Self directed online learning during a Radiology Rotation Improves Medical Students' Diagnostic Accuracy for "Must-See" Pathology: A Pre-Post Assessment

Purpose: While medical schools aim to enhance radiology competency prior to graduation, the approaches used vary widely. Prior work has demonstrated substantial gains in diagnostic performance using didactic-rich, competency-based radiology clerkships. However, the effectiveness of low-infrastructure, self-directed models remains unclear. This study evaluates the efficacy of a four-week radiology rotation which relies on online self-guided resources and reading room shadowing to improve fourth-year medical students’ diagnostic accuracy for AMSER “Must See” pathology.

Methods/Materials: Forty-four fourth-year medical students completed a 26-question, multiple-choice examination featuring common radiographic findings aligned with the AMSER “Must See” manual before, and after a four-week radiology rotation. During the rotation, students used an online self-guided radiology resource alongside routine clinical shadowing. Pre-post performance differences were analyzed by category and individual diagnosis.

Results: Overall diagnostic accuracy improved from 68.95% (pre) to 80.30% (post), an 11.3% point increase (95% CI, 7.7-14.6; p< 0.001). Notable improvements: intra-articular fracture (34% to 68%), pneumomediastinum (39% to 64%), ascites (43% to 70%), aortic rupture (45% to 66%). High-baseline cases (pneumothorax, dissection, hydrocephalus) showed ceiling effects, proving this model targets knowledge gaps.

Conclusions: Even in the absence of structured didactic teaching, a self-directed online curriculum combined with a four-week shadowing-based radiology rotation significantly enhanced fourth-year medical students’ diagnostic proficiency for AMSER “Must See” pathology. Thus, a low-infrastructure online learning approach is relevant for training programs with limited instructional resources or radiology faculty; supporting scalable, resource-light radiology education.