International Journal of Advanced Engineering, Management and

Science (IJAEMS)
Peer-Reviewed Journal
ISSN: 2454-1311 | Vol-9, Issue-1; Jan, 2023
Journal Home Page: https://ijaems.com/
Article DOI: https://dx.doi.org/10.22161/ijaems.91.3

Radiology and Imaging Diagnosis in Undergraduate

Medicine in a Curriculum using Active Methodologies: A
Systematic Review from 2011 to 2021
Vera Lúcia Lameira Picanço¹, Guilherme Alves Da Silva², Tainá Marques De Sousa
Ferreira², Juliana Saraiva Gomes² , Rita De Cássia Barroso Tavares², Marcos Alberto
Figarella De Oliveira², Brenda Michelly Da Silva Carvalho², Maria Tereza Dias Ferreira²,
Giovana Duarte Pereira², Hanna Kainã Rocha Souza Adão², Gabriel Carvalho De
Oliveira², Samuel João Dos Santos Santana², Ingrid De Paula Costa Pereira², Jaíne
Cardoso Da Silva², Maria Jéssica Alves Pinheiro², Heloisa Pamplona Boulhosa²,
Adrianne Raposo Ponte², Camylla Rebbeca Bezerra De Aragão², Edilson Pamplona
Boulhosa² , Bruno Henrique Da Silva³, Enzo Lobato Da Silva², Matheus Albert De Souza
Puerro², Carolina Donadio De Oliveira², Luíza Pinheiro Nascimento², Fernanda
Cafezakis Coelho Amoedo², .Victor Viana Alves², Yorhanna de Morais Cardoso², Ana
Laura Nobre e Nobre², Lucian Herlan da Costa luz Fernandes²

1 Docente\orientadora do curso de Medicina UNIFAMAZ, BELÉM

2Discentes do curso de Medicina UNIFAMAZ, BELÉM-PA

³Discente do Curso de Medicina, FMO, OLINDA-PE

Received: 07 Dec 2022; Received in revised form: 03 Jan 2023; Accepted: 10 Jan 2023; Available online: 18 Jan 2023

Abstract— Radiology is a medical specialty that renews itself and advances every day, in a process of
modernization that, in addition to investments, requires a continuous effort to update. The use of
radiological images is a fundamental part of learning because of its availability and undeniable clinical
relevance. Thus this study will make it possible to review how the teaching and learning of radiology and
diagnostic imaging in medical education is developed in an integrated and interdisciplinary undergraduate
curriculum in medicine. Objective: To identify the importance of radiology and diagnostic imaging in
undergraduate medical education in a curriculum using active methodologies. Methodology: The present
study is a systematic literature review, therefore it does not require ethics committee approval, it was
carried out from a screening of articles in the period from January 2011 to March 2021 from two
electronic databases: PubMed and Science Direct. The descriptors used in the search were "radiology"
AND "medical education". Academic articles were searched for authors who correlated Active
Methodologies, Medical Education, Transversal Teaching in Medical Graduation, Radiology and
Diagnosis. Results and Discussion: Studies that had Active Methodologies, Medical Education or
Radiology and diagnosis were included in this review, as well as literature review studies that accounted
for 05 articles and editorials. To better understand the role of radiology in medical practice, it is necessary
to review its history in medicine. Since the advent of imaging exams, radiology and diagnostic imaging
have presented important advances in several areas. Its implementation in the curriculum was addressed
by the author AL QAHTANI et al, 2014, in which he pointed out the importance of a cross-curriculum for
the insertion of the axis of this skill and not only a discipline in a single period of the course, because the

This article can be downloaded from here: www.ijaems.com 21

©2023 The Author(s). Published by Infogain Publication.
This work is licensed under a Creative Commons Attribution 4.0 License. http://creativecommons.org/licenses/by/4.0/
Picanço et al. International Journal of Advanced Engineering, Management and Science, 9(1) -2023

content is related to other areas of Medicine, such as Medical Pathology, Human Anatomy and Emergency
and Urgent Care.With all this mentioned, it should be understood that the teaching environment should be
seen as a place of individual and collective transformation, being receptive to new methodologies and new
approaches to teaching and insertion of new skills to the students.
Keywords— medical education, radiology and active methodologies.

