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Noushad B, Van Gerven PWM, de Bruin ABH. Twelve tips for applying the think-aloud method to capture cognitive processes. MEDICAL TEACHER 2024; 46:892-897. [PMID: 38071621 DOI: 10.1080/0142159x.2023.2289847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
The think-aloud method is an established technique for studying human thought (cognitive) processes. Problem-solving and decision-making are essential skills for medical professionals, and the cognitive processes underlying these skills are complex. Studying these thought processes would enable educators, clinicians, and researchers to modify or refine their approaches and interventions. The think-aloud method has been utilized for capturing cognitive processes in a variety of fields, including computer usability, sports and cognitive psychology. Medical education also recognizes thought processes as valuable data for research and education. This article aims to guide researchers and educators through the preparation and implementation of a think-aloud method to record participants' thought processes during an activity.
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Affiliation(s)
- Babu Noushad
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- College of Health Sciences, University of Buraimi, Al Buraimi, Sultanate of Oman
| | - Pascal W M Van Gerven
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Anique B H de Bruin
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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2
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Hoffmann E, Masthoff M, Kunz WG, Seidensticker M, Bobe S, Gerwing M, Berdel WE, Schliemann C, Faber C, Wildgruber M. Multiparametric MRI for characterization of the tumour microenvironment. Nat Rev Clin Oncol 2024; 21:428-448. [PMID: 38641651 DOI: 10.1038/s41571-024-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.
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Affiliation(s)
- Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Bobe
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
| | | | | | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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3
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Göndöcs D, Dörfler V. AI in medical diagnosis: AI prediction & human judgment. Artif Intell Med 2024; 149:102769. [PMID: 38462271 DOI: 10.1016/j.artmed.2024.102769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/02/2023] [Accepted: 01/14/2024] [Indexed: 03/12/2024]
Abstract
AI has long been regarded as a panacea for decision-making and many other aspects of knowledge work; as something that will help humans get rid of their shortcomings. We believe that AI can be a useful asset to support decision-makers, but not that it should replace decision-makers. Decision-making uses algorithmic analysis, but it is not solely algorithmic analysis; it also involves other factors, many of which are very human, such as creativity, intuition, emotions, feelings, and value judgments. We have conducted semi-structured open-ended research interviews with 17 dermatologists to understand what they expect from an AI application to deliver to medical diagnosis. We have found four aggregate dimensions along which the thinking of dermatologists can be described: the ways in which our participants chose to interact with AI, responsibility, 'explainability', and the new way of thinking (mindset) needed for working with AI. We believe that our findings will help physicians who might consider using AI in their diagnosis to understand how to use AI beneficially. It will also be useful for AI vendors in improving their understanding of how medics want to use AI in diagnosis. Further research will be needed to examine if our findings have relevance in the wider medical field and beyond.
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Affiliation(s)
| | - Viktor Dörfler
- University of Strathclyde Business School, United Kingdom.
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Choe AI, Conaty S, Ha J, Mack J, Aumann EK, Wasserman E, McGillen K. What's in the Shadows? Formal Analysis: Art History Method to Improve Interpretation Skills for Mammography and Chest Radiographs in Resident Education. Acad Radiol 2024; 31:383-389. [PMID: 38401984 DOI: 10.1016/j.acra.2023.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 02/26/2024]
Abstract
RATIONALE AND OBJECTIVES To assess the feasibility of using an art history tool of formal analysis in resident education for interpretations of mammography and chest radiographs METHODS: In a pre-post study design, residents were shown pre-selected 10 mammograms and 10 chest radiographs for a total of 20 unique anonymized patient cases. After the pretest, residents attended four formal analysis art history lessons. The formal elements included line, light, dark, shade, proportion and balance. The post-tests were administered utilizing the same set of images given during the pre-test. After the completion of the pre- and post-tests, the participants filled out a written survey. RESULTS On average, participants improved their image descriptions for a mean of 30% of the total number of mammographic images they evaluated, and similarly they improved their image diagnoses for a mean of 31% of the mammographic images. On average, participants improved their image descriptions for a mean of 37% of the total number of chest radiographs they evaluated, while improving their image diagnoses for a mean of 52% of the chest X-rays. Of the 20 participants, 14 (70%) completed the post study survey. Almost all of the respondents endorsed agreement in understanding the application of formal analysis to radiologic interpretation. Eight out of 14 (57%) participants self-reported improvement in identifying abnormalities and contriving descriptors. CONCLUSION This pilot study shows that formal art analysis used by art historians may improve radiologic learners' ability to perceive and describe relevant radiologic abnormalities which in turn would lead to a more accurate radiologic differential diagnosis. The formal analysis process trains the eye to detect and categorize the underlying structure of images. This method provides an alternative arts intervention specifically designed to improve fundamental visual skills in radiology education.
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Affiliation(s)
- Angela I Choe
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.).
| | - Siobhan Conaty
- La Salle University, 1900 W. Olney Ave, Philadelphia, Pennsylvania 19141, USA (S.C.)
| | - Jason Ha
- Penn State College of Medicine, 700 HMC Crescent Drive, Hershey, Pennsylvania 17033, USA (J.H.)
| | - Julie Mack
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.)
| | - Emel K Aumann
- Penn State Health Milton S. Hershey Medical Center, 30 Hope Drive, Hershey, Pennsylvania 17033, USA (A.I.C., J.M., E.K.A.)
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Hershey, Pennsylvania 17033, USA (E.W.)
| | - Kathryn McGillen
- Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, Pennsylvania 17033, USA (K.M.)
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Chang RJ, Elyan R, Ahmed B, Karunanayaka P. A review and perspective on the neural basis of radiological expertise. J Clin Imaging Sci 2023; 13:33. [PMID: 37941921 PMCID: PMC10629248 DOI: 10.25259/jcis_135_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/09/2023] [Indexed: 11/10/2023] Open
Abstract
Radiological expertise requires tremendous time, effort, and training. While there has been a myriad of studies focusing on radiological expertise and error, the precise underlying neural mechanism still remains largely unexplored. In this article, we review potential neural mechanisms, namely, the fusiform face area, working memory, and predictive coding and propose experiments to test the predictive coding framework.
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Affiliation(s)
- Ryan Juien Chang
- Department of Radiology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Rommy Elyan
- Department of Radiology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Biyar Ahmed
- Department of Radiology, Penn State College of Medicine, Hershey, Pennsylvania, United States
| | - Prasanna Karunanayaka
- Department of Radiology, Penn State College of Medicine, Hershey, Pennsylvania, United States
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Alius C, Serban D, Tribus LC, Costea DO, Cristea BM, Serboiu C, Motofei I, Dascalu AM, Velescu B, Tudor C, Socea B, Bobirca A, Vancea G, Tanasescu D, Bratu DG. When Not to Operate on Acute Cases-A Surgeon's Perspective on Rapid Assessment of Emergency Abdominopelvic Computed Tomography. J Imaging 2023; 9:200. [PMID: 37888307 PMCID: PMC10607302 DOI: 10.3390/jimaging9100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Clinical problem solving evolves in parallel with advances in technology and discoveries in the medical field. However, it always reverts to basic cognitive processes involved in critical thinking, such as hypothetical-deductive reasoning, pattern recognition, and compilation models. When dealing with cases of acute abdominal pain, clinicians should employ all available tools that allow them to rapidly refine their analysis for a definitive diagnosis. Therefore, we propose a standardized method for the quick assessment of abdominopelvic computed tomography as a supplement to the traditional clinical reasoning process. This narrative review explores the cognitive basis of errors in reading imaging. It explains the practical use of attenuation values, contrast phases, and windowing for non-radiologists and details a multistep protocol for finding radiological cues during CT reading and interpretation. This systematic approach describes the salient features and technical tools needed to ascertain the causality between clinical patterns and abdominopelvic changes visible on CT scans from a surgeon's perspective. It comprises 16 sections that should be read successively and that cover the entire abdominopelvic region. Each section details specific radiological signs and provides clear explanations for targeted searches, as well as anatomical and technical hints. Reliance on imaging in clinical problem solving does not make a decision dichotomous nor does it guarantee success in diagnostic endeavors. However, it contributes exact information for supporting the clinical assessments even in the most subtle and intricate conditions.
