OPINION
Benefits of an Informal Curriculum: Recruiting Medical Students Into Interventional Radiology Eric King, MS, MD, Nicholson Chadwick, MD, Andrew Lee, MD, Nicole Keefe, MD, Rahul Nayyar, MBA, MD, Geogy Vatakencherry, MD INTRODUCTION Recruitment into interventional radiology (IR) has failed to keep pace with the demand for interventional procedures [1]. The approval of a dual certificate in IR and diagnostic radiology by the ABR in 2012 will require that medical students commit to a career in IR during their fourth year of medical school instead of during residency. Consequently, there is an urgent need to prioritize medical student exposure to IR in order to sustain the specialty. Even before the dual certificate was approved, medical students’ exposure to IR was inadequate [2]. As clinical interventionalists increasingly interact with other specialists, IR must establish itself in the minds of medical students. A strong effort will remind future referring physicians of IR’s diverse utility and will increase recruitment to the specialty. Toward that end, the Society of Interventional Radiology launched the Medical Student Liaison Program in 2006 to prioritize medical student education [3]. However, few medical schools across the country have implemented models of IR education [4]. Medical student recruitment into the new dual certificate should be revisited, reprioritized, and redefined to leverage student interest groups to
provide extracurricular preclinical lessons and clinical mentorship.
BENEFITS OF A FORMAL CURRICULUM Any procedure-oriented specialty dependent on capturing the attention of medical students will have difficulty recruiting quality, technically adept applicants without prioritizing student education. Surgical specialties that recently transitioned to direct training pathways are most effective when they actively engage students early in medical school [5]. Compton et al [6] demonstrated that medical students exhibit a declining interest in surgery over the first 2 years of medical school. When vascular surgeons added 7 hours of formal instruction to 947 hours of preclinical education at an American institution, Godshall et al [5] saw twice as many students volunteer for vascular surgery rotations. Although various stakeholders defend the core curriculum, the literature demonstrates that increased recruitment can result from relatively small changes to traditional schedules. Similarly, Ghatan et al [7] demonstrated that 3 case-based IR lectures improved impressions and perceptions of IR for 75% of the second-year
ª 2015 American College of Radiology 1546-1440/15/$36.00 n http://dx.doi.org/10.1016/j.jacr.2014.07.027
medical students at a single American institution. Twenty-two percent of students also expressed interest in pursuing an elective IR rotation. Zimmerman et al [8] created a yearlong radiology elective with 5 weeks of IR instruction. By the end of the elective, the authors saw a 73% increase in the number of medical students interested in a career in IR. The elective was so successful that IR education is now integrated into that institution’s first-year curriculum. By introducing IR to preclinical students, the specialty can offer a procedural alternative to surgery at a stage when interest in surgery declines.
BENEFIT OF AN INFORMAL CURRICULUM Despite gains made in the lecture hall, medical schools that lack a robust IR presence or a flexible core curriculum remain at a recruitment disadvantage relative to other procedural specialties. Fortunately, student interest groups can provide an informal curriculum to improve recruitment [9]. The American College of Obstetricians and Gynecologists recognized the importance of interest groups and developed a website to organize groups at the national level [10]. To emulate our
965
colleagues, the Resident and Fellow Section of the Society of Interventional Radiology formed the Medical Student Council in 2011 to create and sustain medical student interest in IR. IR interest groups were one of the main strategies designed to spur student interest. Although interest groups can provide didactic introductions to a specialty, their greatest value is outside of the classroom through clinical exposure, mentorship, and workshops. Extracurricular opportunities offered by interest groups are crucial, as Nissim et al [2] found that only 0.4% of medical students claimed that mandatory IR rotations were part of their institutions’ curricula. Kothary et al [11] demonstrated that greater one-to-one mentorship and procedural time increased radiology residents’ satisfaction in IR (from 23% to 70%). The same approach would likely result in similar outcomes with medical students. Students who identify mentors can delve deeper into the specialty and obtain letters of recommendation when applying for residency [12]. Additionally, interest groups offer the chance to use devices in workshops so that students can better understand procedures they observe in the IR suite. Participation in IR electives can provide a sense of ownership and satisfaction from direct patient care that didactics will never equal [12]. In the spirit of the Medical Student Liaison Program, the Medical Student Council tracks IR mentors and lists 31 of them on its website (http://rfs.sirweb.org). A panel of 5 of those mentors with 26 attendees participated in an interest group webinar in April 2014 sponsored by the Resident and Fellow Section. The focus of the hour-long session was on the role of interest groups in 966
specialty recruitment. The panel also participated in a question-andanswer session on the specialty, which led to active discussions on future training pathways and the future of IR.
