Representation in Action: Early Radiology Exposure for Low Socio-Economic Status High School Students

Under-representation is pervasive in many fields, including radiology. ¹ In 2023, the Canadian Association of Radiologists (CAR) equity, diversity, and inclusion (EDI) working group published recommendations to improve EDI. ¹ Recommendations emphasize increasing the early exposure to radiology for underrepresented minorities (URM). ¹ Strategies proposed include exposure to radiology as early as kindergarten, shadowing opportunities for URM students and close mentorship of URM medical students. ¹ Recent work has further highlighted the importance of tailoring outreach to specific communities, particularly Indigenous youth, to address long-standing under-representation in medicine and radiology. ² In Canada, the most critical moments of career self-discovery happen in high school, where youth must make complex career decisions. A 2021 systematic review suggested that interventions should emphasize the perceived attainability of success to encourage youth to pursue STEM fields. ³ In other words, the old saying “you can’t be what you can’t see” rings true for URM youth, highlighting that early exposure may help bolster intrinsic motivation by shifting this perception.

One of the challenges in radiology is how to make the complex field level-appropriate and engaging for high schoolers. Another challenge is how to target URM youth specifically in high schools. Since 2020, Academic Immersion in Healthcare, a student-led initiative supported by McGill University’s Faculty of Medicine to inspire low socio-economic status (SES) high school students aged 13 to 17 to explore careers in healthcare, has worked to address these challenges. ⁴ Thus far, the program has served over 601 high schoolers, with the help of 146 volunteer medical student mentors. The program has 2 components: in-person workshops and a longitudinal online-mentorship program with a fixed curriculum. Our workshop component has been the most successful, with demand exceeding capacity. The workshop focuses on teaching level-appropriate point-of-care ultrasound (POCUS), suturing, and physical examination skills such as auscultation and reflexes. The radiology component is always the most loved by students. Table 1 provides an overview of our program along with a checklist to support radiologists in responding to similar needs in their communities. Scaling such initiatives nationally could make radiology more visible and attainable, fostering a more diverse and equitable workforce.

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Table 1.

Checklist for Radiologists Supporting URM High School Engagement.

Domain	Action item	Recommendations
Program development	• Partner with local URM-serving high schools by connecting with their guidance counsellors.	Use local postal code data to identify low-SES areas, and contact schools via email, followed by reception desk phone calls.
	• Recruit faculty/trainee volunteers.	We recruit URM volunteers with POCUS experience to act as workshop leads (2-4 individuals).
	• Secure institutional support.	Institutional support allows for better sustainability and continuity.
	• Identify portable ultrasound machines that can be used.	One tablet-based ultrasound was shared per ~30 students, projected for the class, with consenting volunteer workshop leads available for practice.
	• Prepare consent forms for parents to sign so the high school students can participate.*	Parental consent is required before workshops, and students may not image one another.
	• With the school, identify science teachers who can welcome a workshop in their classes.	Ask about students’ biology/anatomy and physics knowledge, plan early, and confirm AV equipment, class layout, and time.
Curriculum planning	• Plan a curriculum based on the students’ knowledge level. †	Explain basic ultrasound physics (including hyperechoic, hypoechoic, and anechoic) with simple knowledge checks, introduce key anatomy views (heart, kidney, lung, bladder), and connect common conditions to future careers.
Workshop delivery	• Start with ice-breakers. Provide an introduction of the workshop leads. We explain the different fields of medicine and radiology.	Share background stories of the workshop leads and allow time for questions.
	• Explain basic level-appropriate principles of ultrasound.	We explain the physics behind the ultrasound probe using the curriculum plan with the help of a slide deck and examples.
	• Demonstrate basic POCUS views on team volunteers and relate them to common health concerns.	We start with the cardiac view, which piques curiosity about a live beating heart.
	• Allow students to test ultrasound views.	Students, one by one, can do POCUS on our volunteer leads.
	• Connect students to pre-existing STEM pipeline programs.	Provide referrals to pre-existing programs available in your community.
Evaluation	• Connect with the high school staff to gather feedback and ways to improve.	Adapt the program based on feedback, and advocate scaling it to other schools.

Note. URM = underrepresented minority; POCUS = point-of-care ultrasound.

*

A draft of the consent form can be provided upon request by contacting aih.healthcare@mcgill.ca.

†

Our PowerPoint presentations can be shared by contacting aih.healthcare@mcgill.ca.