As stated in the introduction session, in the medical literature reviewing the status and innovations of medical curriculum, the main focus is on the curriculum shift from a first generation curriculum (e.g., conventional curriculum) to a second (e.g., problem-based) and a third generation curriculum (e.g., competence-based). In this context recent research points at the importance of radiology within the medical curriculum [13] and calls for the improvement of radiology education [14]. The current analysis of the present situation in Europe regarding formal radiology undergraduate teaching shows some clear trends. One of the optimistic findings is that within both conventional and modern medical curricula, radiology courses are mostly present as mandatory courses. The situation in Europe seems to differ from the US and Canada where radiology is rather present as an elective course [15, 16]. Also, radiology seems to be a consistent part of the medical curriculum in every medical training year. This is an important observation in view of the effect of the exposure on the students' beliefs about radiology and their future career choice [17]. From the present study, it becomes clear that one of the advantages of a modern type of curriculum (i.e., problem based, hybrid, integrated, modular) is the fact that students already get their first radiology experience during the first year of medical training. Also the second year and the sixth year of the training seem to be important within modern curricula, while the conventional curriculum rather emphasizes radiology teaching in the third and fourth year of the training. Year 6 radiology exposure might be important to influence decisions of students to adopt radiology as a career choice.
Although the proportion of the curriculum focusing on radiology is comparable in both types of the curriculum, the involvement of radiology-related teaching staff is considerably higher in modern curricula (15 vs. 8 teachers). The fact that within modern curricula more teachers and also other medical specialists participate in the teaching and learning process (i.e., sub-specialized radiologists, clinicians, and radiographers) can be explained by the stronger multidisciplinary teaching focus that stresses the linkages between and integration of medical disciplines [18]. However, the results reiterate the findings of previous research that radiology is preferably taught by general radiologists [12] that are considered as successful educators [17, 19, 20].
The fact that specialized radiologists are involved in teaching is favored in the literature but might also be a point of concern [21, 22]. Attention should be paid to the adequate level of radiology teaching. There is a risk that specialized radiologists teach at a too high level and prefer to focus on rare diseases and advanced techniques, thus forgetting about first line radiology. In the literature it is stressed that teaching staff needs to adopt a consistent educational approach: compatible teaching methods, clear learning objectives pursued throughout the different curriculum years and taking into account the progressive level in radiology competences of undergraduate students [13].
Also, the involvement of radiology trainees in radiology teaching is more prominent in modern curricula (50% vs. 28%). It is important to keep in mind that attention should be paid to adequate training to improve teaching skills. Formal instruction, based on effective teaching methods, is critical for resident teachers. Also, effective support and development opportunities should be provided [23–25].
The expanded use of multimedia [26–28] and e-learning (radiology software and Internet usage) [27, 29–35] as part of the didactical approach in radiology teaching can be expected to foster effective learning. Also, from the student perspective, e-learning is a highly appreciated component of an innovative radiology curriculum [36]. The results of the present study are in line with previous research and show clear differences in the types of e-learning implemented within a conventional and a modern curriculum. Educational radiology software is typically found in modern medical curricula. Teaching based on PACS or web-based PACS is typically found in conventional curricula. However, the use of the Internet is popular within both types of curricula.
Clinical clerkships are reported in the literature as a vital part of a radiology curriculum [21, 37–39]. Previous European research supports this finding [12]. By considering the limitations of a first benchmarking study, the present study paid special attention to the types and the position of the radiology clerkships (or “practical sessions”) within the medical curriculum. Our finding that in more than half of the modern medical curricula a clerkship is a mandatory activity is positive and promising. In this way, modern medical curricula underpin the finding of previous research that considers radiology clerkships to be a critical curriculum component of effective radiology education [40]. In contrast, institutions adopting a conventional curriculum reported dominantly elective radiology clerkships. This reflects the situation in US medical schools, where radiology clerkships are rather present as an elective and are to a lesser extent a mandatory building block [21, 41] during the clinical years. Our finding that—in modern European medical curricula—students already have the possibility to be involved in radiology departments during pre-clinical years responds to the conclusions of research that promotes these practice-related activities during the early clinical curriculum phase [42]. It is clear from our research that observation tasks are present in both types of curricula. But active tasks, such as following radiological examinations, working with radiology files, as well as attending radiology conferences or participation in multidisciplinary meetings, are a more established part in modern curricula. The latter reflects the benefits of modern curricula that focus on the multidisciplinary and integrated nature of the clinical learning context.
Limitations
The limitations of this article are related to a number of issues. First, there are limitations as to our distinction between a "conventional" and ""modern" curriculum. Although we build on previous research that states that the conventional curriculum dominates in European medical curricula [12], we also have to admit that a “conventional” curricula can reflect innovative features. Due to our focus on the characteristics of the “modern” curriculum, the advantages and/or potential strengths of the traditional curriculum approach have been neglected. Also the fact that the content and structure of a curriculum is partly context bound neglects that fact that, in particular settings, a traditional approach might be more relevant and desirable.
The questionnaire was focused and as such limited to the formal nature of radiology teaching. The impact of “informal” teaching activities and, e.g., the “hidden” curriculum could therefore not be captured in this research.
A second limitation is related to the different entry requirements into medical schools. The quality of novices in the curriculum differs widely between countries and within countries, if we observe the implementation of entrance tests, the insistence on minimal grade levels, selection procedures based on interviews, etc. This type of information is still not available in our database and should be incorporated in future versions of the questionnaire. A curriculum type might be more geared to a particular type of novice.
Thirdly, we have acknowledged the possibility of response bias that is typical in survey-based studies that build on questionnaires. Although the distribution of the questionnaire was supervised by ESR and the questionnaire was filled out by radiology teaching staff and chiefs of teaching hospitals (one response per institution), questions can still be raised about the validity/reliability of certain responses. Related to this, we have to stress that the data were not obtained from a stratified sample that considered specific institutional or country characteristics. For instance, the size of the institutions was neglected in the present study. The adoption of a type of radiology curriculum can be influenced by institution size. Though we did not intend to focus on between-country variation or within country variation, the way institutions vary should be considered in future studies that adopt a sampling framework.
Future research should adopt a triangulation approach to corroborate the data gathered via the questionnaire. Qualitative interviews could help to develop a more in-depth picture.
Lastly, the statistical analysis of our research data was restricted to a descriptive exploration of curriculum characteristics. No inferential statistical tests have been carried out to test the significance of group differences due to the structure of the data set, the nature of some of the variables, and the fact that the data were not obtained from a stratified sample. Future research could look at particular patterns, associations, and potentially causal relationships between certain data.