THE INTEREST GROUP ROADMAP Fricke and Gunderman [9] wrote that creating a guide on forming a radiology interest group would be “one opportunity for radiology organizations to facilitate increasing student imaging education.” In response, the Medical Student Council debuted an online roadmap at the 2014 Society of Interventional Radiology annual meeting in San Diego on how to create, fund, advertise, and sustain interest groups. A record-setting 142 medical students registered for a special 2-day introduction to the field and were provided links to the roadmap (J. O. Gornal, personal communication). At the time of publication, 21 institutions had requested a roadmap to bolster the informal IR curriculum at their campuses. The roadmap content was written by medical students and residents at 11 medical schools represented on the Medical Student Council. Solutions to commonly encountered problems with funding, membership, and networking were provided to assist both new and established groups. The roadmap also includes access to a downloadable lecture series created by the Medical Student Council and Resident and Fellow Section and edited by attending advisors to introduce interventional radiologic management of diverse pathology (Table 1). The 13 evidence-based presentations provide a convenient curriculum at medical
Table 1. Society of Interventional Radiology Lecture Series 1. Introduction to Interventional Radiology 2. Interventional Radiology Frontiers 3. Interventional Oncology 4. Peripheral Artery Disease 5. Thoracic Aortic Aneurysm 6. Abdominal Aortic Aneurysm 7. Carotid Disease 8. Chronic Liver Disease 9. Gastrointestinal Bleeding 10. Lower Extremity Ulcers 11. Deep Vein Thrombosis 12. Varicose Veins 13. Trauma Interventional Radiology
schools that may lack formal didactic exposure. These are designed to be used at interest group meetings or during clinical electives in IR. In addition to promoting IR awareness and education, an indirect benefit of the interest group roadmap is to increase recruitment by fostering physician-student mentorship. Nissim et al [2] emphasized the value of resident teaching, as residents are closer in age and perspective to medical students [2]. The availability of these lectures facilitates resident, fellow, or junior faculty participation in interest group meetings. Resident-student interaction is invaluable for recruitment purposes because resident satisfaction is important to medical students when choosing their specialties [12].
CONCLUSIONS The dual certificate brings exciting new opportunities for advancing IR, but the specialty must actively recruit medical students to survive. Ideally, the core curriculum at medical schools will increase medical student exposure to IR. For campuses with inadequate curricula or the inability for curricular reform, it is critical to
Journal of the American College of Radiology Volume 12 n Number 9 n September 2015
leverage interest groups to provide an informal curriculum of downloadable lectures, clinical electives, and mentorship opportunities. Regardless of the methods, engaging students throughout medical school would be the strategic move toward meeting the demand for interventionalists with quality, highly motivated trainees.
3.
4.
5.
REFERENCES 1. Sunshine JH, Cypel YS, Schepps B. Diagnostic radiologists in 2000: basic characteristics, practices, and issues related to the radiologist shortage. AJR Am J Roentgenol 2002;178:291-301. 2. Nissim L, Krupinski E, Hunter T, Taljanovic M. Exposure to, understanding of, and interest in interventional radiology
6.
7.
in American medical students. Acad Radiol 2013;20:493-9. Siragusa DA. Vascular and interventional radiology training: a perspective from the Association of Program Directors in Interventional Radiology. J Vasc Interv Radiol 2006;17:S155-8. Chadwick N, King E, Campos L, Bhatt A, Vatakencherry G. Time for an intervention? The current state of medical student interventional radiology education. J Vasc Interv Radiol 2013;24:S180-1. Godshall CJ, Moore PS, Fleming SH, et al. A vascular disease educational program in the preclinical years of medical school increases student interest in vascular disease. J Vas Surg 2010;52:775-81. Compton MT, Frank E, Elon L, Carrera J. Changes in U.S. medical students’ specialty interests over the course of medical school. J Gen Intern Med 2008;23:1095-100. Ghatan CE, Kuo WT, Hofmann LV, Kothary N. Making the case for early medical school education in interventional radiology: a survey of 2nd-year students in
8.
