The Right Exposure
Limited exposure for medical students could leave the specialty in the shadows.
There are plenty of jobs for radiologists, and the pay is good. AI looks more like a time-saving tool than a threat to the specialty. Plus, this year’s radiology residency and fellowship match was stellar. So why aren’t more medical students getting excited about radiology?
It depends on who you ask regarding how students perceive the specialty — who radiologists are, what they actually do, etc. Still, no one argues that first- and second-year medical students have practically no exposure to the field. It pops up in their third year, is mainly an elective, can be boring, and usually includes limited hands-on experience.
According to Andrea A. Birch, MD, associate professor of clinical radiology and radiological sciences at Vanderbilt University School of Medicine, the need for radiologists is greater than ever. “Our roles in assessing and treating patients are unparalleled compared to the way they were even ten years ago,” Birch says.
Residency and fellowship programs in both diagnostic and IR continue to see a high fill rate — based on preliminary numbers released in March by the National Resident Matching Program (NRMP). All IR program slots were filled, and only 10 diagnostic radiology programs in the country reported unfilled PGY-2 slots (the year following an intern year, but before residency begins). With more medical students matching to their desired radiology residency programs, it would seem the pipeline of talent into the specialty is wide open.
The problem is not that medical students aren’t interested in radiology, but that the need for primary care providers — especially in underresourced and underserved areas — is so great that some medical schools leverage institutional priorities in their mission statements and encourage students to seek out primary care specialties, Birch says.
According to Birch, “When you compound that with the fact that there is a shortage of PCPs, it makes it hard for schools to promote radiology.” Unfortunately, there is a real need for medical students to understand that radiology is more than looking at images during group rounds. “That’s their perception because it is often the only way they interact with the radiology department,” Birch says.
“Diagnostic radiology is the one rotation in medical school where you don’t ‘do’ what the doctor does,” says Ann K. Jay, MD, program director of diagnostic radiology residency at MedStar Georgetown University Hospital. “That’s one of the benefits of the IR rotation,” Jay says. “With IR, students are actively participating in the duties of an interventionalist, where in DR rotations the students are watching others ‘do’ radiology. Engagement and interest can be difficult to sustain, which ultimately has an effect on students’ impressions of our field.”
Students may also get the impression that radiology interpretation can be performed by other types of physicians. “If chest X-rays are taught by pulmonologists and MSK studies are taught by orthopedists, it conveys the message to students that a level of expertise is not needed to be a radiologist,” Jay says.
Misconceptions about AI also contribute to some students’ reservations about choosing radiology as a specialty. With the help of the lay media, students might be inclined to think AI is going to displace the field, Jay says. “But radiologists are actually leading the efforts for the implementation of AI in imaging,” she says. “I tell students that using AI in daily clinical practice is a tool that radiologists want — as it will only help us in improving patient care.”
Driving other misconceptions is a lack of exposure to radiology in preclinical years — at least not in a robust or effective manner, Jay says. Research shows that students participating in a curriculum offering radiology in their first year believe the specialty has greater importance to the overall practice of medicine, are more likely to choose radiology as a clinical elective, and are more likely to consider it as a career track. Add to that, most medical students at some point could become referring clinicians.
It isn’t fair to expect teaching institutions to unilaterally promote radiology at their own expense, Birch admits. The onus is on faculty and other seasoned radiology professionals to spark interest and present a clearer picture of the field.
For instance, misconceptions abound when it comes to radiation, even among medical students. Radiologists can allay concerns by presenting the literature on exposure to medical scans and any associated risks. Students may also view radiology as lacking in opportunities for direct patient interaction. “That is far from the case for me as a breast imager,” Birch says. She tells students that she talks to patients daily — and that surgeons and other providers follow her recommendations to care for patients.
Connecting with students to present the appealing aspects of radiology can be a juggling act, Jay says. She organizes student lectures as often as possible — but they are largely given by fourth-year medical students or first-year residents. Jay notes that getting senior residents, fellows, and faculty involved in the conversation would have more impact. “But it’s a time commitment,” she says, “and there’s no compensation aside from educational credits. Some institutions don’t even offer that.”
