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Teaching of diagnostic radiology in the undergraduate curriculum
ClinicalRadiology (1981) 32, 601-605 © 1981 Royal Collegeof Radiology
0009-9260/81/01680601502.00
Teaching of Diagnostic Radiology in the Undergraduate Curriculum A Report of the Education Board to the Council of The Royal College of Radiologists Diagnostic radiology, incorporating as it does all methods of medical imaging, has a major part to play in the making of clinical decisions and the management of patients. It is increasingly necessary, therefore, that medical students should understand the values, limitations, hazards and, to a certain extent, the financial implications of these forms of examination. Moreover, modern methods of imaging demonstrate anatomy as well as the biophysical and biochemical processes in a way which can be valuable to the medical student from his first pre-clinical year and throughout his clinical work. The Education Board set up a Working Party under the chairmanship of Professor Ian Isherwood to advise the College on the way in which radiology should be taught to medical students. The report of the Working Party is published in this Journal. We would like to know if you have any suggestions to make and above all we would like your help and support in putting these ideas into practice. John W. Laws President
1. The Education Board of the Royal College of Radiologists approved the setting up of a Working Party to examine the teaching of radiology in the undergraduate curriculum. 2. The following members of the Education Board were elected to form the Working Party: Professor Ian Isherwood - Chairman Dr J. O. M. C. Craig Dr J. K. Davidson Dr K. C. Simpkins
3. Terms of Reference To offer advice and recommendations to the Education Board of the Royal College of Radiologists on the role of diagnostic radiology in the undergraduate curriculum. 4.. The Working Party assumed the power to coopt and extend its range of discussion to include any aspects of the curriculum where diagnostic radiology is relevant.
Preamble 5. The practice of diagnostic radiology has increased considerably in both technique and application and now includes not only the conventional methods but new imaging processes such as isotope scanning, ultrasound and computed tomography. 6. The more recent advances in diagnostic imaging indicate a role for diagnostic radiology in the demonstration of both biophysical and biochemical processes. 42
7. The advent of academic departments of diagnostic radiology with research programmes has led to an increased awareness not only of the potential value of collaborative study but also of integrated teaching programmes at both pre-clinical and clinical levels. 8. Diagnostic radiology is: (a) A precise discipline demonstrating how disease processes affect form and function and at the same time enabling evidence to be evaluated and judgements to be formed. ~b) One of the vehicles for demonstrating the relevance of learning the basic sciences, viz. anatomy, physiology and pathology, in the pre-clinical curriculum, at the same time sustaining and stimulating interest in these basic sciences. (c) A subject which provides an introduction to clinical investigation enabling an undergraduate to enter at an early stage the ambience of medicine. (d) A discipline with an active role to play in problem-solving and one which should not be regarded merely as a visual aid. (e) A very important link between pre-clinical and clinical undergraduate years. 9. The Working Party feels strongly that radiological imaging methods should be made available in the undergraduate medical curriculum at the earliest stage and continue through subsequent clinical years. Investigations employing a biological pathway, either cellular or morphological, are frequently of particular value since they may demonstrate function as well as
602
CLINICAL RADIOLOGY
structure in a way that is possible by no other method. 10. Almost without exception patients entering a district general hospital are referred to the department of diagnostic radiology where procedures are carried out which may be lengthy, costly, not without risk and requiring special skills. Most general practitioners have access to radiological facilities. A significant proportion of clinical decisions are based on diagnostic radiological information. 11. It is mandatory, therefore, that all medical students should understand the values, limitations and hazards of radiodiagnosis in the clinical management of patients and at the same time gain an insight into the financial implications.
PRESENT SITUATION
12. Diagnostic radiology is not universally accepted as an essential discipline in the teaching of the medical undergraduate, having a variable and in some centres relatively minor role. 13. The absence of university departments of diagnostic radiology has contributed to this deficiency.
Pre-clinical Curriculum
19. At the time of writing there are only eight university departments of diagnostic radiology in the United Kingdom which might be involved with preclinical teaching (Bristol, Cambridge Cardiff, Edinburgh, Liverpool, Manchester, Nottingham, Oxford). 20. There are no academic departments of diagnostic radiology concerned with undergraduate teaching in London. 21. Any undergraduate pre-clinical teaching in diagnostic radiology outside university departments, and often within some, is carried out by National Health Service radiological staff. 22. The importance of a close and co~operative relationship between the diagnostic radiologist and the pre-clinical departments is appreciated. 23. The basic medical scientist is often very unaware of the value and relevance of diagnostic radiology (75% of physiologists are not medically qualified). 24. The extent of radiological teaching will continue to vary depending on available resources. The Working Party feels, however, that it is important that both ideal and basic recommendations should be stated.
