Getting the interest of students in the specialty: Promoting NM in the undergraduate curriculum and clinical rotations Annare Ellmann Nuclear Medicine Stellenbosch University and Tygerberg Hospital

Introduction  NM teaching and training  Traditionally postgraduate  Linked to / separate from Radiology  Why undergraduate teaching in NM  Students of today are clinical colleagues of tomorrow  Create awareness of NM

Questions about cost  Most training institutions under stringent financial control  Cost must be weighed in terms of marginal and opportunity cost * * Smith et al. Invest Radiol 1994; 29:

Questions about cost  Most training institutions under stringent financial control  Cost must be weighed in terms of marginal and opportunity cost * long term investment  How will doctors be able to refer if they know nothing about the specialty? = long term investment * Smith et al. Invest Radiol 1994; 29:

Undergraduate teaching: International perspectives  Information through questionnaires and university web pages (181 colleagues, 162 departments)  Report included 86 departments (77 from Europe)  Results: Average length of NM curriculum  Independent course: 25.4 hrs  Integrated into Radiology / Radiation Oncology: 15.5 hrs  Integrated into clinical modules: 8.1 hrs Lass et al. Eur J Nucl Med Mol Imaging 2003; 30:

Undergraduate teaching: International perspectives Variations in:  Length of NM curriculum  0 – 62 hrs  Form of NM teaching  Integrated into other modules  Independent  Optional Lass et al. Eur J Nuc Med Mol Imaging 2003; 30:

Problems of undergraduate curriculum  Overcrowded / overloaded  Serious problem with information overload Ell (editorial). Eur J Nucl Med 1997;24:

Problems of undergraduate curriculum  Overcrowded / overloaded  Serious problem with information overload  What is important to be included? Ell (editorial). Eur J Nucl Med 1997;24:

NM teaching in South Africa  Postgraduate specialist qualification  MMed or FCNP  Four year study period  MSc in Medical Sciences (Nuc Med)  Two year study period  Includes research component  Also for scientists / radiopharmacists  Not offered by all universities

Status of undergraduate NM teaching and training at Stellenbosch University Lectures during theoretical blocks8 hrs Middle Clinical Rotations8 hrs Rotating through NM in elective block2-4 wks

Status of undergraduate NM teaching and training at Stellenbosch University Lectures during theoretical blocks  Cardiovascular  Respiratory  Endocrine (thyroid and other)  Genito-urinary  Neurology  Orthopedics  Infection and inflammation

Status of undergraduate NM teaching and training at Stellenbosch University Middle Clinical Rotations  Small group rotations (±20 students)  During 4 th and first 6 months of 5 th year of study  Include internal med, surgery, pediatrics, family medicine, pathology, etc.  Length of rotations vary  Radiation and Imaging: one week, ±5 students  Radiology, Radiation Oncology: 2 days each  Nuclear Medicine: 1 day

Status of undergraduate NM teaching and training at Stellenbosch University Nuclear Medicine Rotation  Attend:  Thyroid scanning and clinic, including administration of RAI for hyperthyroidism  Stress study and reporting myocardial perfusion imaging  General NM, e.g. skeletal scintigraphy  Case discussion session  Evaluation: Pre- and post-test

Status of undergraduate NM teaching and training at Stellenbosch University Evaluation: Pre- and post-test  Pre-test questions covering  Radiation physics taught in first year  Physiology and pathophysiology relevant to NM  Knowledge acquired in lectures during theoretical rotations  Post-test  Testing knowledge acquired during day rotation in NM

Status of undergraduate NM teaching and training at Stellenbosch University Radiation and Imaging consider to add  Case studies to integrate role of different modalities in evaluation of patient  Students need to “follow” patient to various areas, discuss potential imaging option with relevant staff  Write report on the management of the patient  E.g. patient presenting with PUO, student should consider role of NM infection imaging, CT/MR, etc.

Status of undergraduate NM teaching and training at Stellenbosch University Elective module  One month in either 4 th or 5 th year  Student can choose activity  Some have chosen NM  Programme worked out according to student’s interests  Emphasis on pathophysiology  Will include thyroid module

Student feedback  Generally positive  Odd negative remarks  Too much packed into too short time  Too much testing  Need more time in Radiology – take from NM

Status in remainder of South Africa  Large variation in what is offered on undergraduate level  Some institutions virtually nothing, others extensive exposure

Perceptions from private NM specialists  Greater awareness of what NM has to offer amongst US students  Less difficult to market services in drainage areas of US graduates  Referring physicians trained at US refer more readily to NM

Conclusions  Need to create awareness of NM services at undergraduate level  Should be discussed on international level  International guidelines will assist local NM departments to negotiate with authorities / curriculum developers to include NM in undergraduate curriculum