I. INTRODUCTION II. OBJECTIVE

Radiology is a medical specialty that renews itself and 2.1 Objective General: Identify the importance of
advances every day, in a process of modernization that, in radiology and diagnostic imaging in undergraduate
addition to investments, requires a continuous effort to medical education in a curriculum using active
update. Intrinsically linked to technological development, methodologies. 2.2 Specific Objective: To
diagnostic imaging methods allow the physician to obtain understand the role of radiology in the current practice of
information even imagined less than ten years ago, with a medicine and reflect on the teaching of radiology in
speed and efficiency that enhance medicine as a whole undergraduate medical courses, based on the available
(SCATIGNO NETO,2019). The use of radiological literature; Identify the teaching of radiology and applied
images is a fundamental part of learning because of its diagnostics across the board in medical school.
availability and undeniable clinical relevance. Some
studies indicate that the "early" insertion of this skill
enriches the understanding of pathophysiological III. METHODOLOGY
processes as well as anatomy. This is due to rapid 3.1 TYPE OF STUDY.
technological advances, the availability and use of
The present study is a systematic literature review,
alternative resources for teaching anatomy and correlation
therefore it does not require ethics committee approval, it
with the clinic (KALAMI TR et al. , 2016). It plays an
was conducted from a screening of articles in the period
important role in modern medicine as imaging
January 2011 to March 2021 from two electronic
technologies have revolutionized the clinical practice of
databases: PubMed and Science Direct. The descriptors
medicine in Brazil and worldwide, (CORR P. 2012), but
used in the search were "radiology" AND "medical
many of the students are not properly introduced/prepared
education". Academic articles were searched for authors
for the discipline during the first years of college or are
who correlated Active Methodologies, Medical
introduced to the discipline in a non-adversarial
Education, Cross-cutting Teaching in undergraduate
manner.(BRANSTETTER BF et al., 2017).Radiology and
medical education, Radiology, and diagnosis.
diagnostic imaging represents relevant knowledge in
medical education, helping in clinical diagnosis. Since 3.2 INCLUSION AND EXCLUSION CRITERIA
this is a new study, the research is faced with the lack of Inclusion criteria were: 1) studies with medical students
current literature that demonstrates its or directed to medical students, 2) studies with medical
importance.However, many students are not properly residents, and 3) studies that evaluate the use of
introduced/prepared for this competency during the first technological development in teaching human anatomy.
years of college (BRANSTETTER BF et al., 2017). Excluded were: 1) studies with animals, 2) studies with
Concomitantly, in most medical schools in Brazil, the set students from other health courses, and 3) studies
of operational and interpretative skills in radiology and involving the surgical field or surgical technique.
diagnostic imaging is not mandatory, despite the
3.3 DATA ANALYSIS
recognition of its importance.(SILVA et al. , 2019, p.97).
Medical undergraduate courses should provide theoretical The data were analyzed by means of analytical reading,
and practical knowledge of radiological examinations ordering the information collected as specified in the
directed to different clinical settings (AL QAHTANI et al, result item, seeking to obtain the answer to the research
2014). Thus, this study will make it possible to review objective.
how the teaching and learning of radiology and diagnostic
imaging are developed in medical education, in an IV. RESULTADOS
integrated and interdisciplinary undergraduate medical
curriculum. It is presented in the flowchart in Figure 1 to generally
simplify the selection of articles performed by the
researchers. Thus, studies that had Active Methodologies,

This article can be downloaded from here: www.ijaems.com 22

©2023 The Author(s). Published by Infogain Publication.
This work is licensed under a Creative Commons Attribution 4.0 License. http://creativecommons.org/licenses/by/4.0/
Picanço et al. International Journal of Advanced Engineering, Management and Science, 9(1) -2023

Medical Education or Radiology and diagnosis were studies that accounted for 05 articles and editorials.
included in this review, as well as literature review

Chart 1 - collected and used academic articles

AUTHORS TITLE SUMMARY

Fahd Al "Integrating radiology At Al-Baha University School of Medicine, Al-Baha, Saudi

