Radiology Education Rethy K. Chhem · Kathryn M. Hibbert Teresa Van Deven (Eds.) Radiology Education The Scholarship of Teaching and Learning Rethy K. Chhem Teresa Van Deven Professor & Chair Curriculum and Pedagogy Support Department of Medical Imaging Centre for Education in Medical Imaging Schulich School of Medicine and Dentistry Schulich School of Medicine and Dentistry University of Western Ontario University of Western Ontario London,ON London, ON Canada N6A 5C1 Canada N6A 5C1 Kathryn M. Hibbert Director Centre for Education in Medical Imaging Assistant Professor Department of Medical Imaging Schulich School of Medicine and Dentistry University of Western Ontario London, ON Canada N6A 5C1 ISBN: 978-3-540-68987-4 e-ISBN: 978-3-540-68989-8 DOI: 10.1007/978-3-540-68989-8 Library of Congress Control Number: 2008928775 © 2009 Springer-Verlag Berlin Heidelberg This work is subject to copyright. 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In every individual case the user must check such information by consulting the relevant literature. Cover design: Frido Steinen-Broo, e-Studio Calamar, Spain Printed on acid-free paper 9 8 7 6 5 4 3 2 1 springer.com Foreword This is a book about scholarship in the broadest sense. The writing of this book has shown how through scholarship we can bring together academics, practitioners, scientists, radio logists, and administrators from around the world to begin the kinds of conversations that promise to move us to a new way of thinking about and enacting radiology education. Over the past century, we have witnessed tremendous change in biomedical science and the scope of this change has demanded new approaches to medical education. The most significant of the changes in medical education has been a fundamental paradigm shift from a teacher-centered approach to a student-centered approach. This shift, com- bined with the explosion of knowledge, has pressed medical schools to undertake major curricular and institutional reform. At the same time, progress in medical education research methods has led to innovative approaches to support the improvement of learning methods and evaluation. Over the past several years there has also been a shift toward thinking about and planning for medical education beyond the undergraduate level to include postgraduate and continuing medical education, but also to consider learning within the professional environment and the development of professional continuous education. Viewing medical education as a continuum that spans from the first year of medical school until retirement introduces new ways to conceptualize the teaching and learning needs that address lifelong learning demands that extend over 30 or 40 years. To add complexity to the demands, we have to consider the changing role and function of radiology in the twenty-first century. Given the historic advancement of knowledge, coupled with technological development, radiology as a specialty has progressively reached a tremendous scope during its golden age. These advancements have called for a redefinition of the boundaries of this specialty. As a consequence, medical imaging has positioned itself as an important component at the core of any medical curriculum. It has also become a very popular specialty among medical students and consequently has led to innovative residency training and research program initiatives. These initiatives often serve as models for general medical education curriculum design and implementation. There is no question v vi Foreword that current medical students, residents, colleagues, and patients have benefited much more from this revised curriculum than the curriculum I experienced during my own training a couple of decades ago. Although I am reassured by the quality of the current radiology education content, I remain worried and uncomfortable about some of the other professional competencies. For example, what is the best way to teach residents how to obtain informed consent from a patient before undertaking a complex interventional procedure? How can we help our medical students to develop the processes of self-assessment, communication, and collaboration with other health professionals even within our own radiology department? When I observe a general lack of respect for colleagues or a radiologist who takes refuge in the comfort of his/her subspecialty (thereby not offering general radiology services), I wonder, Have I failed in my role as a teacher? Have I not been a good role model? Clearly, accumulating radiological content knowledge and skills as a superb medical expert is not sufficient. To be accountable to our patients, and to society gener- ally, requires more than diagnostic and therapeutic skills. Patients today are often much more sophisticated and informed about their own illness and expect to communicate as partners in their health care team. Patients want quick access to medical imaging facili- ties despite scarce health care resources. As taxpayers, they exercise their right to make demands on universities and teaching hospitals to meet their needs. Schools of medicine and continuous medical education providers should adopt mechanisms to accurately assess the characteristics and needs of the populations they serve. Economic, social, and demo- graphic parameters should all be taken into consideration by medical curriculum designers in order to meet societal needs. These parameters include aging process, chronic disease, poverty, vulnerable population, multicultural society, system of beliefs, globalization and ecohealth system, scarce resources, and interprofessional collaboration. Finally, zero tolerance for nonethical and irresponsible behavior should be assumed as the core value of medical education. Advances in technology and changing societal needs have meant that radiology has ceased to be a pure “contemplative” activity, and instead the radiologist’s role has evolved into that of an attending physician with full responsibility for the entire spectrum of patient management. Beyond the clinical role then, radiologists should be engaged in debate on the key issues that affect society. Increasingly, there is an expectation that a physician