OBJECTIVES
Ideal Situation
14. The primary objective should be to integrate diagnostic radiology into the medical undergraduate curriculum by the introduction of new technologies at both pre-clinical and clinical levels. Integration implies that any change is by mutual agreement and does not mean a 'take-over'. 15. It is appreciated that not all curricula are divided into pre-clinical and clinical years, but it is convenient to consider the problem in this manner. 16. It is not the intention of the Working Party to recommend that an undergraduate should be trained as a radiologist. Diagnostic radiology is a discipline which requires postgraduate training. 17. It is recognised that there are significant problems related to a crowded, ever-increasing medical curriculum and the pressure on established undergraduate disciplines to reduce e~isting teaching time. These difficulties are common to the general problem of medical undergraduate education. I n those centres where student opinion is known, these views are shared and there is a genuine wish to see them implemented. 18. A large proportion of students in the basic sciences may be non-medical (up to 50% in some departments of physioiogy). It seems likely therefore that integrated teaching in physiology may be more difficult to achieve than in anatomy.
25. Teaching should involve both consultant and trainee diagnostic radiologists and take place in both the Department of diagnostic radiology and the preclinical departments. (A ) Proclinical Departm en t
26. Static and dynamic imaging techniques should be employed to demonstrate normal and abnormal clinical and radiological situations. 27. Such techniques should complement normal teaching methods and be presented by members of the radiological staff. 28. FRCR trainee registrars could be appropriate junior staff to participate in such a teaching programme with mutual advantage to both teacher and student. It is recognised that not all FRCR trainees are-suited to take an active role in undergraduate teaching activities. This clearly depends on individual aptitude and careful selection. Trainee registrars can, however, show the clinical relevance of pre-clinical studies. 29. A teaching programme of diagnostic radiology within the pre-clinical department would include: (a) Formallectures (10-15) (i) Introductory (ii) Systems orientated
'rEACHING
OF
DIAGNOSTIC
(b) Small group tutorials. Tutorials would be system based on a structured weekly timetable around exhibition material and they might be jointly organised or entirely radiological. (c) Practical classes. (d) Revision classes.
{B) Department of Diagnostic Radiology 30. Each student would attend a clinical Department of diagnostic radiology at least twice per term and more frequently where numbers and facilities permitted. 31. Attendance could be in units of 5 10 preclinical students. 32. An opportunity to see disordered anatomy and physiology and the techniques employed in their radiological investigation would be available. 33. All methods of imaging the living patient should be demonstrated.
(C) Intercalated BSc Students 34. Intercalated BSc students should be encouraged to undertake radiological projects with radiological supervision.
{19)Examinations 35. There should be a contribution to the undergraduate examination structure concerned with diagnostic radiology. The contribution should be determined by the department of diagnostic radiology but fall within the examination framework of the particular discipline concerned.
RADIOLOGY
603
(b) Attendance by small groups of pre-clinical students in a clinical department of diagnostic radiology at least twice per annum enabling (i) all methods of imaging the living patient to be demonstrated; (ii) an opportunity to see disordered anatomy and physiology and the techniques employed in their radiological investigation. 39. The frequency of attendance and the numbers of students involved must be governed by local circumstances. 40. The implementation of any of these recommendations would require significant interdisciplinary communication and cooperation. CLINICAL CURRICULUM 41. Whilst the skills of history-taking and physical examination are still of prime importance in the first clinical year, the role of diagnostic radiology in clinical management should be introduced and emphasised at this stage. 42. Since diagnostic radiology is concerned with clinical management it must form part of the undergraduate curriculum. If national resources are to be used efficiently all potential clinicians should understand something of the values, limitations and hazards of diagnostic imaging in clinical management.
Ideal Situation 43. Teaching should take place in both the Department of diagnostic radiology and the appropriate clinical departments. 44. Teaching should involve both consultant and post-graduate trainee radiologists.
