Radiology Undergraduate Radiology Curriculum April 2012
INTRODUCTION This curriculum is intended to form a framework for undergraduate learning and teaching in radiology. It refers to the relevant competencies outlined in Tomorrow s Doctors 2009 and in the latest iteration of the Foundation curriculum. It is intended to prepare Foundation doctors with the necessary knowledge and skills to routinely arrange and correctly interpret basic radiological investigations in the context of the individual patient with understanding of applicability and limitations. It has deliberately concentrated on common, important, clinical topics to address these objectives. The curriculum is divided into 3 sections: 1. Fundamental principles 2. Common emergency conditions 3. Imaging in other common presentations The RCR considers the whole curriculum to be appropriate learning for medical students to prepare them for life as a Foundation doctor, but sections 1 and 2 should be prioritised. Assessment forms an integral part of any curriculum. In the tables that follow, the assessment methods shown are those that are appropriate for that topic and which could be used to assess each competency. These may vary according to the structure of course and timing of learning events, but the following are suggested as core assessment methods: OSCE Single Best Answer Questions (SBA) Extended Matching Questions (EMQ) The mini-ipx is an assessment tool used by radiologists in training for image viewing and basic reporting It may, in the future, be adapted for use for undergraduates. At present it is suggested that this assessment functionality be obtained using OSCE assessment. 2
1 FUNDAMENTAL PRINCIPLES The Learning Outcomes are characterised by understanding of the knowledge, insights and attitudes, which are common to the doctor s use of imaging services in their practice. Anatomy and Function Recognition of normal structures as they appear on imaging. Understanding of normal function processes related to imaging investigations. Ability to interpret basic imaging studies. Ability to relate radiological reports to structures on images. OSCE OSCE OSCE National law governing radiation protection. Risks of MRI. Risks of interventional procedures. Risks of contrast media. Ability to refer patients safely. Patient Safety Understanding of the doctor s role in limiting risk to the patient. Nature of Imaging Investigations Indications and preparatory requirements for imaging studies, how frequently requested studies are conducted, their effects on the patient, and follow-up (care where required) Ability to refer patients effectively and appropriately Ability to understand limitations of imaging techniques Understanding of the requirements to the patient and the service of undergoing imaging investigation. Assessment Methods 3
The Patient Awareness and Experience The knowledge of what an imaging investigation entails from the point of view of the patient Ability to inform patients accurately prior to imaging, to prepare adequately and to limit anxiety Understanding the psychological issues raised by investigation, and by invasion of some investigations. OSCE, Principles and practice of informed consent Informed Consent Ability to inform patients accurately and obtain consent where relevant. Understanding of the importance of patient involvement in consent decisions. Interacting with the Radiology Department Roles of staff groups in radiology Requirements of radiology departments for accurate referral information Referral and reporting mechanisms Ability to practise effective, timely and appropriate patient referral. Understanding of the importance of communication to effective clinical management. Relevant links in the Foundation Programme F1 outcomes: Requests/arranges appropriate basic imaging (radiology), laboratory tests and other investigations in a timely fashion Provides concise, accurate information when requesting investigation Has an understanding of what the test/procedure entails in order to prevent inappropriate referrals/requests Discusses the indications for and expectations of the test to radiology/laboratory staff Seeks out, documents and relays results in a timely fashion Relevant links in the Foundation Programme competences: Recognises that requesting investigations and seeking out then interpreting and acting upon their results is a crucial element of modern medical practice. Requests investigations appropriate for the patients needs and the clinical context Discusses requests appropriately and provides relevant information on the request form Avoids unnecessary investigations and recognises that investigations are only needed if the result will impact on patient management 4
Recognises contraindications to test/procedure Recognises that ionizing radiation, magnetic fields and intravascular contrast can be harmful Explains (to the patient s level of understanding) the risks, possible outcomes and implications of potential results Gains informed consent when appropriate Discusses test results when available Prioritises importance of investigations, results 2 COMMON EMERGENCY CONDITIONS The Learning Outcomes are characterised by the ability to request and perform basic interpretation of the following imaging studies in situations in where the Foundation Year doctor may be providing first line clinical management or referral for assistance, including under emergency circumstances. Investigation: Conditions Knowledge Skills Attitudes Chest radiograph (CXR) Abdominal radiograph (AXR) Skeletal radiograph Misplaced nasogastric tube