The education of clinicians is based in both traditions and aspirations for collecting and applying knowledge in ways that are better than ever before. Gunderman has presented the idea (Gunderman ...2006) that “the quality of medical education hinges on the quality of leadership in academic medical centers,” with success dependent upon the ability to promote and encourage dialogue that inspires innovation and the consideration of an organization and its actions. Like many fields in the twenty-first century, advances and changes in imaging research, technology, and our ability to collaborate globally, have and continue to profoundly transform Radiology and Nuclear Medicine. Therefore, innovation in the education of tomorrow's experts in this department is both compelling and necessary. Recognizing the symptoms of declining scholarly health among medical institutions worldwide, the Department of Medical Imaging (DMI) at the Schulich School of Medicine and Dentistry, the University of Western Ontario sought “professional help.” In 2006, a Centre for Education was established to optimize the role and function of educational scholarship in the DMI through curriculum design and development, support for faculty in the “art of teaching” and the establishment of a program to foster scholarship in teaching. The ideas presented in our work draw upon a clinical metaphor, where the DMI is the “patient” and is given a professional examination. This case study documents the process undertaken by one physician-educationalist and two “Education Doctors” as they assessed the DMI's “clinical condition,” arrived at a differential diagnosis, offered recommendations for “treatment” and explain their prognosis in this work.
Imagine a scenario where a surgeon, oncologist, and radiologist at a research hospital work together to treat a cancer patient suffering from esophageal adenocarcinoma. After treatments of ...cisplatinum and fluorouracil administered by the oncologist, a round of teletherapy treatments from the radiologist, and a successful esophajectomy performed by the surgeon, the patient develops cauda equina syndrome (CES) weeks after the surgery which causes severely decreased mobility in his legs. The radiologist is perplexed by this and is interested in whether the megavoltage teletherapy treatments administered to the patient may have caused the CES. So, she sits down at her computer to do some research. She queries PubMed, MedNet, Dynamic MepPix, DynaMed, and MedlinePlus only to find a vast amount of disparate data from a variety of different sources. Not only is it difficult to find a set of relevant and precise terms, but she also has great difficulty discerning the connections between various seemingly related results. Further, regarding what little she does find, she must go to the journal’s Web sites, or to her university’s medical library, in order to piece together this disparate information for herself. She continues with a general Web search: there is something that looks vaguely relevant from a laboratory in Germany, but the researchers in that laboratory have not annotated any of their information for the benefit of other researchers on the Web; a laboratory in the Netherlands is composed of researchers with impressive publications in journals such as Radiology, Science, and Nature, but they deliberately choose not to make their results available on the Web, as they are vying for million-dollar research grants; still another laboratory in Columbia has what appear to be relevant conclusions that are available to anyone on the Web, but the researchers there have annotated their information in such a way that only other members of the laboratory can decipher it. Owing to this informational quagmire, the radiologist gives up her research and moves on to other projects. The surgeon and oncologist encounter the same sea of confusion in their own searches, and move on to other projects as well. Although the cancer patient is treated for CES, no reliably certain cause of the syndrome is discovered and, in addition to the complications due to his esophajectomy — such as gastric dumping syndrome — the patient’s right leg atrophies, becomes gangrenous, and must be amputated.
Over the past decade and a half, the CanMEDS initiative has become the Royal College of Physicians and Surgeons of Canada’s flagship standards document in Canada. Described fundamentally as an ...initiative focused on improving patient care, the framework evolved through ongoing collaboration with hundreds of Royal College Fellows, family physician educators, educationalists, and other contributors (Frank 2005). In 2001, a diagram of CanMEDS was created to capture both the elements and the interconnectivity among the elements (see Fig. 1).