Basic Recommendations 36. It is acknowledged that an ideal programme would require not only adequate and able staff together with appropriate financial support but a willingness from all concerned to make a scheme work. 37. It should be possible, nevertheless, in centres concerned with pre-clinical teaching, for a basic programme to be formulated and added to from the Meal recommendations as staff and t'mancial resources become available. 38. A basic minimum programme should include: (a) Formal lectures (say 6) (i) Introductory (ii) Systems orientated
(A ) Department of Diagnostic Radiology 45. At least 20 h of radiological teaching by dedicated radiological personnel should be available in the first clinical year. 46. Teaching should be structured and based on the analytical radiological management of clinical problems. A 'ward round' type teaching programme round the department might be appropriate. 47. Groups of first year clinical students would not exceed 10. 48. It is assumed that students allied to clinical 'firms' would attend appropriate clinico-radiological meetings held in the department of diagnostic radiology.
604
CLINICAL
RADIOLOGY
49. A similar type of teaching would be extended to the fourth and fifth undergraduate years in the radiological departments of associated district general Hospitals. An academic department could ensure uniformity of standards.
(B) Clinical Departments 50. Diagnostic radiologists should contribute to teaching in a clinical environment. This teaching should be appropriate to the clinical discipline, of a didactic nature and with emphasis on the contribution of imaging to clinical management. 51. It is anticipated that each student would attend at least 20 sessions in each clinical year. 52. If a systematic course of lectures was part of the first clinical year then diagnostic radiology should be represented in each system.
(C) Paraclinical Departments 53. Diagnostic radiology can make a significant contribution to the teaching of pathology by allowing a detailed correlation to be made between clinical, radiological and pathological aspects of disease processes. 54. A radiological contribution should be made to each practical class with static and dynamic displays correlating the clinical manifestations of the disease process under discussion.
(D) Final Year 55. In the third clinical year a short systematic course should be available on a tutorial basis and designed for the pre-qualification period. Attention should be directed towards: (a) Emergency radiology appropriate to acute medical and surgical situations and including the basis of radiological interpretation. (b) Correct and efficient use of an imaging department and imaging techniques. (c) Radiological hazards, viz. 10-day rule.
(E) Elective Studies 56. Elective periods of 6 - 8 weeks should be available in the final year and coordinated where possible by an academic department to enable the interested student to investigate in depth the potential of diagnostic radiology. 57. An elective period should: (a) Be properly supervised with a dedicated tutor. (b) Enable a student to see the wide scope of radiology as an imaging discipline.
(c) Incorporate a small project requiring documentation and reference to appropriate literature.
(F) Examinations 58. Diagnostic radiology should have a role in the arrangements for the final examinations. 59. Radiological participation in the final examination structure could be: (a) Contribution of questions, particularly MCQs which relate to imaging. (b) Selection of imaging material for viva situations. (c) Viva examination by diagnostic radiologists. (d) Review of examination results. 60. If a 'clinical sciences' examination incorporating applied pathology and investigative techniques were to be introduced into the clinical course then diagnostic radiology should make a contribution to such an examination of integrated investigative methods.
Basic Recommendations 61. It is acknowledged that, as in the pre-clinical curriculum recommendations, an ideal programme would require not only adequate and able staff but also financial support and a willingness from all concerned to make the scheme work. 62. A basic minimum programme should nevertheless include: (a) Small group tutorials concerned with problemsolving exercises in the department of diagnostic radiology on the basis of two 2h sessions per clinical term (i.e. 12 h per year). (b) Participation in an integrated systematic lecture course. (c) A contribution to Pathology practical teaching with a minimum of six lectures. 63. It is anticipated that in association with these basic recommendations, students in each clinical year would attend the appropriate departments of diagnostic radiology: (a) To accompany patients under their care through relevant imaging procedures. (b) To participate in clinico-radiological discussions with the clinical unit to which they were assigned. GENERAL COMMENTS
64. Diagnostic radiology has a major role in the clinical management of patients and must therefore
TEACHING OF DIAGNOSTIC RADIOLOGY
be included in any medical undergraduate teaching programme. 65. Diagnostic radiology should be properly represented in any planning groups concerned with the medical undergraduate curriculum. 66. Consideration might be given when consultant staffing is at a more favourable level to the possibility of some senior appointments in diagnostic radiology having a sessional commitment to teaching in the basic sciences. 67. The teaching programmes for diagnostic radiology should be organised wherever possible by the appropriate academic department of diagnostic radiology. 68. It is appreciated that constraints exist related to finance, staffing and curriculum time. The Working Party Report represents a guide to the educational objectives of the Royal College of Radiologists and a practical means of achieving them.