should embrace the role of community leader. The skills necessary to take up that role must be integrated as fundamental learning outcomes during the design of curriculum, at all levels of medical education. This book calls upon radiologists to expand their role beyond limited understandings of themselves as simply a clinical service provider and to engage in dialogue, scholarship, and educational activities rooted in professional responsibility and accountability toward the community. Rethy Chhem, the senior editor of this collection, has demonstrated such a commitment to societal needs throughout his entire career. It is not surprising to see that he has taken up the challenge of producing a book that expands the understanding of the scholarship of teaching and learning in medicine, with a special focus on radiology education. The chapters included in this book highlight a path that has been taken by a few pioneers in radiology education, and also offer innovative ideas that may help medi- cal educators in their commitment to train and educate radiologists equipped as “medical experts” with full social responsibility. Rethy Chhem and his coeditors Kathy Hibbert and Foreword vii Teresa Van Deven are to be congratulated for having gathered leaders and experts in radiology education across the globe to come together to share their expertise in this exciting and promising field. This book promised to fill a void, as there is currently no book available that addresses radiology education from a scholarship of teaching and learning perspective. Let the dialogue begin! Montreal, PQ, Canada Louise M. Samson April 2008 Acknowledgements We wish to thank the radiology faculty and residents of the Department of Medical Imag- ing, Schulich School of Medicine and Dentistry University of Western Ontario for wel- coming us into their departments and for their valuable input along the way. We thank our Deans for their enthusiastic support; we thank, Dr. Carol Herbert, Dean of the Schulich School of Medicine & Dentistry, University of Western Ontario and Dr. Julia O’Sullivan, Dean of the Faculty of Education, University of Western Ontario. We also wish to thank the following Research Assistants for their contributions to this work: Sarah Flynn, Hongfang Yu, Senlin Yang, Lucy Karanja, Jennifer Neil and Holly Ellinor. We would like to acknowl- edge the support of a Faculty Support for Research in Education grant from the Schulich School of Medicine & Dentistry, University of Western Ontario. Rethy Chhem I would like to thank Dr. Louise Samson, President of the Royal College of Physicians and Surgeons for both her support of this project and for graciously writing the Forward to our book. As always, I thank my family for their encouragement and continual support: my wife, Yanny, my daughters, Sirika and Kanika and my son, Siriwat. Kathy Hibbert I read a quote once that seems appropriate to include here: “Don’t ask yourself what the world needs. Ask yourself what makes you feel like you have come alive. And then go and do that. Because what the world needs is people who have come alive.” Thank you to my colleagues Rethy Chhem, Teresa Van Deven, Sharon Rich, Roz Stooke and Rachel Heydon, and to my family, Bill, Darren and Ali for their friendship and support—all things that make me feel like I have come alive. Thanks too, to all of the wonderful physicians and residents that we have worked with to complete this book. Teresa Van Deven First and foremost I thank the radiology physicians and residents from the three hospital sites in London, Ontario, for taking the steps towards these dialogues around scholarship. These dialogues have truly constituted the beginnings of this book. I thank my colleagues and mentors who have helped to cultivate not only my own sense of scholarship but also ix x Acknowledgements the passion to pursue this work: Dr. Kathy Hibbert, Dr. Rethy Chhem, Dr. Suzanne Majh- anovich, Dr. Allan Pitman, Dr. Geoffrey Milburn and Father Francisco de las Heras . I thank and cherish those in my life who have so enthusiastically encouraged my new jour- ney into medical education: Kate Danielle, Joan, Louis, Kimberly, Richard James, and Brooklyne. Contents Introduction Transforming Radiology Education Through Scholarship ..................................... 1 C.P. Herbert, J. O’Sullivan Part I Education for Non-Educators 1 The Genesis and Application of Radiology Education: Mind the Gap .......................................................................................................... 5 T. Van Deven, K. Hibbert, R.K. Chhem 1.1 Introduction............................................................................................... 6 1.2 Border Crossings ...................................................................................... 6 1.3 Communities of Professional Practice ................................................... 7 1.4 Building a New Home but Living the Same Old Life Within It .................................................................................................... 8 1.5 Cultivating Scholarship ........................................................................... 9 References ................................................................................................. 11 2 Scholarship in Radiology Education ................................................................... 13 R.K. Chhem 2.1 What is Scholarship in Radiology Education? ...................................... 14 2.2 Why Expand Scholarship in Medical Imaging? ................................... 18 2.3 How to Expand Scholarship in Medical Imaging Education? ............. 19 2.3.1 Academic Leadership .............................................................................. 19 2.3.2 Faculty Members ...................................................................................... 20 2.3.3 Specific Educational Structures ............................................................. 21 2.4 Conclusion ................................................................................................ 22 References ................................................................................................. 23 xi