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Affiliation(s)
- Catalin Alius
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Dragos Serban
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Laura Carina Tribus
- Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
- Department of Internal Medicine, Ilfov Emergency Clinic Hospital Bucharest, 022104 Bucharest, Romania
| | - Daniel Ovidiu Costea
- Faculty of Medicine, Ovidius University Constanta, 900470 Constanta, Romania;
- General Surgery Department, Emergency County Hospital Constanta, 900591 Constanta, Romania
| | - Bogdan Mihai Cristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Crenguta Serboiu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Ion Motofei
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Ana Maria Dascalu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Bruno Velescu
- Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
| | - Corneliu Tudor
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Fourth General Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Department of General Surgery, Emergency Clinic Hospital “Sf. Pantelimon” Bucharest, 021659 Bucharest, Romania
| | - Anca Bobirca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
| | - Geta Vancea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania; (C.A.); (B.M.C.); (C.S.); (I.M.); (A.M.D.); (C.T.); (B.S.); (A.B.); (G.V.)
- Clinical Hospital of Infectious and Tropical Diseases “Dr. Victor Babes”, 030303 Bucharest, Romania
| | - Denisa Tanasescu
- Department of Nursing and Dentistry, Faculty of General Medicine, ‘Lucian Blaga’ University of Sibiu, 550169 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, University “Lucian Blaga”, 550169 Sibiu, Romania;
- Department of Surgery, Emergency County Hospital Sibiu, 550245 Sibiu, Romania
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Singh M, Kumar B, Agrawal D. Good view frames from ultrasonography (USG) video containing ONS diameter using state-of-the-art deep learning architectures. Med Biol Eng Comput 2022; 60:3397-3417. [DOI: 10.1007/s11517-022-02680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
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8
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Gertrude VG, Lambrechts M, Jacobs R, Declerck D. Impact of case complexity on paediatric dentists' ability to radiographically diagnose traumatic dental injuries. Dent Traumatol 2022; 38:450-456. [PMID: 36057961 DOI: 10.1111/edt.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS Being able to correctly interpret radiographs after a traumatic dental injury is an essential skill for providing appropriate and timely treatment. The aim of this study was to assess the impact of case complexity on paediatric dentists' performance when radiographically diagnosing traumatic dental injuries (TDI) and to investigate a possible added value of cone-beam computed tomography (CBCT) when compared with digital intra-oral radiography (2D vs 3D). MATERIALS AND METHODS A test panel of paediatric dentists was instructed to detect, identify and interpret radiographic findings using either 2D or 3D images. Intra-oral radiographs and CBCT images of 20 trauma cases were presented in random order, and the findings were recorded using structured scoring sheets. Case complexity was determined by two experienced benchmark scorers. Results were analysed using generalized linear mixed modelling. RESULTS In general, performance for detection, identification and interpretation of findings was low, both with 2D and 3D images, with significantly lower values for difficult cases (p < 0.05). For easy as well as for difficult cases, 3D imaging resulted in a significantly better performance for detection and identification of findings (P < 0.001). This was not the case for correct interpretation, where significantly poorer performance was seen when using 3D images for difficult cases (p < 0.05). CONCLUSION This study provides evidence that case complexity of traumatic dental injuries influences diagnostic performance. The use of CBCT enhanced detection and identification of findings but when case complexity increased, 3D imaging adversely affected correct interpretation.
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Affiliation(s)
- Van Gorp Gertrude
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental care, University Hospitals Leuven, Leuven, Belgium
| | - Marjan Lambrechts
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental care, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dominique Declerck
- KU Leuven Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental care, University Hospitals Leuven, Leuven, Belgium
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Hewis J, Harcus J, Pantic V. Qualitative content analysis of image interpretation education in UK pre-registration diagnostic radiography programmes. Radiography (Lond) 2022; 28:1080-1086. [PMID: 35994976 DOI: 10.1016/j.radi.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Image interpretation is a required capability for all UK pre-registration programmes in diagnostic radiography to meet the needs of graduate practice. It also provides a potential educational foundation for future advanced clinical practice. The aim of this study was to explore how image interpretation education is designed, delivered, and assessed within contemporary UK pre-registration diagnostic radiography programmes. METHODS Qualitative content analysis of open-source image interpretation curriculum data extracted from UK Higher Education Institute (HEI) websites. RESULTS Extracted search data was initially coded and three overarching themes emerged, image interpretation education vision, operationalisation, and delivery and assessment. CONCLUSION This study identified significant heterogeneity in all aspects of UK pre-registration image interpretation education which may suggest an equal heterogeneity can be expected in the image interpretation knowledge, skill, confidence between newly registered practitioners. IMPLICATIONS FOR PRACTICE There may be a need for clearer expectations on HEIs by professional and regulatory bodies to ensure consistency in pre-registration image interpretation education.
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Affiliation(s)
- J Hewis
- School of Dentistry & Medical Sciences, Faculty of Science & Health, Charles Sturt University, Port Macquarie, NSW, Australia.
| | - J Harcus
- School of Medicine, University of Leeds, Leeds, UK
| | - V Pantic
- School of Medicine, University of Leeds, Leeds, UK
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10
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Rudolphi-Solero T, Lorenzo-Alvarez R, Ruiz-Gomez MJ, Sendra-Portero F. Impact of compulsory participation of medical students in a multiuser online game to learn radiological anatomy and radiological signs within the virtual world Second Life. ANATOMICAL SCIENCES EDUCATION 2022; 15:863-876. [PMID: 34449983 DOI: 10.1002/ase.2134] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 05/22/2023]
Abstract
Competitive game-based learning within Second Life enables effective teaching of basic radiological anatomy and radiological signs to medical students, with good acceptance and results when students participate voluntarily, but unknown in a compulsory context. The objectives of this study were to reproduce a competitive online game based on self-guided presentations and multiple-choice tests in a mandatory format, to evaluate its development and student perceptions compared to a voluntary edition in 2015 (N = 90). In 2016 and 2017, respectively, 191 and 182 third-year medical students participated in the game as a mandatory course activity. The mean (±SD) score of the game was 74.7% (±19.5%) in 2015, 71.2% (±21.5%) in 2016, and 67.5% (±21.5%) in 2017 (P < 0.01). Participants valued positively the organization and educational contents but found the virtual world less attractive and the game less interesting than in the voluntary edition. The experience globally was rated with 8.2 (±1.5), 7.8 (±1.5), and 7.1 (±1.7) mean points (±SD) in a ten-point scale, in the 2015, 2016, and 2017 editions, respectively (P < 0.05). Competitive learning games within virtual worlds like Second Life have great learning potential in radiology, but the mean score in the game decreased, acceptance of virtual world technology was lower, and opinion about the game was worse with a compulsory participation, and even worse when dropouts were not allowed. Under the conditions in which this study was conducted, learning games in three-dimensional virtual environments should be voluntary to maintain adequate motivation and engagement of medical students.
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Affiliation(s)
| | | | - Miguel J Ruiz-Gomez
- Department of Radiology and Physical Medicine, Universidad de Málaga, Málaga, Spain
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11
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Sahraian S, Yousem D, Beheshtian E, Jalilianhasanpour R, Morales RE, Krupinski EA, Zhan H. Improving Radiology Trainees' Perception Using Where's Waldo? Acad Radiol 2022; 29 Suppl 5:S11-S17. [PMID: 33172815 DOI: 10.1016/j.acra.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES Perception is an essential skill leading to expertise in diagnostic radiology. We determined if practicing "Where's Waldo?" images improves accuracy and speed with which first and second year radiology residents detect abnormalities on chest radiographs (CXRs). MATERIALS AND METHODS Residents at three institutions were pretested using 50 CXRs, identifying locations of potential abnormalities. They were then split into trained (examining 7 "Where's Waldo?" images over three weeks) and control groups (no "Where's Waldo?"). They were then re-tested on the 50 CXRs. At one site, visual search parameters were acquired. Data were analyzed with repeated measures ANOVAs. RESULTS There was no significant difference in performance for trained vs control (F = 0.622, p = 0.436), with both improving significantly on post-test (F = 4.72, p = 0.037). Session time decreased significantly for both groups from pre to post-test (F = 81.47, p < 0.0001) and the decrease was significantly more (F = 31.59, p < 0.0001) for the trained group than the control group as well as for PGY with PGY3 having a larger average decrease in session time than PGY2. Eye-tracking data also showed significant increases in per image search efficiency with training. CONCLUSION Practicing "Where's Waldo?" or similar nonradiology search tasks may facilitate the acquisition of radiology image search but not detection skills, impacting reading efficiency more than detection accuracy.
