Factors Driving Resistance to Clinical Decision Support: Finding Inspiration in Radiology 3.0.

PURPOSE: The effectiveness of evidence-based guidelines (EBGs) and clinical decision support (CDS) is significantly hampered by widespread clinician resistance to it. Our study was designed to better understand the reasons for this resistance to CDS and explore the factors that drive it. METHODS: We used a mixed-methods approach to explore and identify the drivers of resistance for CDS among clinicians, including a web-based multispecialty survey exploring clinicians' impressions of the strengths and weaknesses of CDS, two clinician focus groups, and several one-on-one focused clinician interviews in which individual participants were asked to comment on their rationale for choosing imaging utilization that might not be supported by EBGs. Additionally, a unique electronic learning and assessment module known as Amplifire was used to probe clinician knowledge gaps regarding EBGs and CDS. RESULTS: In both the quantitative and qualitative portions of the study, the primary factor driving resistance to CDS was a desire to order studies not supported by EBGs, primarily for the purpose of reducing the clinician's diagnostic uncertainty. CONCLUSIONS: Our results suggest that to enhance the effectiveness of CDS, we must first address the issue of clinician discomfort with diagnostic uncertainty and the role of imaging via educational outreach and ongoing radiologist consultation.

Medical Student Elective to Improve Diagnosis in Health Care: Developing Solutions to Reduce Patient Harm.

RATIONALE AND OBJECTIVES: At our institution, a new medical student elective was designed and implemented by the department of radiology to teach medical students about diagnostic error. The purpose of this article is to describe the diagnostic error elective structure and implementation, present objective and subjective evaluations of the elective, and provide a model for other radiology departments to run their own electives. MATERIALS AND METHODS: Starting in January 2018, a 2-week in-person career exploration session elective was offered for third year medical students. In 2020 due to the COVID pandemic, the elective was expanded to fourth year medical students. All students were required to complete a project that addressed diagnostic error. Subjective comments were recorded, and objective measurements obtained from student evaluations. RESULTS: A total of 11 sessions were held, consisting of 3 fourth year and 26 third year students. A total of 12 projects (11 groups) were completed, seven of which have been accepted for presentation at national meetings. On a 1 to 5 scale (5 highest), students rated their educational experience at a mean score of 4.61. Subjective comments focused on the benefit of exposure to new topics, mentorship by radiologists, and ability to complete a project in such a short time. CONCLUSION: Diagnostic errors and solutions are vague, new concepts to medical students and even facilitator faculty. This course allowed students to gain awareness of diagnostic error and could easily be replicated at other institutions with interested faculty and medical school support.

Development of the AMSER standardized examinations in radiology for medical students.

RATIONALE AND OBJECTIVES: The variability in medical imaging evaluation across US medical schools inspired leading radiology student educators to develop the Alliance of Medical Student Educators in Radiology (AMSER) Standardized Exam (SE). This examination tests the understanding of essential material and concepts which are endorsed by the AMSER National Medical Student Curriculum in Radiology. MATERIALS AND METHODS: The AMSER Electronics Committee developed and deployed the AMSER SE using Radiology ExamWeb (REW), a previously-developed databank of imaging questions. The Committee created an examination blueprint that placed emphasis on effective use of medical imaging and less emphasis on image interpretation. Question items correlating to the blueprint were used from the REW databank to draft AMSER SE version 1, which was piloted in early 2012. Item performance was then analyzed, and the exam was revised. After national deployment, a subsequent revision was performed 1 year later. AMSER SE version 2, developed in a similar manner, was released in early 2013 and will go through a similar process of revision. A 20-question Practice Exam was also developed. RESULTS: Since national deployment, more than 1400 students, in over 22 institutions, have taken the AMSER SEs. CONCLUSIONS: The collaborative project of the AMSER Electronics Committee has resulted in the successful national deployment of two examinations using questions that have been validated and based on the AMSER peer-reviewed national curriculum. We hope that this assessment tool will help drive a more uniform approach to curriculum development, promoting more effective and safe use of medical imaging. This step should also help promote the value radiologists bring to the patient care arena.

