scores of our county's primary grade students improved 2.5% this year as compared to last year's decrease of 2.2%. School Board President Dr. Wendell Blackboard attributed this improvement to the implementation of the highly regarded ‘Read Well Program’ and applauded the efforts of all the county's dedicated teachers in achieving this success. [Et cetera, et cetera, et cetera.]"
On the other hand, in districts that do poorly on standardized tests, a search for a scapegoat ensues. School administrators and teachers are subjected to governmental and media scrutiny and may be scorned and vilified for failing to educate "the fine, outstanding children of this district." School administrators may lose their jobs because students score poorly on such tests. (After all, you can't fire the teachers [apparently] or the students.) The public recognizes the need for literacy and the matter is treated seriously.
Now, medical school is also serious business, and that is why the students are subjected to lots of tests. You wouldn't want anybody to be a doctor who did not understand anatomy, physiology, pathology, biochemistry, bacteriology, and pharmacology, or who lacked competence in obtaining a medical history or performing a physical examination. Medical students are also required to demonstrate a basic understanding of the clinical disciplines of medicine, surgery, pediatrics, and obstetrics and gynecology. In fact, students are tested in each of these subjects and must pass these examinations to qualify for graduation. Medical students are tested because it has long been recognized that they must have a minimum level of ability, a certain degree of "literacy," with all these subjects in order to function as physicians.
Except for bacteriology and biochemistry, the clinical disciplines and basic sciences as listed above have been around for a long time. They have an established tradition and serve as the foundation of modern scientific medicine. Testing for competence in these medical and surgical disciplines as well as the basic sciences is obviously required.
But medicine is neither doctrinaire nor static. Things change. New discoveries have been made and even new disciplines have appeared, such as genetics and, yes, diagnostic imaging. It is generally accepted that in order to practice medicine in this day and age, a physician must have knowledge of genetics.
And the same should be said for imaging: because imaging in all its forms—radiography, CT, MR imaging, nuclear imaging, and sonography—is now essential to the practice of modern medicine and surgery. Imaging has grown exponentially because of the infusion of new technologies and their ready adoption by the medical profession in recognition of the inherent high sensitivity and specificity that these technologies bring to the identification and assessment of disease—which is to say nothing of the justifiable yet enormous costs associated with the acquisition and use of these technologies.
Because of these developments, it is reasonable to maintain that all medical students as well as practicing physicians should have knowledge of the appropriate use of imaging in order to care properly for patients. This 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. Physicians should also have a similar basic understanding of contrast media. Is there is any other commonly used drug or agent that physicians order or prescribe of which they have so little knowledge as contrast media?
Then what is the current state of the imaging education of medical students? I fear that it is, at best, spotty. In this issue, Gunderman et al. [1] address the vital topic of radiology in a medical school curriculum. The topic should be of concern to all radiologists, and this fine article is certainly worthy of your attention.
Despite the obvious importance of imaging, medical students receive woefully little formal training in radiology and fewer still, if indeed any, receive mandated and required courses in imaging for which the students must show proficiency by passing a test in the subject.
Most courses in imaging are elective: soft touches. No meaningful assignments, no tests, patsy courses, pass/fail: show up and you pass fluff. Medical students often view radiology electives as a little vacation from an otherwise arduous course of clinical assignments and study. As a result, "imaging literacy" is not a common attribute among graduating medical students; in fact, quite the opposite, "imaging illiteracy," abounds.
Why is that? Why don't medical students receive sufficient training in imaging? When it comes to the education of medical students, radiologists are often treated as the Rodney Danger-fields of academia: "We don't get no respect!" Time in the crowded medical school curriculum is notoriously hard to come by. Those disciplines that already have scheduled time are reluctant to part with it. And clinicians will maintain that they already teach imaging, dismissively stating, "Why X-rays, Nuc Med scans, CTs, MRIs, and even ultrasound exams are an integral part of all rounds on patients and are discussed in every conference." Yes, but! But such instruction is anecdotal, haphazard, unstructured, and untested and therefore woefully short of the structured educational experience required to prepare students for the proper use of imaging. They must become well grounded in the essentials of imaging as medical students to properly administer patient care in their future practice as physicians.
Although imaging literacy in medical students is a laudable goal, it won't be easy to achieve. But knowledge of imaging is now of major importance in the provision of medical care. Medical students should be properly prepared to practice medicine in this imaging milieu. Academic radiology departments must be more actively involved in the formal education of medical students during all 4 years of the curriculum.
Take the pledge. Let's stamp out imaging illiteracy!
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  B. F. Branstetter IV, L. E. Faix, A. L. Humphrey, and J. B. Schumann Preclinical Medical Student Training in Radiology: The Effect of Early Exposure Am. J. Roentgenol., January 1, 2007; 188(1): W9 - W14. [Abstract] [Full Text] [PDF]
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