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12
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Attard Navarro G, Hamandi K. Lessons from the video-EEG telemetry unit. Pract Neurol 2022; 22:301-310. [PMID: 35418505 DOI: 10.1136/practneurol-2021-003313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/04/2022]
Abstract
Epilepsy is a clinical diagnosis, based primarily on patient and witness histories. Where there is diagnostic uncertainty or when epilepsy surgery is being considered, long-term video-EEG monitoring in a telemetry unit remains the gold standard investigation for diagnostic clarification or presurgical localisation. We present six illustrative cases, highlighting important points that emerged during video-EEG review including potential pitfalls in video-EEG interpretation, and how the investigation helped with diagnosis and subsequent management. The diagnostic process strongly emphasises seizure semiology, more so than EEG.
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Affiliation(s)
- Giulia Attard Navarro
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Khalid Hamandi
- Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK
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13
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Williams LH, Carrigan AJ, Mills M, Auffermann WF, Rich AN, Drew T. Characteristics of expert search behavior in volumetric medical image interpretation. J Med Imaging (Bellingham) 2021; 8:041208. [PMID: 34277889 DOI: 10.1117/1.jmi.8.4.041208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: Experienced radiologists have enhanced global processing ability relative to novices, allowing experts to rapidly detect medical abnormalities without performing an exhaustive search. However, evidence for global processing models is primarily limited to two-dimensional image interpretation, and it is unclear whether these findings generalize to volumetric images, which are widely used in clinical practice. We examined whether radiologists searching volumetric images use methods consistent with global processing models of expertise. In addition, we investigated whether search strategy (scanning/drilling) differs with experience level. Approach: Fifty radiologists with a wide range of experience evaluated chest computed-tomography scans for lung nodules while their eye movements and scrolling behaviors were tracked. Multiple linear regressions were used to determine: (1) how search behaviors differed with years of experience and the number of chest CTs evaluated per week and (2) which search behaviors predicted better performance. Results: Contrary to global processing models based on 2D images, experience was unrelated to measures of global processing (saccadic amplitude, coverage, time to first fixation, search time, and depth passes) in this task. Drilling behavior was associated with better accuracy than scanning behavior when controlling for observer experience. Greater image coverage was a strong predictor of task accuracy. Conclusions: Global processing ability may play a relatively small role in volumetric image interpretation, where global scene statistics are not available to radiologists in a single glance. Rather, in volumetric images, it may be more important to engage in search strategies that support a more thorough search of the image.
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Affiliation(s)
- Lauren H Williams
- University of California, San Diego, Department of Psychology, San Diego, California, United States
| | - Ann J Carrigan
- Macquarie University, Department of Psychology, Sydney, New South Wales, Australia.,Macquarie University, Perception in Action Research Centre, Sydney, New South Wales, Australia.,Macquarie University, Centre for Elite Performance, Expertise, and Training, Sydney, New South Wales, Australia
| | - Megan Mills
- University of Utah, School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, Utah, United States
| | - William F Auffermann
- University of Utah, School of Medicine, Department of Radiology and Imaging Sciences, Salt Lake City, Utah, United States
| | - Anina N Rich
- Macquarie University, Perception in Action Research Centre, Sydney, New South Wales, Australia.,Macquarie University, Centre for Elite Performance, Expertise, and Training, Sydney, New South Wales, Australia.,Macquarie University, Department of Cognitive Science, Sydney, New South Wales, Australia
| | - Trafton Drew
- University of Utah, Department of Psychology, Salt Lake City, Utah, United States
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14
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van Montfort D, Kok E, Vincken K, van der Schaaf M, van der Gijp A, Ravesloot C, Rutgers D. Expertise development in volumetric image interpretation of radiology residents: what do longitudinal scroll data reveal? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:437-466. [PMID: 33030627 PMCID: PMC8041671 DOI: 10.1007/s10459-020-09995-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
The current study used theories on expertise development (the holistic model of image perception and the information reduction hypothesis) as a starting point to identify and explore potentially relevant process measures to monitor and evaluate expertise development in radiology residency training. It is the first to examine expertise development in volumetric image interpretation (i.e., CT scans) within radiology residents using scroll data collected longitudinally over five years of residency training. Consistent with the holistic model of image perception, the percentage of time spent on full runs, i.e. scrolling through more than 50% of the CT-scan slices (global search), decreased within residents over residency training years. Furthermore, the percentage of time spent on question-relevant areas in the CT scans increased within residents over residency training years, consistent with the information reduction hypothesis. Second, we examined if scroll patterns can predict diagnostic accuracy. The percentage of time spent on full runs and the percentage of time spent on question-relevant areas did not predict diagnostic accuracy. Thus, although scroll patterns over training years are consistent with visual expertise theories, they could not be used as predictors of diagnostic accuracy in the current study. Therefore, the relation between scroll patterns and performance needs to be further examined, before process measures can be used to monitor and evaluate expertise development in radiology residency training.
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Affiliation(s)
- Dorien van Montfort
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
| | - Ellen Kok
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands.
| | - Koen Vincken
- Image Sciences Institute, Imaging Dept, University Medical Center, Utrecht, The Netherlands
| | - Marieke van der Schaaf
- Department of Education, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cécile Ravesloot
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dirk Rutgers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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15
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Eder TF, Richter J, Scheiter K, Huettig F, Keutel C. Comparing radiographs with signaling improves anomaly detection of dental students: An eye‐tracking study. APPLIED COGNITIVE PSYCHOLOGY 2021. [DOI: 10.1002/acp.3819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Thésése F. Eder
- non‐university research institute Leibniz‐Institut für Wissensmedien Tübingen Germany
| | - Juliane Richter
- non‐university research institute Leibniz‐Institut für Wissensmedien Tübingen Germany
| | - Katharina Scheiter
- non‐university research institute Leibniz‐Institut für Wissensmedien Tübingen Germany
- University of Tübingen Tübingen Germany
| | - Fabian Huettig
- Department of Prosthodontics, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery, University Hospital Tübingen University of Tübingen Tübingen Germany
| | - Constanze Keutel
- Department of Oral‐ and Maxillofacial Radiology, Centre for Dentistry, Oral Medicine, and Maxillofacial Surgery, University Hospital Tübingen University of Tübingen Tübingen Germany
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16
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Rutgers D, van der Gijp A, Vincken K, Mol C, van der Schaaf M, Cate TT. Heat Map Analysis in Radiological Image Interpretation: An Exploration of Its Usefulness for Feedback About Image Interpretation Skills in Learners. Acad Radiol 2021; 28:414-423. [PMID: 31926860 DOI: 10.1016/j.acra.2019.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/25/2019] [Accepted: 11/21/2019] [Indexed: 11/25/2022]
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17
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Kliewer MA, Hartung M, Green CS. The Search Patterns of Abdominal Imaging Subspecialists for Abdominal Computed Tomography: Toward a Foundational Pattern for New Radiology Residents. J Clin Imaging Sci 2021; 11:1. [PMID: 33500836 PMCID: PMC7827582 DOI: 10.25259/jcis_195_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives: The routine search patterns used by subspecialty abdominal imaging experts to inspect the image volumes of abdominal/pelvic computed tomography (CT) have not been well characterized or rendered in practical or teachable terms. The goal of this study is to describe the search patterns used by experienced subspecialty imagers when reading a normal abdominal CT at a modern picture archiving and communication system workstation, and utilize this information to propose guidelines for residents as they learn to interpret CT during training. Material and Methods: Twenty-two academic subspecialists enacted their routine search pattern on a normal contrast-enhanced abdominal/pelvic CT study under standardized display parameters. Readers were told that the scan was normal and then asked to verbalize where their gaze centered and moved through the axial, coronal, and sagittal image stacks, demonstrating eye position with a cursor as needed. A peer coded the reported eye gaze movements and scrilling behavior. Spearman correlation coefficients were calculated between years of professional experience and the numbers of passes through the lung bases, liver, kidneys, and bowel. Results: All readers followed an initial organ-by-organ approach. Larger organs were examined by drilling, while smaller organs by oscillation or scanning. Search elements were classified as drilling, scanning, oscillation, and scrilling (scan drilling); these categories were parsed as necessary. The greatest variability was found in the examination the body wall and bowel/mesentery. Two modes of scrilling were described, and these classified as roaming and zigzagging. The years of experience of the readers did not correlated to number of passes made through the lung bases, liver, kidneys, or bowel. Conclusion: Subspecialty abdominal radiologists negotiate through the image stacks of an abdominal CT study in broadly similar ways. Collation of the approaches suggests a foundational search pattern for new trainees.
