Background: Internist trainees have traditionally acquired radiology skills in a piecemeal manner, either through elective rotations or through informal “radiology rounds” on inpatient medicine rotations. here is no comprehensive curriculum for teaching basic radiology to internal medicine (IM) residents, and their image interpretation skills are limited (1). Additionally, the rise of the electronic medical record has made imaging reports rapidly available, so internist are less likely to seek the direct input of a radiologist (2). Previous groups have examined the effect of implementing “reverse” radiology rounds, in which a radiologist joins the internal medicine team on rounds to discuss interesting cases (3-4). Although IM residents had favorable opinions of these programs, the interventions adhered to the traditional “radiologist as consultant” approach and did not examine outcomes. To address the limitations in radiology training for internists, we designed and implemented a novel curriculum that provides IM residents with an educational framework for the fundamental principles of diagnostic radiology, in an interactive, case-based lecture series.

Purpose: The primary purpose of this innovative curriculum was to improve post-graduate-year-1 (PGY1) IM residents’ knowledge of diagnostic radiology principles and their confidence in interpreting radiographic images.

Description: One of the authors (a PGY3 IM resident) created and delivered a novel radiology curriculum called “Air, Water, Earth, Fire: Essential Radiology for the General Internist” to PGY1 IM residents at an academic medical center from August to November 2019. The series consisted of four 50-minute interactive lectures: one each for ultrasound (US), radiography (X-ray), computed tomography (CT), and magnetic resonance imaging (MRI). Each session began with a clinical case featuring one diagnostic imaging modality, as recommended by the American College of Radiology Appropriateness criteria (5). Next, the author presented the basic physics principles of each imaging modality. The session then explored the appearance of gas, liquid, solid, and inflammation for that modality through the lens of the four classical Greek “elements” (Figure 1). Finally, residents had the opportunity to practice their interpretation skills in a “think-pair-share” format. Pre- and post-testing demonstrated a statistically significant improvement in residents’ knowledge and confidence for all of the modules (Table 1).

Conclusions: Our radiology curriculum, designed specifically for internal medicine residents, is an effective way to improve residents’ understanding of basic radiology principles and confidence in image interpretation. This innovation is unique in its “by internists, for internists” approach to radiology education and its provision of a memorable educational framework to promote long-term retention of radiology concepts.

IMAGE 1: Figure 1: The “Elements” of radiology, the tissues they represent, and clinical examples that can be seen on imaging. (CSF: cerebrospinal fluid).

IMAGE 2: Table 1: Matched mean scores on pre- and post-tests for each session. (X-ray: radiography, US: ultrasound, CT: computed tomography, MRI: magnetic resonance imaging).