ESTABLISHMENT OF ACADEMIC DEPARTMENTS
69. The need for additional university academic departments of diagnostic radiology is without question. 70. It is vital, however, for the long-term benefit of radiodiagnosis that such departments should be adequately financed and have a proper staffing structure. 71. At present it is considered unlikely that suitably qualified personnel could be found to fill the necessary junior academic posts in such departments even if finance was available. There are only 0.5% of academic lecturer posts in radiology compared with 36% in general medicine. Only 2% of senior posts in radiology are academic appointments compared with 17% in general medicine (DHSS Statistics and Research for England and Wales, 1977). 72. It might therefore be considered that a phased development of university departments should be supported by the College in order to permit an academic career structure to be created in alimited number of academic departments.
605
73. The responsibility for advice on such priorities should rest with the Education Board of the Royal College of Radiologists. SUMMARY AND RECOMMENDATIONS
74. There is a well-established role for diagnostic radiology in the teaching of the basic medical sciences and as a link between the pre-clinical and clinical activities. 75. The contribution which modern imaging methods can make to the demonstration of biophysical and biochemical processes suggests that these methods should be available in the medical undergraduate course from the first pre-clinical year and continue through the clinical years. 76. Diagnostic imaging now has a major role in clinical decision making and it is increasingly necessary, therefore, that the undergraduate should understand the values, limitations, hazards and to a certain extent financial implications of high cost technology in clinical management. 77. Emphasis should be given to the role of diagnostic radiology in clinical management strategy rather than to the acquisition of interpretative skills. 78. The teaching of diagnostic radiology should be undertaken by radiologists and take place in both radiological and appropriate pre-clinical and clinical departments. 79. Diagnostic radiology should have a role in the arrangements for the final undergraduate examinations. 80. There is a clear need for additional university academic departments of diagnostic radiology together with adequate funding and staff support. The immediate priority is to create an academic career structure in diagnostic radiology. A phased development of properly supported departments might then be appropriate. 81. The present responsibility for undergraduate teaching rests heavily upon overworked National Health Service staff. It is important that this responsibility should be recognised and appropriate sessional and financial resources made available.
0009-9260/81/01680601502.00
Teaching of Diagnostic Radiology in the Undergraduate Curriculum A Report of the Education Board to the Council of The Royal College of Radiologists Diagnostic radiology, incorporating as it does all methods of medical imaging, has a major part to play in the making of clinical decisions and the management of patients. It is increasingly necessary, therefore, that medical students should understand the values, limitations, hazards and, to a certain extent, the financial implications of these forms of examination. Moreover, modern methods of imaging demonstrate anatomy as well as the biophysical and biochemical processes in a way which can be valuable to the medical student from his first pre-clinical year and throughout his clinical work. The Education Board set up a Working Party under the chairmanship of Professor Ian Isherwood to advise the College on the way in which radiology should be taught to medical students. The report of the Working Party is published in this Journal. We would like to know if you have any suggestions to make and above all we would like your help and support in putting these ideas into practice. John W. Laws President
1. The Education Board of the Royal College of Radiologists approved the setting up of a Working Party to examine the teaching of radiology in the undergraduate curriculum. 2. The following members of the Education Board were elected to form the Working Party: Professor Ian Isherwood - Chairman Dr J. O. M. C. Craig Dr J. K. Davidson Dr K. C. Simpkins
3. Terms of Reference To offer advice and recommendations to the Education Board of the Royal College of Radiologists on the role of diagnostic radiology in the undergraduate curriculum. 4.. The Working Party assumed the power to coopt and extend its range of discussion to include any aspects of the curriculum where diagnostic radiology is relevant.