Qahta ni and Adel vertically into an Arabia, efforts have been made to integrate radiology vertically
Abdelaziz. undergraduate medical and in a structured way into the undergraduate curriculum from
school curriculum: a three- the first to the sixth year.
phase integration approach".
radiologyvertically into an
undergraduate medical
school curriculum: a three-
phase integration approach".
Alexandre Ferreira da "Medical Student Radiology in the medical course has reached a new dimension
Silva, Robson José de Perceptions of the Insertion not only as acomplementary diagnostic tool, but also for its use
Souza Domingues, Kátia of Radiology into as a teaching tool, integratedwith the study of anatomy and
SimoneKietzerJofre and Undergraduate Education pathology, among other subjects.
Jacob da Silva Freitas Using Active
Methodologies."
Pablo Antonio Maia from "Active Learning in Health This literature review describes a brief historical background of
Farias, Ana Education: HistoricalCourse education, arriving at student-centered education, as well as
Luiza de Aguiar Rocha and Applications" some of the most commonly used active learning methods
Martin, Cinthia Sampaio today.
Cristo.
Jennifer ELim- "An online radiology We describe the development of the online vertical radiology
Dunham,David C curriculum vertically curriculum and evaluate its impact on student performance and
Ensminger, John A integrated developed as the learning process using a mixed-methods approach
McNulty. cognitive learning: impact
on student performance and
learning"
Barton FBranstetter, "Medical student The purpose of this study was to determinewhether an
Laura E Faix Allen L preclinical training in integrated radiology curriculum in the first year of medical
Humphrey radiology: the effect of school changesmedical students' attitudes toward radiology or
early exposure." affects their knowledge of

From the analysis, the articles were separated into 3 V. DISCUSSION

themes as research categories, and the following 5.1 UNDERSTANDINGS OF THE IMPORTANCE
descriptors were considered: Medical education and OF THE ROLE OF RADIOLOGY AND DIAGNOSTIC
radiology and diagnostic imaging; active methodologies IMAGING IN MEDICAL EDUCATION.
and the curricular guidelines for medical education;
In order to better understand the role of radiology in the
transversality of the teaching of radiology and diagnostic
medical practice, it is necessary to review its history in
imaging in medical education.
medicine. Since the advent of imaging exams, radiology
and diagnostic imaging have represented important
advances in several areas. Thus, it is essential that there are
professionals trained to know the techniques and proper
use of these complementary exams (CHEN et al., 2006),
This article can be downloaded from here: www.ijaems.com 23
©2023 The Author(s). Published by Infogain Publication.
This work is licensed under a Creative Commons Attribution 4.0 License. http://creativecommons.org/licenses/by/4.0/
Picanço et al. International Journal of Advanced Engineering, Management and Science, 9(1) -2023