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Affiliation(s)
- Mark A Kliewer
- Department of Radiology and Ultrasound Imaging, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - Michael Hartung
- Department of Radiology and Ultrasound Imaging, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
| | - C Shawn Green
- Department of Psychology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States
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18
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Ben Fadel N, McAleer S. Impact of a web-based module on trainees' ability to interpret neonatal cranial ultrasound. BMC MEDICAL EDUCATION 2020; 20:489. [PMID: 33272272 PMCID: PMC7713003 DOI: 10.1186/s12909-020-02400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Accurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills. METHODS Trainees' needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants' satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project. RESULTS Respondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees. CONCLUSION A WBL module for teaching neonatal CUS interpretation considerably improved trainees' knowledge and enhanced their skills in interpreting neonatal CUS.
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Affiliation(s)
- Nadya Ben Fadel
- Neonatal-Perinatal Medicine program, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Sean McAleer
- Centre for Medical Education, University of Dundee, Dundee, Scotland
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19
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Sethole KM, Rudman E, Hazell LJ. Methods Used by General Practitioners to Interpret Chest Radiographs at District Hospitals in the City of Tshwane, South Africa. J Med Imaging Radiat Sci 2020; 51:271-279. [DOI: 10.1016/j.jmir.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/11/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
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20
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Sha LZ, Toh YN, Remington RW, Jiang YV. Perceptual learning in the identification of lung cancer in chest radiographs. COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2020; 5:4. [PMID: 32016647 PMCID: PMC6997313 DOI: 10.1186/s41235-020-0208-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 01/12/2020] [Indexed: 11/18/2022]
Abstract
Extensive research has shown that practice yields highly specific perceptual learning of simple visual properties such as orientation and contrast. Does this same learning characterize more complex perceptual skills? Here we investigated perceptual learning of complex medical images. Novices underwent training over four sessions to discriminate which of two chest radiographs contained a tumor and to indicate the location of the tumor. In training, one group received six repetitions of 30 normal/abnormal images, the other three repetitions of 60 normal/abnormal images. Groups were then tested on trained and novel images. To assess the nature of perceptual learning, test items were presented in three formats – the full image, the cutout of the tumor, or the background only. Performance improved across training sessions, and notably, the improvement transferred to the classification of novel images. Training with more repetitions on fewer images yielded comparable transfer to training with fewer repetitions on more images. Little transfer to novel images occurred when tested with just the cutout of the cancer region or just the background, but a larger cutout that included both the cancer region and some surrounding regions yielded good transfer. Perceptual learning contributes to the acquisition of expertise in cancer image perception.
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Affiliation(s)
- Li Z Sha
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
| | - Yi Ni Toh
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA
| | - Roger W Remington
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.,School of Psychology, University of Queensland, Brisbane, Australia
| | - Yuhong V Jiang
- Department of Psychology, University of Minnesota, N240 Elliott Hall, 75 East River Road, Minneapolis, MN, 55455, USA.
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21
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Eye movements during music reading: Toward a unified understanding of visual expertise. PSYCHOLOGY OF LEARNING AND MOTIVATION 2020. [DOI: 10.1016/bs.plm.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Waite S, Farooq Z, Grigorian A, Sistrom C, Kolla S, Mancuso A, Martinez-Conde S, Alexander RG, Kantor A, Macknik SL. A Review of Perceptual Expertise in Radiology-How it develops, How we can test it, and Why humans still matter in the era of Artificial Intelligence. Acad Radiol 2020; 27:26-38. [PMID: 31818384 DOI: 10.1016/j.acra.2019.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 10/25/2022]
Abstract
As the first step in image interpretation is detection, an error in perception can prematurely end the diagnostic process leading to missed diagnoses. Because perceptual errors of this sort-"failure to detect"-are the most common interpretive error (and cause of litigation) in radiology, understanding the nature of perceptual expertise is essential in decreasing radiology's long-standing error rates. In this article, we review what constitutes a perceptual error, the existing models of radiologic image perception, the development of perceptual expertise and how it can be tested, perceptual learning methods in training radiologists, and why understanding perceptual expertise is still relevant in the era of artificial intelligence. Adding targeted interventions, such as perceptual learning, to existing teaching practices, has the potential to enhance expertise and reduce medical error.
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23
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Hani S, Chalouhi G, Lakissian Z, Sharara-Chami R. Introduction of Ultrasound Simulation in Medical Education: Exploratory Study. JMIR MEDICAL EDUCATION 2019; 5:e13568. [PMID: 31573944 PMCID: PMC6787531 DOI: 10.2196/13568] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Ultrasound is ubiquitous across all disciplines of medicine; it is one of the most commonly used noninvasive, painless diagnostic tools. However, not many are educated and trained well enough in its use. Ultrasound requires not only theoretical knowledge but also extensive practical experience. The simulated setting offers the safest environment for health care professionals to learn and practice using ultrasound. OBJECTIVE This study aimed to (1) assess health care professionals' need for and enthusiasm toward practicing using ultrasound via simulation and (2) gauge their perception and acceptance of simulation as an integral element of ultrasound education in medical curricula. METHODS A day-long intervention was organized at the American University of Beirut Medical Center (AUBMC) to provide a free-of-charge interactive ultrasound simulation workshop-using CAE Vimedix high-fidelity simulator-for health care providers, including physicians, nurses, ultrasound technicians, residents, and medical students. Following the intervention, attendees completed an evaluation, which included 4 demographic questions and 16 close-ended questions based on a Likert scale agree-neutral-disagree. The results presented are based on this evaluation form. RESULTS A total of 41 participants attended the workshop (46% [19/41] physicians, 30% [12/41] residents, 19% [8/41] sonographers, and 5% [2/41] medical students), mostly from AUBMC (88%, 36/41), with an average experience of 2.27 (SD 3.45) years and 30 (SD 46) scans per attendee. Moreover, 15 out of 41 (36%) participants were from obstetrics and gynecology, 11 (27%) from internal medicine, 4 (10%) from pediatrics, 4 (10%) from emergency medicine, 2 (5%) from surgery and family medicine, and 5 (12%) were technicians. The majority of participants agreed that ultrasound provided a realistic setting (98%, 40/41) and that it allowed for training and identification of pathologies (88%, 36/41). Furthermore, 100% (41/41) of the participants agreed that it should be part of the curriculum either in medical school or residency, and most of the participants approved it for training (98%, 40/41) and teaching (98%, 40/41). CONCLUSIONS All attendees were satisfied with the intervention. There was a positive perception toward the use of simulation for training and teaching medical students and residents in using ultrasound, and there was a definite need and enthusiasm for its integration into curricula. Simulation offers an avenue not only for teaching but also for practicing the ultrasound technology by both medical students and health care providers.
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Affiliation(s)
- Selim Hani
- Department of Industrial Engineering, American University of Beirut, Beirut, Lebanon
| | - Gihad Chalouhi
- International Society of Ultrasound in Obstetrics and Gynecology, London, United Kingdom
- SimECHOLE, Paris, France
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zavi Lakissian
- Simulation Program, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Sharara-Chami
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Waite S, Grigorian A, Alexander RG, Macknik SL, Carrasco M, Heeger DJ, Martinez-Conde S. Analysis of Perceptual Expertise in Radiology - Current Knowledge and a New Perspective. Front Hum Neurosci 2019; 13:213. [PMID: 31293407 PMCID: PMC6603246 DOI: 10.3389/fnhum.2019.00213] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/07/2019] [Indexed: 12/14/2022] Open
Abstract
Radiologists rely principally on visual inspection to detect, describe, and classify findings in medical images. As most interpretive errors in radiology are perceptual in nature, understanding the path to radiologic expertise during image analysis is essential to educate future generations of radiologists. We review the perceptual tasks and challenges in radiologic diagnosis, discuss models of radiologic image perception, consider the application of perceptual learning methods in medical training, and suggest a new approach to understanding perceptional expertise. Specific principled enhancements to educational practices in radiology promise to deepen perceptual expertise among radiologists with the goal of improving training and reducing medical error.