Preamble 5. The practice of diagnostic radiology has increased considerably in both technique and application and now includes not only the conventional methods but new imaging processes such as isotope scanning, ultrasound and computed tomography. 6. The more recent advances in diagnostic imaging indicate a role for diagnostic radiology in the demonstration of both biophysical and biochemical processes. 42
7. The advent of academic departments of diagnostic radiology with research programmes has led to an increased awareness not only of the potential value of collaborative study but also of integrated teaching programmes at both pre-clinical and clinical levels. 8. Diagnostic radiology is: (a) A precise discipline demonstrating how disease processes affect form and function and at the same time enabling evidence to be evaluated and judgements to be formed. ~b) One of the vehicles for demonstrating the relevance of learning the basic sciences, viz. anatomy, physiology and pathology, in the pre-clinical curriculum, at the same time sustaining and stimulating interest in these basic sciences. (c) A subject which provides an introduction to clinical investigation enabling an undergraduate to enter at an early stage the ambience of medicine. (d) A discipline with an active role to play in problem-solving and one which should not be regarded merely as a visual aid. (e) A very important link between pre-clinical and clinical undergraduate years. 9. The Working Party feels strongly that radiological imaging methods should be made available in the undergraduate medical curriculum at the earliest stage and continue through subsequent clinical years. Investigations employing a biological pathway, either cellular or morphological, are frequently of particular value since they may demonstrate function as well as
602
CLINICAL RADIOLOGY
structure in a way that is possible by no other method. 10. Almost without exception patients entering a district general hospital are referred to the department of diagnostic radiology where procedures are carried out which may be lengthy, costly, not without risk and requiring special skills. Most general practitioners have access to radiological facilities. A significant proportion of clinical decisions are based on diagnostic radiological information. 11. It is mandatory, therefore, that all medical students should understand the values, limitations and hazards of radiodiagnosis in the clinical management of patients and at the same time gain an insight into the financial implications.
PRESENT SITUATION
12. Diagnostic radiology is not universally accepted as an essential discipline in the teaching of the medical undergraduate, having a variable and in some centres relatively minor role. 13. The absence of university departments of diagnostic radiology has contributed to this deficiency.
Pre-clinical Curriculum
19. At the time of writing there are only eight university departments of diagnostic radiology in the United Kingdom which might be involved with preclinical teaching (Bristol, Cambridge Cardiff, Edinburgh, Liverpool, Manchester, Nottingham, Oxford). 20. There are no academic departments of diagnostic radiology concerned with undergraduate teaching in London. 21. Any undergraduate pre-clinical teaching in diagnostic radiology outside university departments, and often within some, is carried out by National Health Service radiological staff. 22. The importance of a close and co~operative relationship between the diagnostic radiologist and the pre-clinical departments is appreciated. 23. The basic medical scientist is often very unaware of the value and relevance of diagnostic radiology (75% of physiologists are not medically qualified). 24. The extent of radiological teaching will continue to vary depending on available resources. The Working Party feels, however, that it is important that both ideal and basic recommendations should be stated.
OBJECTIVES
Ideal Situation
14. The primary objective should be to integrate diagnostic radiology into the medical undergraduate curriculum by the introduction of new technologies at both pre-clinical and clinical levels. Integration implies that any change is by mutual agreement and does not mean a 'take-over'. 15. It is appreciated that not all curricula are divided into pre-clinical and clinical years, but it is convenient to consider the problem in this manner. 16. It is not the intention of the Working Party to recommend that an undergraduate should be trained as a radiologist. Diagnostic radiology is a discipline which requires postgraduate training. 17. It is recognised that there are significant problems related to a crowded, ever-increasing medical curriculum and the pressure on established undergraduate disciplines to reduce e~isting teaching time. These difficulties are common to the general problem of medical undergraduate education. I n those centres where student opinion is known, these views are shared and there is a genuine wish to see them implemented. 18. A large proportion of students in the basic sciences may be non-medical (up to 50% in some departments of physioiogy). It seems likely therefore that integrated teaching in physiology may be more difficult to achieve than in anatomy.
25. Teaching should involve both consultant and trainee diagnostic radiologists and take place in both the Department of diagnostic radiology and the preclinical departments. (A ) Proclinical Departm en t
26. Static and dynamic imaging techniques should be employed to demonstrate normal and abnormal clinical and radiological situations. 27. Such techniques should complement normal teaching methods and be presented by members of the radiological staff. 28. FRCR trainee registrars could be appropriate junior staff to participate in such a teaching programme with mutual advantage to both teacher and student. It is recognised that not all FRCR trainees are-suited to take an active role in undergraduate teaching activities. This clearly depends on individual aptitude and careful selection. Trainee registrars can, however, show the clinical relevance of pre-clinical studies. 29. A teaching programme of diagnostic radiology within the pre-clinical department would include: (a) Formallectures (10-15) (i) Introductory (ii) Systems orientated
'rEACHING
OF
DIAGNOSTIC
(b) Small group tutorials. Tutorials would be system based on a structured weekly timetable around exhibition material and they might be jointly organised or entirely radiological. (c) Practical classes. (d) Revision classes.
