In the ever-evolving field of radiology, the integration of Artificial Intelligence (AI) is no longer a distant future concept but a present reality. As technology continues to advance, it's pivotal that AI becomes an integral part of radiology education. In this article, we’ll explore what radiologists' residents think about integrating AI in radiology education, the benefits it can have and the challenges this integration can possess.
In radiology education, trainees need to acquire skills such as analyzing and extracting imaging features, identifying patterns, selecting the most probable diagnosis, and correlating imaging features with clinical findings.
According to a study published in The British Journal of Radiology in 2019, to gain and apply these skills, trainees need to integrate knowledge from diverse sources. Currently, radiology training follows an apprenticeship model, which relies on the trainee's relationship with staff radiologists and the limited time available to review preliminary reports.
As a result, the quality of knowledge and skill acquisition can vary between trainees, as it depends on the number and diversity of cases encountered, which vary from one practice to another. Furthermore, the traditional apprenticeship model is facing challenges due to increasing workload demands on both attending physicians and trainees. Therefore, it can be improved by exploring the relationship between humans and tools in radiology education.
The integration of artificial intelligence into radiology education is a rapidly growing field. AI has the potential to revolutionize the way radiologists are trained, allowing them to learn more quickly and accurately.
With AI, radiologists can gain a deeper understanding of medical imaging and its applications in diagnosing and treating diseases. However, artificial intelligence applications in medical education have been relatively unexplored, unlike AI's potential to improve precision medicine.
What Radiology Residents Think of AI
According to a survey published in Academic Radiology in 2023, radiology residents prefer the inclusion of AI/machine-learning education in their curriculum. The authors noted that the level and depth of such education should be customized to enable the residents and radiologists to handle AI applications effectively in practice.
From the same survey:
- 83% of the respondents agreed that AI/machine learning education should be a part of the radiology residency curriculum.
- 82% of the respondents agreed that education should equip them with the knowledge to troubleshoot an AI tool in practice and determine if it's working as intended.
- 76% of the respondents preferred a continuous course on AI/machine learning throughout their radiology residency.
- 32% of the respondents preferred the AI/machine learning education provided as a mini fellowship during the fourth year of residency.
- 21% of the respondents wished to have AI/machine learning education as a course during their first postgraduate year.
Additionally, the most common resources used in the residency programs that provide AI/ML education are:
- Lecture series (43%)
- National informatics courses (28%)
- In-house/institutional courses (26%)
However, approximately 24% of residents reported that their residency program didn't offer any AI/ML educational courses.
In the same study, the authors reported that respondents considered that the most beneficial or effective resources for AI/ML education are hands-on AI/ML laboratory (67%) and lecture series (61%).
Benefits of AI in Radiology Education
An article published in Medicine in 2023 proposed that artificial intelligence can fill the gaps in the current model of apprenticeship learning in medical education, and that AI's widespread use in radiological practice can empower radiological education.
The authors explained that AI can gather and analyze large amounts of data on trainees' education, performance, and progress during their training, and intelligently tailor instruction to each trainee's individual learning style and needs. As a result, this model can enable more precise and efficient education in radiology, which can benefit both trainees and patients.
Incorporating this algorithm into radiological education is being explored as a way to foster excitement in the learning process and enhance efficiency. Gaming techniques have been incorporated into radiology programs, with rewards given through online platforms for activities such as milestone exams and completing online modules.
Radiologists produce radiological reports to communicate potential disease diagnosis to the referring physician and patient. In diagnostic radiology residency, residents learn to write these reports for various clinical cases. By using AI as an "intelligent tutor", resident competency profiles can be tracked, and challenging topics can be reinforced.
AI can assign cases to residents and guide them through relevant reports and literature to improve their knowledge on the topic. This live teaching file cataloging can help build a substantial case database and improve the diversity of cases experienced by residents. Feedback systems are also provided to allow residents to review cases they missed or misunderstood, and AI can analyze their performance to provide personalized feedback. This helps residents accumulate expertise, and automated case log and volume analytics feedback can reduce the necessity for manual recording.
