jamorosa@univrad.com

This study was conducted to see if on-call experiences provide educational value to medical students in an elective radiology clerkship. Traditionally on-call experiences have been a part of clerkships such as medicine, surgery, ob-gyn, and emergency medicine but are uncommon in radiology despite radiology's role around-the-clock in patient management. We wanted to evaluate the clinical activities students can participate in after usual work hours and assess whether students would be receptive toward an extra time component in an elective clerkship. Ultimately, we wanted medical students, the future physicians, to see the critical importance of radiology in patient management especially after hours.

Medical students were required to take call on two evenings for 2 hours from 5-7 pm as part of the four week diagnostic radiology clerkship. This was a requirement for the course and was 15% of the final grade. Goals and objectives included: observe and help resident with patient information, make phone calls to ED or clinical staff, go to the ED to meet the patient and inquire about clinical presentation, and review images with resident and attending radiologists. The students had a 'passport' with cases they saw (anonymized) which the resident signs and they hand in at the end of the rotation. The medical students were asked to evaluate the usefulness of on-call and their interaction with the resident. They listed their activities, perception of after hours, and provided reasons for and against this on call experience. The evaluations were anonymous. The data was gathered and analyzed.

129 medical students participated in the study. 89 students submitted one evaluation reflecting on their two call experiences. 40 students submitted two evaluations, one per each call experience. The activities the students were involved in during call included: 18.93% of evaluators saw patients (n =32). 15.38% of evaluators called the primary care physician (n=26). 72.78% of evaluators looked up references (n=123). 15.98% of evaluators accompanied the patient for exam or procedure (n=27). 42.60% of evaluators engaged in other activities (n=72). These other activities included: interpreting imaging, reviewing patient's past medical history and past imaging, generating differential, viewing the resident read, reviewing cases with the resident, identifying anatomy, being part of consulting with primary, discussing patient plan, and overview of imaging modalities. Of the evaluators that selected other, 14.20% interpreted images (n=24), 11.83% reviewed patient's past medical history and past imaging (n=20), 2.37% generated differentials (n=4), 31.43% viewed resident reading (n=11), 16.57% reviewed the case with the resident (n=28), 4.14% identified anatomy (n=7), 1.78 % participated in consulting with primary team (n=3), 1.18% discussed patient plan (n=2), and 1.18% learned overview of imaging modalities (n=2). Approximately 6.0% of evaluations rated the call as not useful, 49.7% said the call experience was somewhat useful, and 44.3% rated the call experience as very useful. Regarding their interaction with the resident, 0% of student evaluators were very unsatisfied, 1.2% of evaluators were unsatisified, 1.8% of evaluators were undecided, 28.0% of evulators were satisfied, and 69.5% of evaluators were very satisfied.

After hours on-call experience for medical students has been successfully introduced into a Radiology clerkship with satisfactory evaluations. Given the results of this preliminary study, implementing an on-call component in radiology clerkships may be useful for medical students. Our study indicates that medical students had a satisfactory experience with this newly initiated on-call requirement to the radiology clerkship. These results may encourage other radiology programs to incorporate a similar on-call learning experience into their curriculum. Given the results of this study, implementing an on-call component in radiology clerkships may be beneficial to medical student's education. Future studies should seek to gather more information regarding long term evaluation of the on-call experience, types of experiences students have while on call, and the impact on a resident's teaching skills and attitudes. Team learning and the dynamics of being a part of the radiology team may also be explored in future studies. The on-call experience enhances medical education by increasing learning opportunities. It likely conveys to students the integral role radiology plays in patient management around the clock. The experience discredits the long-held impression that radiologists work hours are only from 9 to 5 and provides a first-hand view of what the role of a radiologist entails.