since the improper use of these tests implies damage to in the construction of knowledge, its use in the teaching of
both the patient and the health system (SILVA et al., radiology and diagnostic imaging in the medical course
2019).Consequently, preparing medical students to become can be encouraged (Dawson et al.,2017).
responsible users of medical imaging, including, to this Dawson et al. in a recent study demonstrated that the
end, the teaching of radiology and diagnostic imaging in technique of realistic simulation, a proactive action
the undergraduate medical curriculum, is an increasing performed mostly in medical residencies and continuing
target of attention (LIM-DUNHAM, 2016). Some authors, education, was effective for the acquisition of required
such as Lewis and Shaffer, make several accounts of the skills. This type of activity promotes the development and
importance of inserting the Axis of radiology and improvement of theoretical and practical skills, as well as
diagnostic imaging in the academic curriculum of the crisis management and free decision making, in a
medical course, such as: teaching skills needed to interpret significant way, from the simulation-based teaching
radiographs on an emergency basis; developing methodology.
appropriate and feasible algorithms for requesting imaging
5.3 ANALYSIS OF THE TRANSVERSAL
methods for common clinical conditions (Lewis and
TEACHING OF RADIOLOGY AND DIAGNOSTIC
Shaffer, year). In addition to understanding the concept of
IMAGING IN MEDICAL EDUCATION.
positive and negative predictive values of imaging exams
and how to incorporate them into patient management; In this sense, some doubts emerged related to the model,
understanding the risks, contraindications, and limitations the content and the ideal period to introduce the learning of
of imaging methods; following the exams so they can radiology and diagnostic imaging, showing the need for
explain them to their future patients; improving their view the elaboration of an effective means for teaching this
of the disease, physiology, and anatomy; understanding the content (SILVA et al., 2019).AL QAHTANI et al (2014),
benefits of clinicaloradiologist collaboration, from the highlights that at Al-Baha University Faculty of Medicine
correct completion of applications and familiarization with (ABUFM) in Al-Baha - Saudi Arabia - it was scored that
image-guided procedures (Lewis and Shaffer, 2017). the best time should be during the early stages of the
medical school curriculum .Alternatives to answer this
With all this mentioned, the importance of teaching
question were to address radiology within other clinical
radiology and diagnostic imaging, using active devices and
disciplines through a "when indicated" approach, allocate a
methodologies is unquestionable, and these must be well
distinct, specialized module, or integrate a related topic
applied, with theories and their applicability in practice, as
longitudinally into the curriculum during their 6 academic
advocated by Piaget's constructive ideas, giving a new
years (AL QAHTANI et al, 2014).Since a large part of
embodiment, a meaningful learning.
medical education routinely uses imaging studies,
5.2 THE USE OF ACTIVE METHODOLOGIES IN consequently, at some point during the undergraduate or
LIGHT OF THE NEW CURRICULAR GUIDELINES professional life, it will be necessary to interpret imaging
FOR THE MEDICAL COURSE exams, regardless of the area, according to some of the
The National Curriculum Guidelines (DCNs) of the studies discussed.In the new integrated and
undergraduate course in Medicine (BRASIL, 2014) defines interdisciplinary curricula with the use of active
the organization, development and evaluation of the methodologies in undergraduate medicine, the teaching of
course, within the scope of the country's higher education radiology and diagnostic imaging became part of the axis
system and guides to the promotion of integration and Attention and Health Education (AES), in the
interdisciplinarity in coherence with the curriculum morphofunctional laboratory (LMF) (UNIFAMAZ, 2017),
development axis, and the use of methodologies that favor developed in some periods, with active methodologies and
the active participation of the student in the construction of favoring the teaching method in vertically integrated
knowledge.Among the elements that make up active internships. The assimilation of content by this means
methodologies, two actors must be considered allows a lasting learning, relevant in practical and real
conceptually: the teacher, who no longer has the role of clinical work of students (LIM-DUNHAM, 2016).The
lecturer or teacher, leaving him/her with the task of evaluation of the development of competencies in
facilitating the process of knowledge acquisition; and the radiology and diagnostic imaging by the medical student in
student, who begins to receive names that refer to the an integrated and interdisciplinary curriculum, using active
dynamic context, such as student or learner.A better methodology, is of significant importance for the
teaching strategy for radiology and diagnostic imaging is formation of the medical professional.Since according to
not so well addressed in studies, but, proactive solutions of recent studies, the breakdown of disciplines and their
updating should be thought for graduation. Methodological reorganization in integrative axes, promotes the union of
strategy that requires the active participation of the student knowledge, facilitating from the physiopathological
This article can be downloaded from here: www.ijaems.com 24
©2023 The Author(s). Published by Infogain Publication.
This work is licensed under a Creative Commons Attribution 4.0 License. http://creativecommons.org/licenses/by/4.0/
Picanço et al. International Journal of Advanced Engineering, Management and Science, 9(1) -2023