Challenges of Implementing AI in Radiology Education
Radiology education encounters specific challenges, such as the absence of high-fidelity simulation training, which prevents trainees from experiencing real-life situations. However, some challenges are shared across medicine, like the need for evolving apprenticeships. According to the study published in The British Journal of Radiology, these are some of the difficulties in integrating AI into radiology training.
Automated Measurement and Case Flow Assignment
In radiology education, incorporating artificial intelligence can help trainees gain experience with a diverse variety of cases. AI can automate lesion segmentation and measurements, improving study interpretation efficiency and leading to more educational cases. This system can also be used to allocate and assign cases for trainees and staff radiologists, creating a more efficient distribution of resources and education.
Assigning specific "must-see" cases based on rotations can help minimize inconsistency in individual trainee experiences and give them time to review critical resources.
Case-Based Learning (Bottom-Up Approach)
Interactive and problem/case-based learning is a "bottom-up approach" to radiology education, in which students interpret cases themselves. AI can complement existing bottom-up platforms to teach radiology, and case-based learning should be implemented as it is more effective than traditional top-down approaches.
Attendings may select bottom-up cases based on rarity, diagnosis differentiation difficulty or lines of evidence integration for trainee learning. Eventually, the algorithm may choose rare cases as it detects rare radiologic or clinical features. AI-based personal tutors can track performance, assess trainees' knowledge, and evaluate their progress.
This approach encourages both individualization of trainee learning and standardization of radiology training and education. Case-based, standardized curricula guided by program directors can lead to more thorough, equitable radiology training and education.
Artificial intelligence algorithms can teach cognitive processes related to diagnostic decisions in radiology education, allowing trainees to learn radiological decision-making. Some AI tools use "decision-trees" to search for the best combination of points that yield the highest accuracy, while others can highlight key anatomical regions that AI uses to make a diagnosis.
Trainees can learn how to make clinical decisions by cross-referencing salient case features with records and teaching files. Educators can analyze trainee decisions and either reinforce or discourage such decisions in the future. By streamlining workflow with automated quantification, AI can reduce time-to-diagnosis and increase the number of cases studied, improving quick decision-making.
High and Low-Level Supervision
To support human-machine interactions and enrich learning experiences, AI can be used for low-level education in radiology while staff physicians provide high-level supervision. Intelligent algorithms can be customized to personalize low-level learning experiences for trainees by directing them to example case reports with similar features, relevant literature, and quantitative measures.
This enables intelligent triangulation and the creation of trainee competency profiles. Trainees will still have face-to-face interactions with attending/staff physicians but may focus on synthesizing and refining information while AI can help address errors in reasoning. Potential metrics of performance are discussed later in the article.
The use of artificial intelligence techniques can also promote interactive flipped learning for personalized education. Many medical schools have implemented flipped classrooms where lessons are introduced at home and ideas are synthesized and applied in place of lecture during class-time; workstations and reading rooms can become flipped, “precision learning classrooms.”
AI supplements unsupervised learning during personal time, while human educators can focus on correcting errors made in unsupervised learning and tailoring training methods and lesson content based on their students’ strengths and weaknesses.
High-Fidelity Simulating Training
In terms of High-fidelity simulation (HFS), there is a lack of HFS compared to other medical fields due to several barriers, such as lack of faculty time and training, cost of equipment and lack of support-staff. AI clinical learning tools are being developed to potentially improve clinical management, but their validation is essential before their clinical adoption.
An AI-integrated platform can help trainees simulate mini-call conditions, extract information from patient charts, and increase autonomy under faculty supervision. The use of artificial intelligence networks and supervisors can provide real-time feedback and situational learning tailored to unique events to promote a better learning environment that balances standardized and individualized learning.
The integration of artificial intelligence in medical and radiology education presents a new era that has the potential to revolutionize the medical field. The use of AI in radiology education can provide a precise and personalized learning environment where teaching is tailored to individual trainees based on their learning styles and needs.
Nonetheless, to achieve this goal, there is a need to incorporate novel AI knowledge and skills into the training of radiologists, beginning in the university phase, strengthening during the residency stage, and maintaining in the continuing education stage after graduation.
As AI technology continues to evolve and improve, the incorporation of AI in medical and radiology education is essential to ensuring that trainees have the necessary skills to provide high-quality patient care in the future.