9.
10.
11.
12.
a single U.S. institution. J Vasc Interv Radiol 2010;21:549-53. Zimmerman N, Nayyar R, Bigelow M, Rajebi M, Zeinati C. Interventional radiology education early in medical school: is it valuable? J Vasc Interv Radiol 2014;25: S37-8. Fricke BB, Gunderman RB. Creating and enhancing radiology student interest groups. Acad Radiol 2010;17: 1567-9. Beinstock JL, Laube DW. The recruitment phoenix: strategies for attracting medical students into obstetrics and gynecology. Obstet Gynecol 2005;105:1125-7. Kothary N, Ghatan CE, Hwang GL, et al. Renewed focus on resident education: increased responsibility and ownership in interventional radiology rotations improves the educational experience. J Vasc Interv Radiol 2010;21:1697-702. Baerlocher MO, Asch M. Protecting the future: attracting interventional radiology trainees—a medical student’s perspective. Can Assoc Radiol J 2006;57:147-51.
Eric King, MS, MD, is from the Department of Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Nicholson Chadwick, MD, is from the Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia. Andrew Lee, MD, is from the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California. Nicole Keefe, MD, is from the Department of Radiology, University of Virginia, Charlottesville, Virginia. Rahul Nayyar, MBA, MD, is from the Department of Radiology, SUNY Upstate, Syracuse, New York. Geogy Vatakencherry, MD, is from the Department of Vascular and Interventional Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Eric King, MS, MD: Department of Radiology, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Street, Los Angeles, CA 90027; e-mail: [email protected].
Journal of the American College of Radiology King et al n Opinion
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Benefits of an Informal Curriculum: Recruiting Medical Students Into Interventional Radiology Eric King, MS, MD, Nicholson Chadwick, MD, Andrew Lee, MD, Nicole Keefe, MD, Rahul Nayyar, MBA, MD, Geogy Vatakencherry, MD INTRODUCTION Recruitment into interventional radiology (IR) has failed to keep pace with the demand for interventional procedures [1]. The approval of a dual certificate in IR and diagnostic radiology by the ABR in 2012 will require that medical students commit to a career in IR during their fourth year of medical school instead of during residency. Consequently, there is an urgent need to prioritize medical student exposure to IR in order to sustain the specialty. Even before the dual certificate was approved, medical students’ exposure to IR was inadequate [2]. As clinical interventionalists increasingly interact with other specialists, IR must establish itself in the minds of medical students. A strong effort will remind future referring physicians of IR’s diverse utility and will increase recruitment to the specialty. Toward that end, the Society of Interventional Radiology launched the Medical Student Liaison Program in 2006 to prioritize medical student education [3]. However, few medical schools across the country have implemented models of IR education [4]. Medical student recruitment into the new dual certificate should be revisited, reprioritized, and redefined to leverage student interest groups to
provide extracurricular preclinical lessons and clinical mentorship.
BENEFITS OF A FORMAL CURRICULUM Any procedure-oriented specialty dependent on capturing the attention of medical students will have difficulty recruiting quality, technically adept applicants without prioritizing student education. Surgical specialties that recently transitioned to direct training pathways are most effective when they actively engage students early in medical school [5]. Compton et al [6] demonstrated that medical students exhibit a declining interest in surgery over the first 2 years of medical school. When vascular surgeons added 7 hours of formal instruction to 947 hours of preclinical education at an American institution, Godshall et al [5] saw twice as many students volunteer for vascular surgery rotations. Although various stakeholders defend the core curriculum, the literature demonstrates that increased recruitment can result from relatively small changes to traditional schedules. Similarly, Ghatan et al [7] demonstrated that 3 case-based IR lectures improved impressions and perceptions of IR for 75% of the second-year
ª 2015 American College of Radiology 1546-1440/15/$36.00 n http://dx.doi.org/10.1016/j.jacr.2014.07.027
medical students at a single American institution. Twenty-two percent of students also expressed interest in pursuing an elective IR rotation. Zimmerman et al [8] created a yearlong radiology elective with 5 weeks of IR instruction. By the end of the elective, the authors saw a 73% increase in the number of medical students interested in a career in IR. The elective was so successful that IR education is now integrated into that institution’s first-year curriculum. By introducing IR to preclinical students, the specialty can offer a procedural alternative to surgery at a stage when interest in surgery declines.