Jay encourages students to shadow a radiologist for a day to get a feel for what imaging includes. This can be tough with scheduling, she admits, and with the workflow of breast imagers in particular. Students at some schools have started clubs revolving around a particular specialty. Faculty should encourage students to form such groups, which provide great networking opportunities and a forum for asking candid questions.
There are more innovative ways to introduce radiology to medical students, Birch says. “Sharing vignettes that highlight a radiologist’s role in assessing patients, for instance, instead of organ-based vignettes where an imaging study is occasionally included in a workshop.” There are non-coursework ways to learn radiology. “Mentoring plays a huge role in early exposure to the specialty — and opens doors to much needed diversity and inclusion awareness.”
“We need a pipeline for women and underrepresented minorities in radiology,” says Raymond B. Wynn, MD, FACR, vice chair of network operations in the department of radiation oncology at Loyola Medicine. Wynn was instrumental in forming the ACR Commission for Women and Diversity — established to encourage radiology groups to put in motion a diversity and inclusion strategy at all levels of training, practice, and leadership.
The commission offers hands-on clinical skills workshops, mentorship, research, career development guidance, and summer internship opportunities. Wynn is a huge advocate for the commission’s Pipeline Initiative for Enrichment of Radiology (PIER) mentoring program to increase minority medical student exposure and preparation for radiology postgraduate training.
The PIER program to date has successfully paired 15 underrepresented minorities and female medical students with mentors in radiology and radiation oncology — offering up to eight weeks of exposure to the specialty, including research opportunities. This summer, new PIER interns visiting ACR headquarters will explore IR, gain exposure to radiation oncology, have a chance to perform simulated biopsies, and participate in other learning opportunities.
To further medical student outreach, ACR formed the Medical Student Education and Outreach (MESO) group — an interdepartmental team that establishes medical student education and outreach as a priority for the College. “We want to inform all medical students about the importance of radiology as a critical component of patient care,” says Jan Cox, PHR, SHRM-CP, ACR senior director of operations. “Through MESO, we’re trying to increase the number and diversity of medical students who choose radiology as a career — or to make those choosing other specialties better physicians,” she says.
The ACR RFS includes a medical student subcommittee that supports the work of the MESO team. Committee members include residents, fellows, and medical students. The subcommittee is working now to establish a database of radiology interest groups within medical schools across the country to expand outreach.
“A lot of radiologists are not used to sharing or advertising what they do,” Wynn says. Mentoring medical students and connecting young talent with radiology leadership is vital to the future of the specialty, he says. Reaching out to students with backgrounds underrepresented in radiology, Wynn adds, should be at the heart of all outreach efforts.
Birch agrees. She believes radiology programs should strive to attract all people, not just certain people. “The future of radiology depends on the makeup of the students who pursue it,” she says. To that end, it is incumbent upon educators and radiology leaders to show students the importance of what they do.
According to Jay, the best and brightest medical students who have yet to discover radiology may need a few lightbulb moments. “The best part of our job is when you are able to put together the pieces of a puzzle — when you have that “Aha!” moment and figure out what is going on with a patient,” she says. “Many medical students just aren’t getting that experience.”
The ACR makes it a high priority to educate students about the field and its future. The goal is to introduce medical students to the field early — particularly those from backgrounds underrepresented in the specialty. The following resources provide insight into the field of radiology and encourage medical students to consider radiology as a career path.
Gaining one-on-one access to practicing physicians can be a major obstacle for physicians-in-training. The ACR has made surmounting that obstacle easier by joining the American Medical Student Association’s Mentoring Program. These practicing physician mentors are available for private or group conversations on issues not normally covered in medical school. Find a mentor.
The RFS journal club, held every two months, lets trainees interact directly with ACR leaders and gain their unique perspectives on their areas of expertise. View upcoming webinars.
The 2020 American Medical Student Association Convention & Exposition, being held in Washington, D.C. on April 16–19, is intended for anyone interested in the future of health care: students, residents, healthcare organizations, and professionals alike.
By Chad Hudnall, senior writer, ACR Press