understanding, clinical context, and mainly associating to [5] FARIAS, Pablo Antonio Maia de; MARTIN, Ana Luiza de
these the complementary radiological imaging exams for a Aguiar Rocha; CRISTO, Cinthia Sampaio. Active learning
broad understanding, since, previously, medical schools in health education: historical path and applications. Revista
brasileira de educação médica, v. 39, n. 1, p. 143-150, 2015.
used a compartmentalized disciplinary structure.
[6] FRANCISCO, Fabiano Celli et al. Radiology: 110 years of
history. Rev Imagem,v. 24, p. 281-6, 2005.
VI. CONCLUSION [7] LIM-DUNHAM, Jennifer E. et al. A Vertically Integrated
Online Radiology Curriculum Developed as a Cognitive
It is not new that the teaching of radiology and diagnostic Apprenticeship:: Impact on Student Performance and
imaging is going through a transformation moment, once Learning. Academic radiology, v. 23, n. 2, p. 252-261, 2016.
its importance is already recognized, as mentioned by [8] MARTINS, Leandro Ortigoza. The diagnostic medicine
some authors, and the need to develop this medical segment in Brazil. Revista da Faculdade de Ciências
knowledge is unquestionable: interpretation of radiographs Médicas de Sorocaba, v. 16, n. 3, p. 139-145, 2014.
in an emergency, when to request complementary imaging [9] KOCH, H. Augusto; RIBEIRO, E. C. Oliveira;
TONOMURA, E. Tchie. Radiologiana Formação do Médico
exams, are some examples of its great value in teaching
Geral. Rio de Janeiro: REVINTER, 1997.
and learning for medical graduation, forming general
[10] Pedagogical Project Course Course from Bachelor's
practitioners skilled in this knowledge.Its implementation Degree at Medicine - (UNIFAMAZ), 2017
in the curriculum was addressed by the author AL [11] SCATIGNO NETO, André. Radiology, the Radiologist and
QAHTANI et al, 2014, in which he pointed out the other specialties. Radiol Bras, São Paulo , v. 38, n. 2, p. III,
importance of a transversal curriculum for the insertion of Apr. 2005 . Available
the axis of this skill and not only a discipline in a single fromhttp://www.scielo.br/scielo.php?script=sci_arttext
period of the course, because the content is related to other &pid=S01 00- 39842005000200001&lng=en&nrm=iso>.
areas of Medicine, such as Medical Pathology, Human access on 18 Nov. 2019. http://dx.doi.org/10.1590/S0100-
39842005000200001
Anatomy and Emergency and Urgent Care, among
[12] SILVA, Alexandre Ferreira da et al. Perception of Medical
others.It was also observed the positive predictive value of
Students about the Insertion of Radiology in Undergraduate
the teaching of this axis, incorporating the active and Teaching Using Active Methodologies. Rev. bras. educ.
integrative teaching methodologies, as already mentioned, méd. v. 43, n. 2, p. 95-105, 2019. APA
some sites already use even realistic simulation resources [13] VALENTE, José Armando et al. The learning spiral: the
for the use of this radiological apparatus for the proper process of understanding the role of information and
learning of the student, as well as its early insertion.With communication technologies in education. 2005.
all this mentioned, it should be understood that the [14] JUNIOR, Decio Hermes Cestari et al. The concept of
teaching environment should be seen as a place of scientific discovery: Roentgen's rays as a case study. 2015
individual and collective transformation, being receptive to
new methodologies and new approaches to teaching and to
the insertion of new skills for the students.

REFERENCES
[1] AL QAHTANI, Fahd; ABDELAZIZ, Adel. Integrating
radiology vertically into an undergraduate medical education
curriculum: a triphasic integration approach. Advances in
medical education and practice, v. 5, p. 185, 2014.
[2] Brazil. Ministry of Education (MEC). National Curriculum
Guidelines 2014. [accessed2019 Oct 5]. Available
at:
http://portal.mec.gov.br/index.php?option=com_docman&vi
ew=download&ali as =15874-rces003-
14&category_slug=june-2014-pdf&Itemid=30192 Corr P.
Using e-learning movies to teach radiology to students. Med
Educ 2012; 46:1119-112
[3] BRANSTETTER IV, Barton F. et al. Preclinical medical
student training in radiology: the effect of early exposure.
American Journal of Roentgenology, v.188, n. 1, p. W9-
W14, 2007.
[4] CHEN, Michael YM; POPE, Thomas L.; OTT, David J.
Radiología básica. McGraw Hill, Interamericana, 2006.
This article can be downloaded from here: www.ijaems.com 25
©2023 The Author(s). Published by Infogain Publication.
This work is licensed under a Creative Commons Attribution 4.0 License. http://creativecommons.org/licenses/by/4.0/