BENEFIT OF AN INFORMAL CURRICULUM Despite gains made in the lecture hall, medical schools that lack a robust IR presence or a flexible core curriculum remain at a recruitment disadvantage relative to other procedural specialties. Fortunately, student interest groups can provide an informal curriculum to improve recruitment [9]. The American College of Obstetricians and Gynecologists recognized the importance of interest groups and developed a website to organize groups at the national level [10]. To emulate our
965
colleagues, the Resident and Fellow Section of the Society of Interventional Radiology formed the Medical Student Council in 2011 to create and sustain medical student interest in IR. IR interest groups were one of the main strategies designed to spur student interest. Although interest groups can provide didactic introductions to a specialty, their greatest value is outside of the classroom through clinical exposure, mentorship, and workshops. Extracurricular opportunities offered by interest groups are crucial, as Nissim et al [2] found that only 0.4% of medical students claimed that mandatory IR rotations were part of their institutions’ curricula. Kothary et al [11] demonstrated that greater one-to-one mentorship and procedural time increased radiology residents’ satisfaction in IR (from 23% to 70%). The same approach would likely result in similar outcomes with medical students. Students who identify mentors can delve deeper into the specialty and obtain letters of recommendation when applying for residency [12]. Additionally, interest groups offer the chance to use devices in workshops so that students can better understand procedures they observe in the IR suite. Participation in IR electives can provide a sense of ownership and satisfaction from direct patient care that didactics will never equal [12]. In the spirit of the Medical Student Liaison Program, the Medical Student Council tracks IR mentors and lists 31 of them on its website (http://rfs.sirweb.org). A panel of 5 of those mentors with 26 attendees participated in an interest group webinar in April 2014 sponsored by the Resident and Fellow Section. The focus of the hour-long session was on the role of interest groups in 966
specialty recruitment. The panel also participated in a question-andanswer session on the specialty, which led to active discussions on future training pathways and the future of IR.
THE INTEREST GROUP ROADMAP Fricke and Gunderman [9] wrote that creating a guide on forming a radiology interest group would be “one opportunity for radiology organizations to facilitate increasing student imaging education.” In response, the Medical Student Council debuted an online roadmap at the 2014 Society of Interventional Radiology annual meeting in San Diego on how to create, fund, advertise, and sustain interest groups. A record-setting 142 medical students registered for a special 2-day introduction to the field and were provided links to the roadmap (J. O. Gornal, personal communication). At the time of publication, 21 institutions had requested a roadmap to bolster the informal IR curriculum at their campuses. The roadmap content was written by medical students and residents at 11 medical schools represented on the Medical Student Council. Solutions to commonly encountered problems with funding, membership, and networking were provided to assist both new and established groups. The roadmap also includes access to a downloadable lecture series created by the Medical Student Council and Resident and Fellow Section and edited by attending advisors to introduce interventional radiologic management of diverse pathology (Table 1). The 13 evidence-based presentations provide a convenient curriculum at medical
Table 1. Society of Interventional Radiology Lecture Series 1. Introduction to Interventional Radiology 2. Interventional Radiology Frontiers 3. Interventional Oncology 4. Peripheral Artery Disease 5. Thoracic Aortic Aneurysm 6. Abdominal Aortic Aneurysm 7. Carotid Disease 8. Chronic Liver Disease 9. Gastrointestinal Bleeding 10. Lower Extremity Ulcers 11. Deep Vein Thrombosis 12. Varicose Veins 13. Trauma Interventional Radiology
schools that may lack formal didactic exposure. These are designed to be used at interest group meetings or during clinical electives in IR. In addition to promoting IR awareness and education, an indirect benefit of the interest group roadmap is to increase recruitment by fostering physician-student mentorship. Nissim et al [2] emphasized the value of resident teaching, as residents are closer in age and perspective to medical students [2]. The availability of these lectures facilitates resident, fellow, or junior faculty participation in interest group meetings. Resident-student interaction is invaluable for recruitment purposes because resident satisfaction is important to medical students when choosing their specialties [12].