Misplaced endotracheal (E-T) tube Misplaced central venous catheter Simple/tension pneumothorax Pleural effusion Lung/lobar collapse Lung consolidation Heart failure Foreign body Pneumoperitoneum (on erect CXR) Small bowel obstruction Large bowel obstruction Toxic megacolon Pneumoperitoneum Foreign body Common causes of normal and abnormal calcification Bone fractures Pelvis Femoral neck Wrist/carpus/scaphoid Long bones Fractures involving joint/epiphyseal plate Joint dislocation Joint effusion Lipohaemarthrosis Fracture/dislocation of spine OSCE OSCE, OSCE OSCE, OSCE OSCE, Relevant links in the Foundation Programme F1 outcomes: Interprets the results correctly within the context of the particular patient presentation e.g. plain radiograph in common acute conditions Relevant links in the Foundation Programme competences: Interprets basic radiographs in the context of the patients history and presentation 5
3 IMAGING IN COMMON CLINICAL PRESENTATIONS The learning outcomes are characterised by the ability to understand the role of diagnostic imaging and intervention in the investigation and management of the common clinical scenarios (listed below). Knowledge Able to describe the role of multi-modality imaging in the investigation of common clinical conditions (including common emergencies) and justify the choice of imaging modality. Skills Able to recognise and describe common pathologies on basic imaging. Adequately appraise a radiological report and take the appropriate action including in the acute setting. Attitude/Behaviour Develops an understanding of how radiological and imaging investigation integrates in the patient care pathway. Communicate effectively with patients, fellow health care professionals and radiological teams in the investigation of diseases including common emergencies. Assessment These are best assessed with OSCE type assessment 6
List of common clinical scenarios: Chest and cardiovascular disease: Gastrointestinal disease: Renal and urological disease: Breast disease: Neurological disease: Musculoskeletal disease: Obstetric and gynaecological disease: Multisystem disease: Chest pain Thoracic trauma Breathlessness Cough Haemoptysis Abdominal pain Abdominal masses Abdominal trauma. Swallowing disorders Bowel obstruction Bowel perforation Change in bowel habit Jaundice. Urinary colic Haematuria Acute kidney injury Urinary obstruction Acute presentation of testicular disease. Masses Abscess Head injury Stroke Severe headache Seizures Altered consciousness Spinal cord compression Bone pain Joint pain Bone and soft tissue trauma Bone and soft tissue infection Spinal injury Neck and back pain. Suspected or abnormal pregnancy Abnormal vaginal bleeding; pelvic pain Pelvic mass Use of ultrasound in normal pregnancy Principles of oncological disease staging by imaging Anaemia Pyrexia of unknown origin Disease in Childhood: Trauma Non-accidental injury basics The limping child The painful limb Principles of imaging specific to children Urinary tract infections. Relevant links in the Foundation Programme F1 outcomes: 7
Requests/arranges appropriate basic imaging (radiology), laboratory tests and other investigations in a timely fashion Provides concise, accurate information when requesting investigation Discusses the indications for and expectations of the test to radiology/laboratory staff Interprets the results correctly within the context of the particular patient/presentation Relevant links in the Foundation Programme competences: Recognises that requesting investigations and seeking out then interpreting and acting upon their results is a crucial element of modern medical practice Requests investigations appropriate for patients needs and the clinical context Discusses requests appropriately and provides relevant information on the request form Avoids unnecessary investigations and recognises that investigations are only needed if the result will impact on patient management Interprets basic radiographs in the context of the patients history and presentation Reviews reports when circumstances change 8
The Royal College of Radiologists 38 Portland Place London W1B 1JQ Tel +44 (0)20 7636 4432 Fax +44 (0)20 7323 3100 Email enquiries@rcr.ac.uk URL www.rcr.ac.uk A Charity registered with the Charity Commission No. 211540 Citation details: The Royal College of Radiologists. Undergraduate Radiology Curriculum. London: The Royal College of Radiologists, 2012. Ref No. BFCR(12)4 The Royal College of Radiologists, April 2012 For permission to reproduce any of the content contained herein, please email: permissions@rcr.ac.uk This material has been produced by The Royal College of Radiologists (RCR) for use internally within the specialties of clinical oncology and clinical radiology in the United Kingdom. It is provided for use by appropriately qualified professionals, and the making of any decision regarding the applicability and suitability of the material in any particular circumstance is subject to the user s professional judgement. While every reasonable care has been taken to ensure the accuracy of the material, RCR cannot accept any responsibility for any action taken, or not taken, on the basis of it. As publisher, RCR shall not be liable to any person for any loss or damage, which may arise from the use of any of the material. The RCR does not exclude or limit liability for death or personal injury to the extent only that the same arises as a result of the negligence of RCR, its employees, Officers, members and Fellows, or any other person contributing to the formulation of the material.