Forget films, radiology goes digital at Harvard

Dr. Kitt Shaffer

Like many people, medical students get expectations about medicine from watching movies and TV shows about doctors. Take the x-ray: in a typical depiction of a hospital, a doctor affixes an x-ray film to a light box, peers at it for a moment, and knowingly points to the problem.

This fall, first-year students at Harvard Medical School may be a little disappointed to find this icon of the clinic, the x-ray film, absent from the radiology used in their course the Human Body. Instead, students will be looking at images in the same format that many hospitals are adopting—on a computer screen.

The course will now feature digital images and web-based technology rather than films. This technology trade off is largely due to the efforts of Harvard Macy alumna Dr. Kitt Shaffer. For Shaffer, an associate professor of radiology at HMS and assistant chief of radiology at the Dana Farber Cancer Institute, digital technology is more than just a way to look at images: it offers a chance to improve the educational experience of students.

A dynamic curriculum
Enrolling in a Harvard Macy course for physician-educators in 1999 helped Shaffer connect with people involved in similar projects and begin the process of finding financial support for her ideas. Encouraged to conduct a more systematic study of what other people were doing in the same area, Shaffer later developed two surveys to determine the current teaching methods and use of digital imaging in medical student teaching of radiology. The results of one of these, published in Academic Radiology in 2000, found that relatively few programs were using digital technology, sticking to the old approaches even as clinical practice in hospitals moves toward digital imaging.

The development of MyCourses, a web portal for medical students at Harvard with access to course materials and other resources, gave Shaffer a vehicle for using more online content in her radiology clerkship for third-year students. But she was also interested in bringing digital images to the classroom and creating new content that took full advantage of the digital format.

Digital images themselves are not an entirely new addition to the first-year curriculum, but the ones used in the past have simply been digital pictures of old films, with a little bit of accompanying text. Shaffer says that this format is really like a standard textbook available online, and does not take full advantage of the technology. The new material she has developed will contain a new set of digital images that are interactive, annotated with mouse-overs that help students review their knowledge. And it will be an integral part of the classroom experience, rather than just supplementary materials.

In the old way of showing digital images at top, scans of radiology films are presented with explanatory text. The new course material uses digital x-rays that are interactive. Here, captions light up when students mouse over a region of the hand.

In this case, the introduction of a new medium into the classroom has helped reshape the way the course is delivered. The standard class, says Shaffer, consisted of having about ten faculty members in different rooms show films to students, who had to crowd around one view box. “Students would perceive a wide variation among the lecturers,” said Shaffer, “and so they would self-redistribute among the rooms.” With films out of the picture, this year the course will follow what Shaffer hopes will be a more successful format. A single lecture will be delivered to all the students using digital images on a screen. Then, the class will break up into small groups of four to five students to explore problem sets independently on the web. Shaffer hopes the new format will be more efficient to teach, and more engaging for the students.

Teaching for the future
The new approach will bring students up to date with the state of radiology at the Harvard-affiliated hospitals, where radiology departments have been working to free themselves of films. “Most radiologists would prefer looking at a computer screen,” Shaffer said. Digital radiology offers several advantages—it is faster and more convenient, can be transferred from place to place, and manipulated for clarity. But the hefty expense of acquiring the technology, and the logistical problems of standardizing software and formats and storing and sending large image files, have kept many departments from abandoning films completely.

If adopting digital technology is difficult for hospitals, it is even more so for course directors and educators, who have very limited resources to spend on a curriculum. Shaffer and her colleagues have had to look for creative funding sources and put in a good deal of spare time to bring the new course materials to fruition.

Though one might expect students to be the most enthusiastic adopters of a new technology, Shaffer said they often seem more reluctant than practicing radiologists to go digital. “They’ve all seen on ER people throwing films up on a light box,” she said, and these expectations are hard to give up. With an eye to the future, however, “it’s better for students to get used to digital images right from the beginning.”