1. 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

3. 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

4. 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; 29:856-858

5. 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; 29:856-858

6. 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; 30:1018-1023

7. 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; 30:1018-1023

8. Problems of undergraduate curriculum  Overcrowded / overloaded  Serious problem with information overload Ell (editorial). Eur J Nucl Med 1997;24:1081-1082

9. Problems of undergraduate curriculum  Overcrowded / overloaded  Serious problem with information overload  What is important to be included? Ell (editorial). Eur J Nucl Med 1997;24:1081-1082

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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

18. 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

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

20. 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

21. 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