{B) Department of Diagnostic Radiology 30. Each student would attend a clinical Department of diagnostic radiology at least twice per term and more frequently where numbers and facilities permitted. 31. Attendance could be in units of 5 10 preclinical students. 32. An opportunity to see disordered anatomy and physiology and the techniques employed in their radiological investigation would be available. 33. All methods of imaging the living patient should be demonstrated.
(C) Intercalated BSc Students 34. Intercalated BSc students should be encouraged to undertake radiological projects with radiological supervision.
{19)Examinations 35. There should be a contribution to the undergraduate examination structure concerned with diagnostic radiology. The contribution should be determined by the department of diagnostic radiology but fall within the examination framework of the particular discipline concerned.
RADIOLOGY
603
(b) Attendance by small groups of pre-clinical students in a clinical department of diagnostic radiology at least twice per annum enabling (i) all methods of imaging the living patient to be demonstrated; (ii) an opportunity to see disordered anatomy and physiology and the techniques employed in their radiological investigation. 39. The frequency of attendance and the numbers of students involved must be governed by local circumstances. 40. The implementation of any of these recommendations would require significant interdisciplinary communication and cooperation. CLINICAL CURRICULUM 41. Whilst the skills of history-taking and physical examination are still of prime importance in the first clinical year, the role of diagnostic radiology in clinical management should be introduced and emphasised at this stage. 42. Since diagnostic radiology is concerned with clinical management it must form part of the undergraduate curriculum. If national resources are to be used efficiently all potential clinicians should understand something of the values, limitations and hazards of diagnostic imaging in clinical management.
Ideal Situation 43. Teaching should take place in both the Department of diagnostic radiology and the appropriate clinical departments. 44. Teaching should involve both consultant and post-graduate trainee radiologists.
Basic Recommendations 36. It is acknowledged that an ideal programme would require not only adequate and able staff together with appropriate financial support but a willingness from all concerned to make a scheme work. 37. It should be possible, nevertheless, in centres concerned with pre-clinical teaching, for a basic programme to be formulated and added to from the Meal recommendations as staff and t'mancial resources become available. 38. A basic minimum programme should include: (a) Formal lectures (say 6) (i) Introductory (ii) Systems orientated
(A ) Department of Diagnostic Radiology 45. At least 20 h of radiological teaching by dedicated radiological personnel should be available in the first clinical year. 46. Teaching should be structured and based on the analytical radiological management of clinical problems. A 'ward round' type teaching programme round the department might be appropriate. 47. Groups of first year clinical students would not exceed 10. 48. It is assumed that students allied to clinical 'firms' would attend appropriate clinico-radiological meetings held in the department of diagnostic radiology.
604
CLINICAL
RADIOLOGY
49. A similar type of teaching would be extended to the fourth and fifth undergraduate years in the radiological departments of associated district general Hospitals. An academic department could ensure uniformity of standards.
(B) Clinical Departments 50. Diagnostic radiologists should contribute to teaching in a clinical environment. This teaching should be appropriate to the clinical discipline, of a didactic nature and with emphasis on the contribution of imaging to clinical management. 51. It is anticipated that each student would attend at least 20 sessions in each clinical year. 52. If a systematic course of lectures was part of the first clinical year then diagnostic radiology should be represented in each system.
(C) Paraclinical Departments 53. Diagnostic radiology can make a significant contribution to the teaching of pathology by allowing a detailed correlation to be made between clinical, radiological and pathological aspects of disease processes. 54. A radiological contribution should be made to each practical class with static and dynamic displays correlating the clinical manifestations of the disease process under discussion.
(D) Final Year 55. In the third clinical year a short systematic course should be available on a tutorial basis and designed for the pre-qualification period. Attention should be directed towards: (a) Emergency radiology appropriate to acute medical and surgical situations and including the basis of radiological interpretation. (b) Correct and efficient use of an imaging department and imaging techniques. (c) Radiological hazards, viz. 10-day rule.
(E) Elective Studies 56. Elective periods of 6 - 8 weeks should be available in the final year and coordinated where possible by an academic department to enable the interested student to investigate in depth the potential of diagnostic radiology. 57. An elective period should: (a) Be properly supervised with a dedicated tutor. (b) Enable a student to see the wide scope of radiology as an imaging discipline.
