Dr Sally Ayesa
Radiology education and engagement
The recent RANZCR college meeting was a busy one for me, with my final speaking invitation taking centre stage at the Faculty Forum. The important issue of engagement of medical students and junior doctors was on the table.
This post contains my speech, where I tried to inject my characteristic optimism and wrote from a standpoint of hope for the future. In the short weeks since I delivered these words, my academic career has undergone a significant setback which has steadfastly revealed a different perspective. Read these words with a grain of salt, as I believe that I am only telling half of the story. For radiology education to flourish it needs to be a two way street. Academic institutions need to not only make sure the door is open for those radiologists who wish to walk through it, but be mindful of the obstacles which years of disconnection have placed in our way.
The conversation which rose from the room after I completed this speech was illustrative of the frustration that many of us face in connecting with medical students and non-radiologists clinicians. There are many reasons why we choose to engage in education, but I believe many are underpinned by a sense of feeling valued or adding value. When we feel that our time, energy and good-will is not appreciated, it can breed disengagement. A dedicated radiology educator may choose to opt-out, which is a loss for the medical imaging community as a whole.
Thank you for joining me in the conversation.
"I am an early career academic, radiologist and nuclear medicine physician. I like to research, start conversations and write about radiology education. At different times I have delivered content to radiologists, trainees, post-graduate masters students, medical students and non-radiologist pre and post-vocational colleagues. Across these roles and through my ongoing PhD research, I spend a lot of time thinking about how we can engage students and clinicians outside of the subspecialty of radiology, and how we can inspire and excite the next generation of junior doctors when it comes to medical imaging.
As you can image I have some opinions, but I am only one clinician. Thank you to those who answered my call on #medtwitter to help me gather perspectives.
Addressing perceptions of radiology as a specialty among medical students is a complex task, but at its root, I believe are issues related to positive exposure at junior doctor and student level, and the visibility of role models. In addition, building positive, respectful and collaborative relationships with our non-radiologist colleagues is paramount.
As a medical student I was fascinated by physics and found the best part of the anatomy tutorial was when the CT came up at the end. In retrospect, it was clear that I should have been considering a specialty like radiology, but it never crossed my mind. I had limited exposure to radiologists, with medical imaging primarily taught by non-radiologist clinicians or embedded in lecture content. I came across radiologists sporadically in the MDT setting, but they seemed distant and inaccessible. The stereotype of the anti-social doctor confined to their dark room was presented to me without rebuttal and reinforced by the clinical ward doctors I worked with.
From my Twitter straw-poll it was not only me who couldn’t picture their future selves within the specialty. To reach and inspire the diverse medical student and junior doctor populations, the visible role models in radiology need to be equally diverse – across gender, sexuality and ethnicity. You cannot be what you cannot see.
Considering how medical students are exposed to radiology education, we need to consider who is delivering the sessions, how it is delivered and how well it prepares the students for practice.
Medical imaging education is heterogenous across universities in Australia & New Zealand and the provision of learning outcomes and integration of radiology curricula into programs is widely variable. Graduating students and the educators who teach them do not have a clear understanding of what the basic level of radiology competency expected on the first day of internship is, what students should be learning and at what stage of medical school they should be learning it. Too many students lack the basic skills to review basic studies or identify and assess common and life-threatening pathologies. Europe and the UK have solid committee drawn recommendations for the core knowledge and skills expected of medical students, but Australia and New Zealand do not.
We know from surveying groups of Australian junior doctors that despite acknowledging the critical importance of sound medical imaging knowledge, a significant number of junior doctors felt their radiology education did not adequately prepare them for internship. While many radiologists are engaged and willing to teach, involvement in the process is hindered by increasing clinical loads, and the demands placed on public radiologists to train and educate our own registrars. There are only so many hours in the day and only so much mental energy.
Encouragingly, my informal survey I found that positive engaging experiences as a medical student – whether during a ward-based rotation or from short stint within an imaging department – had the potential to inspire and change the trajectory of a career.
Unfortunately, medical schools are too often turning to our non-radiologist colleagues to teach radiology to students. Reasons range from lack of availability and willingness of radiologists to participate, to a lack of acknowledgement or respect exercised from academic and clinical colleagues. If we work to build mutual respect between our specialties and grow junior doctors into specialists with a healthy regard for the value we add,, this will be reflected in how our specialty is viewed by the next generation. Additionally, if we take the time to teach these doctors well when they are students and juniors, the ad hoc medical imaging teaching that occurs on the ward within teams will subsequently be of higher quality.
With so many of our professional and educational interactions moving online, another layer of difficulty is added. If challenging the stereotype of the radiologist disconnected from patient and collegial interaction wasn’t hard enough, we now too often face it through a digital barrier.
A final thought. One of the great joys of my career is working with my medical students. Last week, a first-year medical student with an engineering background came to me for advice, worried he wasn’t studying anatomy effectively. When he shared his notebook, it was filled with beautiful anatomical drawings, showing off his visual and technical skill. So I shared with him radiological anatomical drawings completed by my colleagues at Radiopaedia. This started a conversation about the different ways his talents could be used to not only help him learn, but also reach the broader medical community.
We are not faceless and anti-social, we are an increasingly diverse and rich community of doctors who have the potential to engage students in interesting and creative ways. We need to put our hands up and make ourselves available, because we have so much to offer."