Authors: Abdulrhman Aleisa , Osama Ayidh Alotaibi , Abdullah Abdulhalim Alruwayshid , Saad Fahad Alqumayzi , Faisal Mohammed Alaswad , Abdullah Mohammed Aldakhil , Kadi Meshal Alotaibi , Nasser Saud Alabdulsalam , Abdulrhman Khalid Al Khaldi

Abstract

Background: Radiology underpins diagnosis across clinical specialties, yet remains underrepresented in many undergraduate curricula. This study assessed knowledge of imaging appropriateness and image interpretation among medical students and interns in Riyadh, compared performance between pre-clinical and clinical training stages, and described awareness of appropriateness frameworks.

Methods: Analytical cross-sectional study conducted September 2025–January 2026 at universities in Riyadh, Saudi Arabia. A self-administered online questionnaire assessed perceptions of radiology education, awareness of appropriateness frameworks, and knowledge through six scenario-based and six image-based single-best-answer items. Participants were classified as pre-clinical (years 1–3) or clinical (year 4 to internship). Analyses used Welch's t-tests, chi-square tests, and mixed-effects regression with a random intercept for university.

Results: Of 495 responses, 493 were analysed (257 pre-clinical, 236 clinical). Clinical-stage participants scored higher on total knowledge (7.14 ± 2.48 versus 4.38 ± 2.43; mean difference 2.76, 95% CI 2.33 to 3.20; Hedges' g = 1.12; p < 0.001), with a larger difference in image-based than scenario-based items (g = 1.16 versus 0.67). This persisted after adjusting for academic achievement and institution. Awareness of appropriateness frameworks was reported by 45 participants (9.1%) and did not differ by training stage (8.2% versus 10.2%; p = 0.54), academic year (p = 0.27) or institution (p = 0.50).

Conclusions: Applied imaging knowledge was substantially higher at the clinical stage, with gains concentrated in image interpretation. Awareness of appropriateness frameworks was near-absent and did not increase at any point in training, suggesting that clinical immersion develops pattern recognition while leaving explicit frameworks untaught.

Keywords: Radiology/education, medical students, undergraduate medical education, diagnostic imaging, clinical competence, Saudi Arabia.