Visiting Professors Teach Radiology in Well-wired Estonia

Michelle A. Michel, M.D., and Loren H. Ketai, M.D., (second and third from left) spent the better part of 11 days last fall teaching and presenting seminars in Estonia as part of the RSNA-sponsored International Visiting Professor Program. Here they pose with Estonian hosts, Mare Lintrop, M.D., (far left) and Pilvi Ilves, M.D., Ph.D., (far right) both from the Department of Radiology at the University of Tartu Hospital.

Although they were able to see the sights, sample local fare and learn a bit of the language, two members of this year's International Visiting Professor (IVP) Program devoted the majority of their fall 2009 visit to the Republic of Estonia in Northern Europe to a decidedly more important endeavor: education.

The team spent the better part of 11 days giving presentations and teaching seminars to the Estonian Society of Radiology (ESR) and the University of Tartu's (UT) radiology department whose members were more than eager to learn.

"In the Soviet era, radiology was not a highly sought area of specialization but it has become increasingly popular," said Loren H. Ketai, M.D. "There are now many well-trained radiologists in Estonia, but they work hard to maintain the clinical workload and they have little time or formal structure to support resident education. The education of all 30 Estonian radiology residents is managed by only three faculty members, so while their equipment is rapidly approaching state of the art, they just didn't have the academic infrastructure in place."

While in Estonia, Dr. Ketai, of the University of New Mexico in Albuquerque, and Michelle A. Michel, M.D., of the Medical College of Wisconsin in Milwaukee, gave presentations at UT and ESR's annual meeting in Tartu.

"We were fortunate to spend a lot of time teaching residents who are self-motivated, enthusiastic and really want to learn," Dr. Ketai said. "We stayed in Tartu, which was great, safe and fun. We were teaching every day but it was relaxing."

Improving the Quality of Care

Estonia, bordered to the north by the Gulf of Finland, to the west by the Baltic Sea, to the south by Latvia and to the east by the Russian Federation, fits perfectly into the category of "developing" country.

RSNA International Visiting Professors Michelle A. Michel, M.D., and Loren H. Ketai, M.D., and Estonian host Pilvi Ilves, M.D., Ph.D., (all center) pose with radiology residents in Estonia. Residents study at the University of Tartu Hospital and at hospitals in Tallinn.

This post-Soviet country was incorporated into the European Union (EU) in May 2004. While Estonians are a Finnic people with their own language, most speak English.

"Estonians are truly in a transition phase after joining the European Union," Dr. Michel said. "They brought their country up by the bootstraps after the Soviets left and are really working hard to improve the quality of care. It was very rewarding to assist these people in their mission.

The two major hospitals are in Tallinn, the capital city, and Tartu, which is home to the country's only medical school. "The hospital in Tallinn was built in the Soviet era and the radiology department was small, gloomy and institutional-looking, Dr. Ketai said. "Now, with an influx of EU funds, a three-story facility is being built and it's going to be great. The change is even more dramatic in Tartu where the medical school and university hospital have just recently moved from buildings built in the 19th century."

Another major goal is the creation of an academic infrastructure to support the development of radiology throughout the country, he said.

"Estonia has all of the ingredients for creating an academic radiology system, but they need help with the academic infrastructure," he said. "It would be a good place to do some clinical research that would be beneficial."

Estonia Among "Most Wired" Countries

While some areas are ripe for development, Estonia's information technology sector is surprisingly advanced, said Drs. Michel and Ketai. In fact, Estonia has been called one of the "most wired" countries in Eastern Europe.

Estonia

"The whole country is very well wired and we basically had Internet access everywhere," Dr. Michel said. "Even when we were in medieval towns we were able to get online anywhere, which was very nice."

Both doctors were also surprised that the entire country operates under one PACS. "This allows anyone to view a patient's images from any location in the country, and they use one medical record system, too," Dr. Michel said. "We could only imagine the research potential and ease of consulting with other radiologists under such a uniform system."

As for the residents, Dr. Ketai was impressed with the amount of independent study taken on by students. "They do not get many subspecialty lectures and they really work hard on their own to learn," he said.

Dr. Ketai also pointed out the "cultural shock" experienced by the Estonian radiology residents in terms of U.S. teaching methods.

"In the U.S., individual residents look at images and present cases," he said. "By nature, Estonians are more reserved and they were initially rather horrified at what we were asking them to do. It took us awhile to show them it's a valuable experience and not to be intimidated."

Drs. Michel and Ketai tried to make the residents feel more comfortable in any way possible.

"We gave didactic lectures every morning and case conferences with smaller groups in the afternoon," said Dr. Michel. "We also showed the residents many pictures of the U.S. and of our families and I think they really enjoyed that."

RSNA Relationship Could Continue

While the IVP team undoubtedly taught a lot to the Estonians, Dr. Ketai said the doctors also took back a few lessons.

"It's a place I probably never would have visited, but I'm so glad I went because it is a beautiful country and they were wonderful people," he said. "Having to teach in a completely different setting makes you reevaluate. You get in kind of a rut when teaching and you keep doing things the same way, but in this case you get to reevaluate and see what works."

Dr. Ketai added that the Estonian radiologists expressed an interest in a continuing relationship with RSNA, which he agreed would be a "worthwhile investment."

Established in 1986, the RSNA IVP annually sends teams of North American professors to lecture at national radiology society meetings and visit with radiology residency training programs at selected host institutions in developing nations. The RSNA Committee on International Radiology and Education administers the program, which is made possible by support from Agfa HealthCare and Fujifilm Medical Systems.

In addition to Estonia, 2009 IVP teams traveled to Argentina, Bolivia, South Africa and Mexico. In 2010, IVP teams will travel to the Philippines, Brazil, Thailand and Mexico. Other recent trips have included China, Nigeria, Vietnam and Mexico.