Imrun Nagra: Is undergraduate education on radiology failing doctors?

The fear and lack of confidence many junior doctors feel in interpreting and requesting scans is a problem that stems from medical school, writes Imrun Nagra

I was on a general surgical ward round when the consultant turned to the final year medical student and said, “Interpret this radiograph.” A look of dread passed over the student’s face, a few moments passed, and the student was unable to offer a diagnosis. The consultant shook his head with disappointment and continued the ward round. We have all experienced this as medical students and even as junior doctors, and it is never pleasant. Yet the universality of this experience suggests that something is going wrong in our radiology education.

A 2018 survey of 150 doctors across four NHS trusts found that 77% of junior doctors wished they had experienced more radiology teaching as part of their undergraduate curriculum. They also reported that they lacked confidence in interpretation. Reflecting on my time at medical school, I only had a handful of radiology lectures and most of the teaching came from junior doctors on ward rounds during clinical placements. This is worrying, especially as the majority of newly qualified junior doctors do not feel comfortable interpreting radiographs themselves. The way I was taught radiology at medical school is still representative of most medical schools today: sporadic, ad-hoc teaching given by non-specialists. 

This neglect of radiology will have continual, everyday implications for junior doctors. Imagine you are a newly qualified doctor who is on call when a patient becomes acutely unwell and you need to get a chest x ray to rule out a pneumothorax; or an older patient falls and you need to get a pelvic x ray to rule out a fracture. These are emergency situations that need urgent assessment and management, but what happens if you are unable to interpret the imaging without senior support? As you can imagine, it is not a position any junior doctor wants to be in. These shortcomings seem to me to be the result of poorly structured undergraduate radiology curriculums at medical schools. 

Medical schools give dedicated placements to specialties such as anaesthetics, dermatology, and ophthalmology. Why not radiology? With the greater availability of scans and improvements in imaging, along with the ongoing development of artificial intelligence, radiology is arguably evolving the fastest of all the specialties. If a patient presents with probable appendicitis, for example, most clinicians would now request a scan, whereas in previous times they would have used their clinical judgment to assess if the patient needed surgery or not.  With the culture of medicine moving in the direction of “scan first, assess later,” it is more important than ever for medical schools to adapt their curriculums to expose students to radiology. 

I am currently working as a clinical teaching fellow at the Great Western Hospital in Swindon, where I assist the Swindon academy with delivering the undergraduate curriculum. I have been working closely with our radiology department to transform how our undergraduate curriculum is delivered. Most learning is now done online through virtual tutorials due to the covid-19 pandemic. This suits radiology more than most specialties as cases and images can be easily shared and discussed over online platforms. Our medical students receive weekly radiology tutorials. We have WhatsApp groups set up where interesting cases are posted daily to promote discussion, workshops to simulate “on-call” scenarios, and student-led case based sessions and shared resource folders. 

These innovations are by no means “groundbreaking,” but they are just some examples of how our radiology department has adapted to engage more with students and to promote enthusiasm for and education in radiology. In order to address the educational gap, other radiology departments could show initiative by getting in touch with their respective medical schools to offer dedicated and structured placements. 

The fear and lack of confidence in interpreting and requesting scans is an inherent problem among many junior doctors that stems from medical school. Radiology is evolving at a rate that undergraduate curriculums are not currently keeping up with, and this gap will continue to grow unless medical schools adapt their curriculums to include more structured radiology teaching. If action is not taken, doctors’ understanding of radiology will fall behind the times.

Imrun Nagra is a clinical teaching fellow in Swindon. He is hoping to be accepted into radiology training this year.

Competing interests: None declared.