(c) Incorporate a small project requiring documentation and reference to appropriate literature.
(F) Examinations 58. Diagnostic radiology should have a role in the arrangements for the final examinations. 59. Radiological participation in the final examination structure could be: (a) Contribution of questions, particularly MCQs which relate to imaging. (b) Selection of imaging material for viva situations. (c) Viva examination by diagnostic radiologists. (d) Review of examination results. 60. If a 'clinical sciences' examination incorporating applied pathology and investigative techniques were to be introduced into the clinical course then diagnostic radiology should make a contribution to such an examination of integrated investigative methods.
Basic Recommendations 61. It is acknowledged that, as in the pre-clinical curriculum recommendations, an ideal programme would require not only adequate and able staff but also financial support and a willingness from all concerned to make the scheme work. 62. A basic minimum programme should nevertheless include: (a) Small group tutorials concerned with problemsolving exercises in the department of diagnostic radiology on the basis of two 2h sessions per clinical term (i.e. 12 h per year). (b) Participation in an integrated systematic lecture course. (c) A contribution to Pathology practical teaching with a minimum of six lectures. 63. It is anticipated that in association with these basic recommendations, students in each clinical year would attend the appropriate departments of diagnostic radiology: (a) To accompany patients under their care through relevant imaging procedures. (b) To participate in clinico-radiological discussions with the clinical unit to which they were assigned. GENERAL COMMENTS
64. Diagnostic radiology has a major role in the clinical management of patients and must therefore
TEACHING OF DIAGNOSTIC RADIOLOGY
be included in any medical undergraduate teaching programme. 65. Diagnostic radiology should be properly represented in any planning groups concerned with the medical undergraduate curriculum. 66. Consideration might be given when consultant staffing is at a more favourable level to the possibility of some senior appointments in diagnostic radiology having a sessional commitment to teaching in the basic sciences. 67. The teaching programmes for diagnostic radiology should be organised wherever possible by the appropriate academic department of diagnostic radiology. 68. It is appreciated that constraints exist related to finance, staffing and curriculum time. The Working Party Report represents a guide to the educational objectives of the Royal College of Radiologists and a practical means of achieving them.
ESTABLISHMENT OF ACADEMIC DEPARTMENTS
69. The need for additional university academic departments of diagnostic radiology is without question. 70. It is vital, however, for the long-term benefit of radiodiagnosis that such departments should be adequately financed and have a proper staffing structure. 71. At present it is considered unlikely that suitably qualified personnel could be found to fill the necessary junior academic posts in such departments even if finance was available. There are only 0.5% of academic lecturer posts in radiology compared with 36% in general medicine. Only 2% of senior posts in radiology are academic appointments compared with 17% in general medicine (DHSS Statistics and Research for England and Wales, 1977). 72. It might therefore be considered that a phased development of university departments should be supported by the College in order to permit an academic career structure to be created in alimited number of academic departments.
605
73. The responsibility for advice on such priorities should rest with the Education Board of the Royal College of Radiologists. SUMMARY AND RECOMMENDATIONS
74. There is a well-established role for diagnostic radiology in the teaching of the basic medical sciences and as a link between the pre-clinical and clinical activities. 75. The contribution which modern imaging methods can make to the demonstration of biophysical and biochemical processes suggests that these methods should be available in the medical undergraduate course from the first pre-clinical year and continue through the clinical years. 76. Diagnostic imaging now has a major role in clinical decision making and it is increasingly necessary, therefore, that the undergraduate should understand the values, limitations, hazards and to a certain extent financial implications of high cost technology in clinical management. 77. Emphasis should be given to the role of diagnostic radiology in clinical management strategy rather than to the acquisition of interpretative skills. 78. The teaching of diagnostic radiology should be undertaken by radiologists and take place in both radiological and appropriate pre-clinical and clinical departments. 79. Diagnostic radiology should have a role in the arrangements for the final undergraduate examinations. 80. There is a clear need for additional university academic departments of diagnostic radiology together with adequate funding and staff support. The immediate priority is to create an academic career structure in diagnostic radiology. A phased development of properly supported departments might then be appropriate. 81. The present responsibility for undergraduate teaching rests heavily upon overworked National Health Service staff. It is important that this responsibility should be recognised and appropriate sessional and financial resources made available.