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Affiliation(s)
- Stephen Waite
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Arkadij Grigorian
- Department of Radiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Robert G. Alexander
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Stephen L. Macknik
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Marisa Carrasco
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - David J. Heeger
- Department of Psychology and Center for Neural Science, New York University, New York, NY, United States
| | - Susana Martinez-Conde
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Neurology, SUNY Downstate Medical Center, Brooklyn, NY, United States
- Department of Physiology/Pharmacology, SUNY Downstate Medical Center, Brooklyn, NY, United States
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25
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Rutgers DR, van Raamt F, ten Cate TJ. Development of competence in volumetric image interpretation in radiology residents. BMC MEDICAL EDUCATION 2019; 19:122. [PMID: 31046749 PMCID: PMC6498553 DOI: 10.1186/s12909-019-1549-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/08/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND During residency, radiology residents learn to interpret volumetric radiological images. The development of their competence for volumetric image interpretation, as opposed to 2D image reading, is not completely understood. The purpose of the present study was to investigate how competence for volumetric image interpretation develops in radiology residents and how this compares with competence development for 2D image interpretation, by studying resident scores on image-based items in digital radiology tests. METHODS We reviewed resident scores on volumetric and 2D image-based test items in 9 consecutive semi-annual digital radiology tests that were carried out from November 2013 to April 2018. We assessed percentage-correct sum scores for all test items about volumetric images and for all test items about 2D images in each test as well as for all residents across the 9 tests (i.e. 4.5 years of test materials). We used a paired t-test to analyze whether scores differed between volumetric and 2D image-based test items in individual residents in postgraduate year (PGY) 0-5, subdivided in 10 half-year phases (PGY 0-0.5, 0.5-1.0, 1.0-1.5 et cetera). RESULTS The percentage-correct scores on volumetric and 2D image-based items showed a comparable trend of development, increasing in the first half of residency and flattening off in the second half. Chance-corrected scores were generally lower in volumetric than in 2D items (on average 1-5% points). In PGY 1.5-4.5, this score difference was statistically significant (p-values ranging from 0.02 to < 0.001), with the largest difference found in PGY 2.5 (mean: 5% points; 95% CI: -7.3 - -3.4). At the end of training in PGY 5, there was no statistically significant score difference between both item types. CONCLUSIONS The development of competence in volumetric image interpretation fits a similar curvilinear growth curve during radiology residency as 2D image interpretation competence in digital radiology tests. Although residents performed significantly lower on volumetric than 2D items in PGY 1.5-4.5, we consider the magnitude of this difference as relatively small for our educational setting and we suggest that throughout radiology training there are no relevant differences in the development of both types of competences, as investigated by digital radiology tests.
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Affiliation(s)
- D. R. Rutgers
- Department of Radiology, University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Radiological Society of the Netherlands, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - F. van Raamt
- Department of Radiology, Gelre Hospitals, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands
- Radiological Society of the Netherlands, Mercatorlaan 1200, 3528 BL Utrecht, The Netherlands
| | - Th. J. ten Cate
- Center for Research and Development of Education, University Medical Center, P.O. Box # 85500, 3508 GA Utrecht, The Netherlands
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26
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Guimarães B, Firmino-Machado J, Tsisar S, Viana B, Pinto-Sousa M, Vieira-Marques P, Cruz-Correia R, Ferreira MA. The Role of Anatomy Computer-Assisted Learning on Spatial Abilities of Medical Students. ANATOMICAL SCIENCES EDUCATION 2019; 12:138-153. [PMID: 29762903 DOI: 10.1002/ase.1795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/07/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
Currently, medical education context poses different challenges to anatomy, contributing to the introduction of new pedagogical approaches, such as computer-assisted learning (CAL). This approach provides insight into students' learning profiles and skills that enhance anatomy knowledge acquisition. To understand the influence of anatomy CAL on spatial abilities, a study was conducted. A total of 671 medical students attending Musculoskeletal (MA) and Cardiovascular Anatomy (CA) courses, were allocated to one of three groups (MA Group, CA Group, MA + CA Group). Students' pre-training and post-training spatial abilities were assessed through Mental Rotations Test (MRT), with scores ranging between 0-24. After CAL training sessions, students' spatial abilities performance improved (9.72 ± 4.79 vs. 17.05 ± 4.57, P < 0.001). Although male students in both MA Group and CA Group show better baseline spatial abilities, no sex differences were found after CAL training. The improvement in spatial abilities score between sessions (Delta MRT) was correlated with Musculoskeletal Anatomy training sessions in MA Group (r = 0.333, P < 0.001) and MA + CA Group (r = 0.342, P < 0.001), and with Cardiovascular Anatomy training sessions in CA Group (r = 0.461, P = 0.001) and MA + CA Group (r = 0.324, P = 0.001). Multiple linear regression models were used, considering the Delta MRT as dependent variable. An association of Delta MRT to the amount of CAL training and the baseline spatial abilities was observed. The results suggest that CAL training in anatomy has positive dose-dependent effect on spatial abilities.
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Affiliation(s)
- Bruno Guimarães
- Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
- Physical and Rehabilitation Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Firmino-Machado
- Unidade de Saúde Pública, ACeS Porto Ocidental, Porto, Portugal
- EPIUnit - Instituto de Saúde Pública (ISPUP), University of Porto, Porto, Portugal
| | - Stanislav Tsisar
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Benedita Viana
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marco Pinto-Sousa
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Vieira-Marques
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Cruz-Correia
- Center for Research in Health Technologies and Information Systems (CINTESIS). Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria Amélia Ferreira
- Department of Public Health, Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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27
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Dournes G, Bricault I, Chateil JF. Analysis of the French national evaluation of radiology residents. Diagn Interv Imaging 2018; 100:185-193. [PMID: 30527527 DOI: 10.1016/j.diii.2018.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE In France, a national evaluation is given annually to radiology residents. The aim of this study was to perform both a docimological analysis of the quality of the questionnaire and a statistical analysis of the results. MATERIALS AND METHODS This retrospective study, which included French radiology residents from Year 1 to Year 5 of residency, was performed from 2015 to 2017 across 25 medical universities in France. Both qualitative and quantitative docimological analyses were performed as assessed by the Cronbach alpha coefficient, the difficulty of question (PDI), and the coefficient of discrimination (Rir). Results to the questionnaire were compared between years of residency. RESULTS The results of the analysis confirmed the quality of the questionnaire (Cronbach alpha coefficient=0.71, mean [PDI=0.40]) though the majority of questions could be answered by memory rather than cognitive ability. The mean Rir was 0.02, indicating that students could not be certified using only the questionnaire. The results measuring resident level of knowledge were moderate, with mean results ranging from 9.2/20 at the first year to 11.3/20 at the fifth year of residency (P<0.001). There were no significant differences in results obtained between the third, fourth, and fifth year of residency but results were significantly different among university hospitals. CONCLUSION Even if close interactions exist between learning and pedagogic environment, our results suggest that it may be useful to further develop an evaluation process in relation with pedagogic instructions in order to provide more optimal training.
