Want to Teach a Millennial Rad? Try a Night at the Museum

If a picture is worth a thousand words, at least some of those are good for radiology reports. At least that’s the approach being used to train residents at the University of Massachusetts Medical School.

Roughly 70 percent of interpretation errors with diagnostic imaging studies are linked to visual perception mistakes. These problems can happen a lot more often when providers focus more on the “answer” lurking in the image rather than having a more in-depth discussion of what the scan might reveal. This approach is a habit among millennials, said the team led by Andrew M. Singer, M.D., a radiologist and director of ultrasound at UMMS.

“We have observed that residents often do not discuss findings or form an impression in a methodical way, but rather jump to one answer, as if interpreting the image as a multiple-choice test question,” the team said in their study published in the May 31 Clinical Imaging. “This change in approach has likely been compounded by the introduction of PACS, remote reading, lack of clinical rounds in the reading room, and the introduction of [artificial intelligence], all of which has created distance between radiologists and clinicians and has decreased one-to-one interactions.”

To combat this trend, and because millennials respond well to immersive, interactive learning environments, the team landed on an unusual strategy – they turned the art museum into a visual learning lab. A reading room filled with Baroque, Classical, and modern images that helped residents fine-tune the nuanced skills needed for more accurate, deft diagnoses.

Beginning in 2016, UMMS implemented this art museum teaching strategy with radiology residents who had completed their first three months of training, including emergency radiology, chest, abdomen, pelvis, and neuroradiology. The workshop consisted of a one-hour lecture followed by a two-hour museum visit.

“We chose the timing of our workshop to synchronize with the stage of their training where they would have gained a basic understanding of the process of interpreting radiologic images which would inform their understanding of the similarities to art observation techniques,” the team explained.

During the lecture, residents were exposed to the main tenets of Visual Thinking Strategies (VTS) – detail, storytelling, ambiguity, and empathy – as the same elements are fundamental to meaningful radiologic interpretation, they said. The students observed four differently styled paintings, and researchers posed and expounded on three VTS questions so that they correlated well to making radiologic findings, communicating the impression, and ACR Imaging 3.0, as well.

Original questions:

• What did you see?
• What makes you say that?
• What else do you see?

Communicating impression:

• What do these findings mean?
• What is the story that the painter is telling?

ACR Imaging 3.0:

• What is the mood expressed by the artist?
• How does it make you feel?
• Are your observations biased by your beliefs?

“The purpose was to identify and describe findings without interpretation, and then to give the findings context, in order to clearly analyze and present the ‘story’ that the artist is conveying in the artwork,” the team said. “This parallels the radiologist’s presentation of the findings and impression for an imaging study.”

Based on the feedback from 35 residents who have participated in the workshop, the researchers determined that the art museum is an effective environment for residents to explore their observational, communication, and analytical skills. Residents reported feeling more comfortable with closely analyzing studies and that they had developed a deeper understanding of weaving findings together cohesively in order to see the overall patient picture more clearly.

For the future, the team said they intend to expand their outside-the-box training efforts to include digital simulations, 3D and virtual anatomy interactive touchscreens, escape room competitions, and “Case of the Week” social media posts.

“Moving forward, we suggest that the radiology reading room not be thought of as an impersonal utilitarian ‘Work Station,’ but rather as a ‘collaborative digital imaging studio’ for reviewing images, static and video, with the added capabilities of digital data manipulation, image reconstruction technology and the capabilities to interface remotely with other radiologists and the clinical providers,” they said. “By transferring skills acquired at the museum to the ‘Radiology Digital Imaging Studio,’ we hope that our program helps to accelerate the radiology residents’ learning process and adds to the enjoyment of radiology.”

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