Response to “Competency-Based Medical Education in Radiology: A Survey of Medical Student Perceptions”

We read with great interest the recent study by Yang et al, ¹ the first original research evaluating medical students’ perception on competency-based medical education (CBME) in diagnostic radiology residency. We believe it is important to discuss the limitations of this study and suggest potential improvements for future research.

The questionnaire responses were based on medical students’ current understanding of CBME in diagnostic radiology without assessing their baseline knowledge. The validity of these responses may be compromised by pre-existing misconceptions about CBME. ² This is highlighted in the results whereby 58% of students who answered “disagree” or “strongly disagree” to understanding CBME, subsequently agreed in a later question that CBME was a positive change to the diagnostic radiology residency program. Further to the authors’ suggestion of a presurvey CBME tutorial, we propose an additional assessment to check students’ understanding of CBME, ensuring an adequate level of baseline knowledge.

Exposure to specialties at undergraduate studies can influence students’ decisions regarding residency application. ³ Years of medical school may not necessarily reflect the level of exposure to diagnostic radiology. It would be interesting to investigate the perception of CBME in diagnostic radiology in a cohort of medical students stratified by exposure to the specialty.

Insufficient statistical analyses were performed in this study. For the yes/no close-ended questions, an unpaired t-test could be used to investigate whether the difference in response between groups is statistically significant. ⁴ For the Likert-scale questions, a Chi-squared test can be used to compare the proportional differences between demographic groups. ⁴

Results showed that of the students uninterested in pursuing diagnostic radiology, 99% did not factor CBME in a radiology residency into their decision-making. However, authors did not report the relevant findings in students who expressed their interests (responded “interested” and “committed”). This is important as it could provide valuable insight into whether the implementation of CBME can be used to incentivise more students to apply for radiology.

We thank the authors for their enthusiasm in evaluating this important topic, and hope that our suggestions could help improve the validity of future studies.