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Affiliation(s)
- G Dournes
- Centre de recherche cardio-thoracique de Bordeaux, U1045, Bordeaux University, 33000 Bordeaux, France; Inserm, centre de recherche cardio-thoracique de Bordeaux, U1045, 33000 Bordeaux, France; Department of cardiovascular and thoracic imaging, CHU de Bordeaux, 33600 Pessac, France.
| | - I Bricault
- Department of medical imaging, hôpital Nord, CHU de Grenoble, 38043 Grenoble, France; Université Grenoble-Alpes, TIMC-IMAG, 38000 Grenoble, France
| | - J-F Chateil
- Department of pediatric imaging, CHU de Bordeaux, 33000 Bordeaux, France; Centre de résonance magnétique des systèmes biologiques, UMR 5536, Bordeaux University, 33076 Bordeaux, France
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den Boer L, van der Schaaf MF, Vincken KL, Mol CP, Stuijfzand BG, van der Gijp A. Volumetric image interpretation in radiology: scroll behavior and cognitive processes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:783-802. [PMID: 29767400 PMCID: PMC6132416 DOI: 10.1007/s10459-018-9828-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 05/07/2018] [Indexed: 05/12/2023]
Abstract
The interpretation of medical images is a primary task for radiologists. Besides two-dimensional (2D) images, current imaging technologies allow for volumetric display of medical images. Whereas current radiology practice increasingly uses volumetric images, the majority of studies on medical image interpretation is conducted on 2D images. The current study aimed to gain deeper insight into the volumetric image interpretation process by examining this process in twenty radiology trainees who all completed four volumetric image cases. Two types of data were obtained concerning scroll behaviors and think-aloud data. Types of scroll behavior concerned oscillations, half runs, full runs, image manipulations, and interruptions. Think-aloud data were coded by a framework of knowledge and skills in radiology including three cognitive processes: perception, analysis, and synthesis. Relating scroll behavior to cognitive processes showed that oscillations and half runs coincided more often with analysis and synthesis than full runs, whereas full runs coincided more often with perception than oscillations and half runs. Interruptions were characterized by synthesis and image manipulations by perception. In addition, we investigated relations between cognitive processes and found an overall bottom-up way of reasoning with dynamic interactions between cognitive processes, especially between perception and analysis. In sum, our results highlight the dynamic interactions between these processes and the grounding of cognitive processes in scroll behavior. It suggests, that the types of scroll behavior are relevant to describe how radiologists interact with and manipulate volumetric images.
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Affiliation(s)
- Larissa den Boer
- Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.
| | | | - Koen L Vincken
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris P Mol
- University Medical Center Utrecht, Utrecht, The Netherlands
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Baim AD. Getting the picture: visual interpretation in ophthalmology residency training. MEDICAL EDUCATION 2018; 52:816-825. [PMID: 29785772 DOI: 10.1111/medu.13590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/16/2017] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Visual interpretation is essential in many fields of health care. Although diagnostic competency can be measured as an educational outcome, few accounts have addressed tacit aspects of visual interpretation in clinical training; these include the disciplining of the trainee's attentions and the trainee's acculturation into expected styles of communicating visual interpretations to others. This paper describes values and dispositions that are taught to ophthalmology trainees as they learn to reason through visual information, and explores how these qualities are evaluated during residency training. METHODS The project was based on 6 months of ethnographic participant observation and interviews in an ophthalmology residency programme. Observational notes and interview transcripts pertaining to visual interpretation were isolated for qualitative analysis in the tradition of sociocultural anthropology, guided by literature on communication in medical education and the socialisation of health professionals. RESULTS Residents and faculty members identified visual interpretation as one of the most challenging skills expected of ophthalmology trainees. They expressed a belief that 'systematic' approaches, where visual information is parsed in a stepwise fashion, reduce the chance of trainees overlooking or misinterpreting key diagnostic features. This sensory discipline was represented in narrative form when faculty members asked residents to interpret images aloud, as residents were expected to follow prescribed sequences for describing the content of images before commenting on possible diagnoses. CONCLUSIONS Sensory processing is ordinarily opaque to outside observers, but the ritual of describing images in highly regimented narratives allows residents to demonstrate how they gather and reason through visual information. The form of these narratives reflects values that residents are expected to embody during their training, such as being thorough and methodical; it may also serve a pedagogical function by entrenching those values. Further research is needed to characterise how the performance of speech genres shapes the interpretive skills of medical trainees.
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Affiliation(s)
- Adam D Baim
- Center for Health and the Social Sciences, The University of Chicago, Chicago, Illinois, USA
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Rutgers DR, van Raamt F, van der Gijp A, Mol C, Ten Cate O. Determinants of Difficulty and Discriminating Power of Image-based Test Items in Postgraduate Radiological Examinations. Acad Radiol 2018; 25:665-672. [PMID: 29198947 DOI: 10.1016/j.acra.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES The psychometric characteristics of image-based test items in radiological written examinations are not well known. In this study, we explored difficulty and discriminating power of these test items in postgraduate radiological digital examinations. MATERIALS AND METHODS We reviewed test items of seven Dutch Radiology Progress Tests (DRPTs) that were taken from October 2013 to April 2017. The DRPT is a semiannual formative examination, required for all Dutch radiology residents. We assessed several stimulus and response characteristics of test items. The response format of test items included true or false, single right multiple choice with 2, 3, 4, or ≥5 answer options, pick-N multiple-choice, drag-and-drop, and long-list-menu formats. We calculated item P values and item-rest-correlation (Rir) values to assess difficulty and discriminating power. We performed linear regression analysis in image-based test items to investigate whether P and Rir values were significantly related to stimulus and response characteristics. Also, we compared psychometric indices between image-based test items and text-alone items. RESULTS P and Rir values of image-based items (n = 369) were significantly related to the type of response format (P < .001), and not to which of the seven DRPTs the item was obtained from, radiological subspecialty domain, nonvolumetric or volumetric character of images, or context-rich or context-free character of the stimulus. When accounted for type of response format, difficulty and discriminating power of image-based items did not differ significantly from text-alone items (n = 881). Test items with a relatively large number of answer options were generally more difficult, and discriminated better among high- and low-performing candidates. CONCLUSION In postgraduate radiological written examinations, difficulty and discriminating power of image-based test items are related to the type of response format and are comparable to those of text-alone items. We recommend a response format with a relatively large number of answer options to optimize psychometric indices of radiological image-based test items.
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Affiliation(s)
- Dirk R Rutgers
- Department of Radiology, University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands; Radiological Society of the Netherlands, Vught 5260 CB, The Netherlands.
| | - Fleur van Raamt
- Department of Radiology, Gelre Hospitals, Apeldoorn 7334 DZ, The Netherlands; Radiological Society of the Netherlands, Vught 5260 CB, The Netherlands
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Christian Mol
- Center for Image Sciences, University Medical Center, Utrecht 3584 CX, The Netherlands
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center, Utrecht 3508 GA, The Netherlands
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Cirigliano MM, Guthrie C, Pusic MV, Cianciolo AT, Lim-Dunham JE, Spickard A, Terry V. "Yes, and …" Exploring the Future of Learning Analytics in Medical Education. TEACHING AND LEARNING IN MEDICINE 2017; 29:368-372. [PMID: 29020521 DOI: 10.1080/10401334.2017.1384731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Northeastern Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. Commentators brainstormed "what's next" with learning analytics in medical education, including advancements in interaction metrics and the use of interactivity analysis to deepen understanding of perceptual, cognitive, and social learning and transfer processes.
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Affiliation(s)
- Matt M Cirigliano
- a Educational Communications and Technology Program , NYU Steinhardt , New York , New York , USA
| | - Charlie Guthrie
- b Graduate School of Arts and Sciences , New York University , New York , New York , USA
| | - Martin V Pusic
- c Ronald O. Perelman Department of Emergency Medicine and Institute for Innovations in Medical Education , NYU Langone Medical Center , New York , New York , USA
| | - Anna T Cianciolo
- d Department of Medical Education , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Jennifer E Lim-Dunham
- e Departments of Radiology, Pediatrics, and Medical Education , Loyola University Chicago Stritch School of Medicine , Maywood , Illinois , USA
| | - Anderson Spickard
- f Departments of Medicine and Biomedical Informatics , Vanderbilt School of Medicine , Nashville , Tennessee , USA
| | - Valerie Terry
- g Department of Medical Education , University of Texas-Rio Grande Valley School of Medicine , Harlingen , Texas , USA
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Goodman TR, Kelleher M. Improving Novice Radiology Trainees’ Perception Using Fine Art. J Am Coll Radiol 2017; 14:1337-1340. [DOI: 10.1016/j.jacr.2017.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/30/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
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Sheridan H, Reingold EM. The Holistic Processing Account of Visual Expertise in Medical Image Perception: A Review. Front Psychol 2017; 8:1620. [PMID: 29033865 PMCID: PMC5627012 DOI: 10.3389/fpsyg.2017.01620] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 09/04/2017] [Indexed: 12/11/2022] Open
Abstract
In the field of medical image perception, the holistic processing perspective contends that experts can rapidly extract global information about the image, which can be used to guide their subsequent search of the image (Swensson, 1980; Nodine and Kundel, 1987; Kundel et al., 2007). In this review, we discuss the empirical evidence supporting three different predictions that can be derived from the holistic processing perspective: Expertise in medical image perception is domain-specific, experts use parafoveal and/or peripheral vision to process large regions of the image in parallel, and experts benefit from a rapid initial glimpse of an image. In addition, we discuss a pivotal recent study (Litchfield and Donovan, 2016) that seems to contradict the assumption that experts benefit from a rapid initial glimpse of the image. To reconcile this finding with the existing literature, we suggest that global processing may serve multiple functions that extend beyond the initial glimpse of the image. Finally, we discuss future research directions, and we highlight the connections between the holistic processing account and similar theoretical perspectives and findings from other domains of visual expertise.
