A Registrar delivered teaching session - An Introduction to Undergraduate Radiology: feedback from the first year
Hood, A, Kalami, T, Phillips, M, Craven I Leeds General Infirmary
The small group teaching session, designed for the third year university of Leeds medical students, is centred on a 78 year old female patient who has been admitted to A&E following a fall. The patient undergoes a series of radiological investigations including pelvic and chest radiographs, a CT pulmonary angiogram, lower limb duplex doppler ultrasound and a CT head. The tutorial is designed to link the clinical presentation, examination findings and radiology observations to come to a unifying diagnosis. This is a vital concept that the students will require during clinical practice, and a key skill adopted by clinical radiologists.
The session is delivered by a radiology registrar who has been provided a set of Powerpoint slides and a number of anonymised cases on PACS to deliver the session. Student participation is vital to the running of the tutorial as there a number of tasks that require student interaction in addition to lecture style teaching. The entire session runs for approximately two hours including a break.
The aims for the session were designed to cover aspects of the undergraduate curriculum, which is detailed below. The curriculum is based on the national RCR guidance.
The aims and objectives of the tutorial are as follows;
- Appreciate the role of radiology in the management of patients.
- Apply clinical knowledge to image interpretation.
- Become familiar with common radiology modalities including plain film, ultrasound and CT.
- Learn some of the underlying principles of such modalities, their clinical uses and limitations.
- Local NG tube placement guidelines.
- Introduction to the NICE head injury guidelines.
During the teaching session and the students’ time in the radiology department we want them to develop and understanding of the job of the clinical radiologist and their role in diagnosis and management of patients.
The students are shown the above radiograph, with detail teaching about the anatomy of the pelvis and proximal femur. After suggesting a method of systematically reviewing an AP pelvic radiograph they are encouraged to discuss the types of femoral neck fractures, mechanism of injury and findings on clinical examination. They are given time to write their own succinct radiology report. The students are then encouraged to share their report with the group, with constructive criticism from the tutor on ways in which the report could be improved. This introduces skills of interpretation and translation into a written report.
After revising the anatomy demonstrated on a PA chest radiograph the students are taught a systematic approach to chest radiograph interpretation. Subsequently, they are asked to individually write a report for the following radiograph and suggest a diagnosis for this patient who presented with a cough and green sputum. This encourages the students to apply clinical knowledge with basic radiology principles to reach a diagnosis that will affect the patient management.
CT imaging is then introduced to the students in the form of a CT pulmonary angiogram and a non-contrast CT head. Discussion is centred on the anatomy, how the images are acquired and the use of contrast to demonstrate pulmonary emboli. During their time in the radiology department the students are encouraged to spend time with the radiographers and watch at least one patient having a CT scan.
A student is offered the opportunity to look through a non-contrast CT head of the patient who suffered a fall whilst taking a therapeutic dose of warfarin as treatment for her pulmonary embolus. In the future all students will have access to anonymised copies of all the scans (using Horus) throughout the tutorial so that they can look at them independently during the session. The NICE head injury guidelines are also covered and how they are used in the assessment of patients with a head injury.
With reference to the local trust guidelines relating to nasogastric tube insertion, the students are taught a systematic approach to identifying the position of an NG on a chest radiograph.
One student is given the opportunity to present a chest radiograph and comment on the NG position. The complications of inappropriate NG position are highlighted to the students, with emphasis on the potential catastrophic outcomes as a consequence of an incorrect tube position.
Finally, the students are taught about the role of duplex Doppler ultrasound in the diagnosis of deep vein thrombosis. The students are not expected to interpret the images but should develop an appreciation of how the clinical condition presents, what the clinical examination findings are and how it should be managed.
After a summary of the cases and time to address any questions the students are requested to complete a feedback questionnaire about the sessions.
I like the following things about the session: here are some representative examples:
“The idea of following through a patient’s hospital admission made me realise how much radiology is used/ how important it is.”
“Introducing systematic approaches of interpreting x-ray/CT. Refreshing anatomy.”
“Just the right amount of information for beginners like us. Radiology was introduced very well. Presenter was very keen to teach.”
The session might be improved by: here are some representative examples:
“N/a” “Nothing really. It was great!”
“Previous access to slides before session so notes could be made as relevant slides.”
“More examples to compare with.”
Radiology registrars can deliver a high quality and enjoyable introductory teaching that establishes both the fundamental skills of radiology and an important appreciation for radiology in future doctors. This will hopefully inspire future high-quality radiology applicants.