CONCLUSIONS The dual certificate brings exciting new opportunities for advancing IR, but the specialty must actively recruit medical students to survive. Ideally, the core curriculum at medical schools will increase medical student exposure to IR. For campuses with inadequate curricula or the inability for curricular reform, it is critical to
Journal of the American College of Radiology Volume 12 n Number 9 n September 2015
leverage interest groups to provide an informal curriculum of downloadable lectures, clinical electives, and mentorship opportunities. Regardless of the methods, engaging students throughout medical school would be the strategic move toward meeting the demand for interventionalists with quality, highly motivated trainees.
3.
4.
5.
REFERENCES 1. Sunshine JH, Cypel YS, Schepps B. Diagnostic radiologists in 2000: basic characteristics, practices, and issues related to the radiologist shortage. AJR Am J Roentgenol 2002;178:291-301. 2. Nissim L, Krupinski E, Hunter T, Taljanovic M. Exposure to, understanding of, and interest in interventional radiology
6.
7.
in American medical students. Acad Radiol 2013;20:493-9. Siragusa DA. Vascular and interventional radiology training: a perspective from the Association of Program Directors in Interventional Radiology. J Vasc Interv Radiol 2006;17:S155-8. Chadwick N, King E, Campos L, Bhatt A, Vatakencherry G. Time for an intervention? The current state of medical student interventional radiology education. J Vasc Interv Radiol 2013;24:S180-1. Godshall CJ, Moore PS, Fleming SH, et al. A vascular disease educational program in the preclinical years of medical school increases student interest in vascular disease. J Vas Surg 2010;52:775-81. Compton MT, Frank E, Elon L, Carrera J. Changes in U.S. medical students’ specialty interests over the course of medical school. J Gen Intern Med 2008;23:1095-100. Ghatan CE, Kuo WT, Hofmann LV, Kothary N. Making the case for early medical school education in interventional radiology: a survey of 2nd-year students in
8.
9.
10.
11.
12.
a single U.S. institution. J Vasc Interv Radiol 2010;21:549-53. Zimmerman N, Nayyar R, Bigelow M, Rajebi M, Zeinati C. Interventional radiology education early in medical school: is it valuable? J Vasc Interv Radiol 2014;25: S37-8. Fricke BB, Gunderman RB. Creating and enhancing radiology student interest groups. Acad Radiol 2010;17: 1567-9. Beinstock JL, Laube DW. The recruitment phoenix: strategies for attracting medical students into obstetrics and gynecology. Obstet Gynecol 2005;105:1125-7. Kothary N, Ghatan CE, Hwang GL, et al. Renewed focus on resident education: increased responsibility and ownership in interventional radiology rotations improves the educational experience. J Vasc Interv Radiol 2010;21:1697-702. Baerlocher MO, Asch M. Protecting the future: attracting interventional radiology trainees—a medical student’s perspective. Can Assoc Radiol J 2006;57:147-51.
Eric King, MS, MD, is from the Department of Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Nicholson Chadwick, MD, is from the Department of Radiology, Virginia Commonwealth University Medical Center, Richmond, Virginia. Andrew Lee, MD, is from the Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California. Nicole Keefe, MD, is from the Department of Radiology, University of Virginia, Charlottesville, Virginia. Rahul Nayyar, MBA, MD, is from the Department of Radiology, SUNY Upstate, Syracuse, New York. Geogy Vatakencherry, MD, is from the Department of Vascular and Interventional Radiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California. Eric King, MS, MD: Department of Radiology, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Street, Los Angeles, CA 90027; e-mail: [email protected].
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