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Affiliation(s)
- Heather Sheridan
- Department of Psychology, University at Albany, State University of New York, Albany, NY, United States
| | - Eyal M. Reingold
- Department of Psychology, University of Toronto, Mississauga, ON, Canada
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Zwaan L, Kok EM, van der Gijp A. Radiology education: a radiology curriculum for all medical students? Diagnosis (Berl) 2017. [DOI: 10.1515/dx-2017-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Diagnostic errors in radiology are frequent and can cause severe patient harm. Despite large performance differences between radiologists and non-radiology physicians, the latter often interpret medical images because electronic health records make images available throughout the hospital. Some people argue that non-radiologists should not diagnose medical images at all, and that medical school should focus on teaching ordering skills instead of image interpretation skills. We agree that teaching ordering skills is crucial as most physicians will need to order medical images in their professional life. However, we argue that the availability of medical images is so ubiquitous that it is important that non-radiologists are also trained in the basics of medical image interpretation and, additionally in recognizing when radiological consultancy should be sought. In acute situations, basic image interpretations skills can be life-saving. We plead for a radiology curriculum for all medical students. This should include the interpretation of common abnormalities on chest and skeletal radiographs and a basic distinction of normal from abnormal images. Furthermore, substantial attention should be given to the correct ordering of radiological images. Finally, it is critical that students are trained in deciding when to consult a radiologist.
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Ravesloot CJ, van der Schaaf MF, Kruitwagen CLJJ, van der Gijp A, Rutgers DR, Haaring C, ten Cate O, van Schaik JPJ. Predictors of Knowledge and Image Interpretation Skill Development in Radiology Residents. Radiology 2017; 284:758-765. [DOI: 10.1148/radiol.2017152648] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Cécile J. Ravesloot
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Marieke F. van der Schaaf
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cas L. J. J. Kruitwagen
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Anouk van der Gijp
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Dirk R. Rutgers
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Cees Haaring
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Olle ten Cate
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
| | - Jan P. J. van Schaik
- From the Department of Radiology (C.J.R., A.v.d.G., D.R.R., C.H., J.P.J.v.S.), Julius Center (C.L.J.J.K.) and Center for Research and Education Development (O.t.C.), University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, the Netherlands; and Department of Education, University Utrecht, Utrecht, the Netherlands (M.F.v.d.S.)
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van der Gijp A, Ravesloot CJ, Jarodzka H, van der Schaaf MF, van der Schaaf IC, van Schaik JPJ, Ten Cate TJ. How visual search relates to visual diagnostic performance: a narrative systematic review of eye-tracking research in radiology. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:765-787. [PMID: 27436353 PMCID: PMC5498587 DOI: 10.1007/s10459-016-9698-1] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 07/09/2016] [Indexed: 05/26/2023]
Abstract
Eye tracking research has been conducted for decades to gain understanding of visual diagnosis such as in radiology. For educational purposes, it is important to identify visual search patterns that are related to high perceptual performance and to identify effective teaching strategies. This review of eye-tracking literature in the radiology domain aims to identify visual search patterns associated with high perceptual performance. Databases PubMed, EMBASE, ERIC, PsycINFO, Scopus and Web of Science were searched using 'visual perception' OR 'eye tracking' AND 'radiology' and synonyms. Two authors independently screened search results and included eye tracking studies concerning visual skills in radiology published between January 1, 1994 and July 31, 2015. Two authors independently assessed study quality with the Medical Education Research Study Quality Instrument, and extracted study data with respect to design, participant and task characteristics, and variables. A thematic analysis was conducted to extract and arrange study results, and a textual narrative synthesis was applied for data integration and interpretation. The search resulted in 22 relevant full-text articles. Thematic analysis resulted in six themes that informed the relation between visual search and level of expertise: (1) time on task, (2) eye movement characteristics of experts, (3) differences in visual attention, (4) visual search patterns, (5) search patterns in cross sectional stack imaging, and (6) teaching visual search strategies. Expert search was found to be characterized by a global-focal search pattern, which represents an initial global impression, followed by a detailed, focal search-to-find mode. Specific task-related search patterns, like drilling through CT scans and systematic search in chest X-rays, were found to be related to high expert levels. One study investigated teaching of visual search strategies, and did not find a significant effect on perceptual performance. Eye tracking literature in radiology indicates several search patterns are related to high levels of expertise, but teaching novices to search as an expert may not be effective. Experimental research is needed to find out which search strategies can improve image perception in learners.
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Affiliation(s)
- A van der Gijp
- Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - C J Ravesloot
- Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H Jarodzka
- Center for Learning Science and Technologies, Open University of the Netherlands, Heerlen, The Netherlands
| | | | - I C van der Schaaf
- Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J P J van Schaik
- Radiology Department, University Medical Center Utrecht, E01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Th J Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Ravesloot CJ, van der Gijp A, van der Schaaf MF, Huige JCBM, Ten Cate O, Vincken KL, Mol CP, van Schaik JPJ. Identifying error types in visual diagnostic skill assessment. ACTA ACUST UNITED AC 2017. [PMID: 29536921 DOI: 10.1515/dx-2016-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Misinterpretation of medical images is an important source of diagnostic error. Errors can occur in different phases of the diagnostic process. Insight in the error types made by learners is crucial for training and giving effective feedback. Most diagnostic skill tests however penalize diagnostic mistakes without an eye for the diagnostic process and the type of error. A radiology test with stepwise reasoning questions was used to distinguish error types in the visual diagnostic process. We evaluated the additional value of a stepwise question-format, in comparison with only diagnostic questions in radiology tests. METHODS Medical students in a radiology elective (n=109) took a radiology test including 11-13 cases in stepwise question-format: marking an abnormality, describing the abnormality and giving a diagnosis. Errors were coded by two independent researchers as perception, analysis, diagnosis, or undefined. Erroneous cases were further evaluated for the presence of latent errors or partial knowledge. Inter-rater reliabilities and percentages of cases with latent errors and partial knowledge were calculated. RESULTS The stepwise question-format procedure applied to 1351 cases completed by 109 medical students revealed 828 errors. Mean inter-rater reliability of error type coding was Cohen's κ=0.79. Six hundred and fifty errors (79%) could be coded as perception, analysis or diagnosis errors. The stepwise question-format revealed latent errors in 9% and partial knowledge in 18% of cases. CONCLUSIONS A stepwise question-format can reliably distinguish error types in the visual diagnostic process, and reveals latent errors and partial knowledge.
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Affiliation(s)
- Cécile J Ravesloot
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anouk van der Gijp
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian P Mol
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan P J van Schaik
- Radiology Department, University Medical Center Utrecht, Utrecht, The Netherlands
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van der Gijp A, Webb EM, Naeger DM. How Radiologists Think: Understanding Fast and Slow Thought Processing and How It Can Improve Our Teaching. Acad Radiol 2017; 24:768-771. [PMID: 28601164 DOI: 10.1016/j.acra.2016.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/08/2016] [Indexed: 10/19/2022]
Abstract
Scholars have identified two distinct ways of thinking. This "Dual Process Theory" distinguishes a fast, nonanalytical way of thinking, called "System 1," and a slow, analytical way of thinking, referred to as "System 2." In radiology, we use both methods when interpreting and reporting images, and both should ideally be emphasized when educating our trainees. This review provides practical tips for improving radiology education, by enhancing System 1 and System 2 thinking among our trainees.
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Improving students’ ability to perform a standardized foetal biometry plane using ultrasound simulators. J Gynecol Obstet Hum Reprod 2017; 46:439-443. [DOI: 10.1016/j.jogoh.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/21/2022]
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Kok EM, van Geel K, van Merriënboer JJG, Robben SGF. What We Do and Do Not Know about Teaching Medical Image Interpretation. Front Psychol 2017; 8:309. [PMID: 28316582 PMCID: PMC5334326 DOI: 10.3389/fpsyg.2017.00309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.