National ultrasound curriculum for medical students.

Ultrasound (US) is an extremely useful diagnostic imaging modality because of its real-time capability, noninvasiveness, portability, and relatively low cost. It carries none of the potential risks of ionizing radiation exposure or intravenous contrast administration. For these reasons, numerous medical specialties now rely on US not only for diagnosis and guidance for procedures, but also as an extension of the physical examination. In addition, many medical school educators recognize the usefulness of this technique as an aid to teaching anatomy, physiology, pathology, and physical diagnosis. Radiologists are especially interested in teaching medical students the appropriate use of US in clinical practice. Educators who recognize the power of this tool have sought to incorporate it into the medical school curriculum. The basic question that educators should ask themselves is: "What should a student graduating from medical school know about US?" To aid them in answering this question, US specialists from the Society of Radiologists in Ultrasound and the Alliance of Medical School Educators in Radiology have collaborated in the design of a US curriculum for medical students. The implementation of such a curriculum will vary from institution to institution, depending on the resources of the medical school and space in the overall curriculum. Two different examples of how US can be incorporated vertically or horizontally into a curriculum are described, along with an explanation as to how this curriculum satisfies the Accreditation Council for Graduate Medical Education competencies, modified for the education of our future physicians.

Medical student radiology education: summary and recommendations from a national survey of medical school and radiology department leadership.

The ACR Task Force on Medical Student Education in Radiology, in partnership with the Alliance of Medical Student Educators in Radiology, investigated the current status of how and to what extent medical imaging was being taught in medical schools. The task force executed a 3-part survey of medical school deans, radiology department chairs, and intern physicians. The results provided an updated understanding of the status of radiology education in medical schools in the United States. This summary includes recommendations about how individual radiology departments and ACR members can assist in advancing the specialty of diagnostic radiology through medical student education.

Testicular ascent as a mechanism for intra-abdominal torsion.

Testicular ascent, while uncommon, can occur. A testicle that has ascended out of the scrotum can torse and may present as an acute inguinal mass or acute abdomen. Testicle ascent can occur even if previous intra-scrotal location has been documented.

Ruptured, weighted, enteral feeding-tube tip presenting as enteric foreign objects.

We present a patient who, upon radiographic examination, was found to have eight metallic-density foreign objects throughout her colon that were identified as pieces of the enteral feeding tube's weighted tip, which was no longer intact. Although this complication is rare, correct identification is important so that the defective feeding tube can be removed and replaced and so that the patient and clinician can be reassured that the metallic foreign objects present minimal risk of complications.

Choosing a specialty in medicine: female medical students and radiology.

OBJECTIVE: The purpose of this study was to determine whether there are identifiable factors that dissuade female medical students from entering the field of radiology. MATERIALS AND METHODS: An anonymous survey was completed by medical students at the end of their third- or fourth-year radiology clinical clerkships at five institutions. In addition to demographic data and residency choice, respondents ranked 10 factors in order of importance to their choice of career. For respondents who did not consider radiology a possible career, a second set of eight factors was ranked for importance in dissuading them. RESULTS: Two hundred eighty-eight respondents completed the survey, 152 (53%) men and 136 (47%) women. Both men and women reported direct patient contact and intellectual stimulation as the most important factors in deciding on a specialty. For those who chose radiology, intellectual stimulation and use of emerging technology were significantly (p < 0.05) more important than other factors. The factor that most strongly (96%) dissuaded men and women from a career in radiology was lack of direct patient contact. There was no significant difference between men and women in ranking factors that dissuaded them from applying to radiology residencies; however, nearly one third of the female respondents cited competitiveness of the residency process as important. CONCLUSION: Patient contact remains an important factor for medical students choosing a career. To attract high-caliber students, medical schools should expose students to areas of radiology involving patient interaction. Academically qualified women should be identified early during their careers and encouraged to apply for radiology residencies.