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E2347. Medical Student Dictation Program: Bringing the Radiology Rotation into the 21st Century
Authors
  1. Matthew Kluckman; Brook Army Medical Center
  2. Rutger Gunther; Brook Army Medical Center
  3. Francis Cloran; Brook Army Medical Center
Objective:
The traditional medical student and off-service resident radiology rotation is a hands off experience. We recently implemented a quality improvement project whereby rotators were provided with access to dictate live cases and function as a contributing member of the radiology team. The objective is to improve rotator engagement with the radiology rotation, to attract talented medical students to the radiology specialty, and to foster improved learning during the rotation.

Materials and Methods:
This ongoing study is being conducted as a prospective crossover trial. Rotators select up to four radiologic specialties with one week on each. Rotators are randomized to spend half of their time in a traditional observer-role and half of their time as a dictating team member. After dictating one or more exams, the student approaches a resident to "sign-out" their cases. The resident reviews the cases, takes ownership of the dictation, and forwards it to the staff for review. Students take a pre-and-post rotation survey and up to four pre-and-post rotation tests using full Digital Imaging and Communications in Medicine (DICOM) datasets. Surveys measure engagement, interest in radiology, and reputation of the radiologic specialty. Each knowledge based test consists of 16-20 multiple choice questions related to 4-6 cases. The change in score between the pre-test and post-test is compared between the observation rotations and the dictation rotations. Survey and test result significance is determined using a paired, two tailed T-test.

Results:
Ten rotators were examined in the quality improvement trial period with 7 students and 3 physician rotators. These rotators generated a total of 10 survey pairs and 25 separate pre-and-post test pairs. The average student age was 26.7 years with 71% male and 29% female. The average physician rotator age was 28.3, with 66.7% male and 33.3% female. Average student engagement Likert rating was 3.9 out of 5 for observation and 4.5 out of 5 for dictation (P-value of 0.04). Average pooled student and physician rotator engagement Likert rating was 3.9 out of 5 for observation and 4.5 out of 5 for dictation (P-value of 0.02). Average student rotation score improvement was 3.6 points out of 100 for observation rotations and 11.3 points out of 100 for dictation rotations. (P-value of 0.28).

Conclusion:
This ambitious project integrates student rotators into the daily radiology workflow to bring their experience in line with other medical clerkships. Even with a small initial cohort of students examined over the course of one month, there is a statistically significant improvement in engagement when rotators are welcomed as participating members of the radiology team. Early objective test results are promising, but more data is needed to achieve significance. An additional benefit of this program is the ability for residents to gain experience "staffing" more junior members of the team by reviewing medical student dictations. Because each case is signed out to a resident, the final report is also quality controlled prior to being sent to a staff radiologist.