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Affiliation(s)
- Ellen M Kok
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Koos van Geel
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Centre Maastricht, Netherlands
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Kok EM, Jarodzka H, de Bruin ABH, BinAmir HAN, Robben SGF, van Merriënboer JJG. Systematic viewing in radiology: seeing more, missing less? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:189-205. [PMID: 26228704 PMCID: PMC4749649 DOI: 10.1007/s10459-015-9624-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 07/16/2015] [Indexed: 05/26/2023]
Abstract
To prevent radiologists from overlooking lesions, radiology textbooks recommend "systematic viewing," a technique whereby anatomical areas are inspected in a fixed order. This would ensure complete inspection (full coverage) of the image and, in turn, improve diagnostic performance. To test this assumption, two experiments were performed. Both experiments investigated the relationship between systematic viewing, coverage, and diagnostic performance. Additionally, the first investigated whether systematic viewing increases with expertise; the second investigated whether novices benefit from full-coverage or systematic viewing training. In Experiment 1, 11 students, ten residents, and nine radiologists inspected five chest radiographs. Experiment 2 had 75 students undergo a training in either systematic, full-coverage (without being systematic) or non-systematic viewing. Eye movements and diagnostic performance were measured throughout both experiments. In Experiment 1, no significant correlations were found between systematic viewing and coverage, r = -.10, p = .62, and coverage and performance, r = -.06, p = .74. Experts were significantly more systematic than students F2,25 = 4.35, p = .02. In Experiment 2, significant correlations were found between systematic viewing and coverage, r = -.35, p < .01, but not between coverage and performance, r = .13, p = .31. Participants in the full-coverage training performed worse compared with both other groups, which did not differ between them, F2,71 = 3.95, p = .02. In conclusion, the data question the assumption that systematic viewing leads to increased coverage, and, consequently, to improved performance. Experts inspected cases more systematically, but students did not benefit from systematic viewing training.
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Affiliation(s)
- Ellen M Kok
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Halszka Jarodzka
- Welten Institute, Research Centre for Learning, Teaching and Technology, Open University of the Netherlands, Heerlen, The Netherlands
- Humanities Laboratory, Lund University, Lund, Sweden
| | - Anique B H de Bruin
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Hussain A N BinAmir
- International Master in Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simon G F Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jeroen J G van Merriënboer
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship: Impact on Student Performance and Learning. Acad Radiol 2016; 23:252-61. [PMID: 26719161 DOI: 10.1016/j.acra.2015.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/15/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES The principles of Collins' cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach. MATERIALS AND METHODS The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding. RESULTS Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R(2) from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students' radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice. CONCLUSIONS The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.
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Tolsgaard MG, Ringsted C, Dreisler E, Nørgaard LN, Petersen JH, Madsen ME, Freiesleben NLC, Sørensen JL, Tabor A. Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:312-8. [PMID: 25580809 PMCID: PMC4600230 DOI: 10.1002/uog.14780] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 11/27/2014] [Accepted: 01/03/2015] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency. METHODS In a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale. RESULTS During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001). CONCLUSION Simulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M G Tolsgaard
- Centre for Clinical Education, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - C Ringsted
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - E Dreisler
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - L N Nørgaard
- Department of Obstetrics and Gynecology, Nordsjaelland Hospital Hillerød, University of Copenhagen, Hillerød, Denmark
| | - J H Petersen
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M E Madsen
- Centre for Clinical Education, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - N L C Freiesleben
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Naestved Hospital, University of Copenhagen, Naestved, Denmark
| | - J L Sørensen
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
| | - A Tabor
- Department of Obstetrics and Gynecology, Juliane Marie Centre, Rigshospitalet, Capital Region and University of Copenhagen, Copenhagen, Denmark
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Todsen T, Jensen ML, Tolsgaard MG, Olsen BH, Henriksen BM, Hillingsø JG, Konge L, Ringsted C. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients--a randomized controlled trial. Am J Surg 2015; 211:40-5. [PMID: 26323998 DOI: 10.1016/j.amjsurg.2015.05.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinicians are increasingly using point-of-care ultrasonography for bedside examinations of patients. However, proper training is needed in this technique, and it is unknown whether the skills learned from focused Ultrasonography courses are being transferred to diagnostic performance on patients. METHODS Thirty-one physicians were randomized to participate in a focused Ultrasonography course or control circumstances before they examined 4 patients with different abdominal conditions by ultrasonography. Performance scores and diagnostic accuracy were compared using independent samples t test and binary logistic regression, respectively. RESULTS There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014). CONCLUSIONS Clinicians could successfully transfer learning from an Ultrasonography course to improve diagnostic performance on patients. However, our results also indicate a need for more training when new technologies such as point-of-care ultrasonography are introduced.
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Affiliation(s)
- Tobias Todsen
- Centre for Clinical Education, University of Copenhagen, The Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen East, Denmark; Greenland Center for Health Research, University of Greenland, Manutooq 1, 3905 Nuuk, Greenland.
| | - Morten Lind Jensen
- Centre for Clinical Education, University of Copenhagen, The Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen East, Denmark; Global Development, Novo Nordisk A/S, Bagsvaerd, Denmark
| | - Martin Grønnebæk Tolsgaard
- Centre for Clinical Education, University of Copenhagen, The Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen East, Denmark; Department of Obstetrics and Gynecology, Nordsjællands University Hospital, Hillerød, Denmark
| | - Beth Härstedt Olsen
- Department of Radiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Birthe Merete Henriksen
- Department of Radiology, Ultrasound Section, Diagnostic Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Georg Hillingsø
- Department of Surgery, Abdominal Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Centre for Clinical Education, University of Copenhagen, The Capital Region of Denmark, Blegdamsvej 9, 2100 Copenhagen East, Denmark
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van der Gijp A, Ravesloot CJ, van der Schaaf MF, van der Schaaf IC, Huige JCBM, Vincken KL, Ten Cate OTJ, van Schaik JPJ. Volumetric and two-dimensional image interpretation show different cognitive processes in learners. Acad Radiol 2015; 22:632-9. [PMID: 25704588 DOI: 10.1016/j.acra.2015.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
RATIONALE AND OBJECTIVES In current practice, radiologists interpret digital images, including a substantial amount of volumetric images. We hypothesized that interpretation of a stack of a volumetric data set demands different skills than interpretation of two-dimensional (2D) cross-sectional images. This study aimed to investigate and compare knowledge and skills used for interpretation of volumetric versus 2D images. MATERIALS AND METHODS Twenty radiology clerks were asked to think out loud while reading four or five volumetric computed tomography (CT) images in stack mode and four or five 2D CT images. Cases were presented in a digital testing program allowing stack viewing of volumetric data sets and changing views and window settings. Thoughts verbalized by the participants were registered and coded by a framework of knowledge and skills concerning three components: perception, analysis, and synthesis. The components were subdivided into 16 discrete knowledge and skill elements. A within-subject analysis was performed to compare cognitive processes during volumetric image readings versus 2D cross-sectional image readings. RESULTS Most utterances contained knowledge and skills concerning perception (46%). A smaller part involved synthesis (31%) and analysis (23%). More utterances regarded perception in volumetric image interpretation than in 2D image interpretation (Median 48% vs 35%; z = -3.9; P < .001). Synthesis was less prominent in volumetric than in 2D image interpretation (Median 28% vs 42%; z = -3.9; P < .001). No differences were found in analysis utterances. CONCLUSIONS Cognitive processes in volumetric and 2D cross-sectional image interpretation differ substantially. Volumetric image interpretation draws predominantly on perceptual processes, whereas 2D image interpretation is mainly characterized by synthesis. The results encourage the use of volumetric images for teaching and testing perceptual skills.
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Affiliation(s)
- Anouk van der Gijp
- Department of Radiology, UMC Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Cécile J Ravesloot
- Department of Radiology, UMC Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | | | - Irene C van der Schaaf
- Department of Radiology, UMC Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Josephine C B M Huige
- Department of Radiology, UMC Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Koen L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Th J Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan P J van Schaik
- Department of Radiology, UMC Utrecht, E01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Ravesloot CJ, van der Gijp A, van der Schaaf MF, Huige JCBM, Vincken KL, Mol CP, Bleys RLAW, ten Cate OT, van Schaik JPJ. Support for external validity of radiological anatomy tests using volumetric images. Acad Radiol 2015; 22:640-5. [PMID: 25683502 DOI: 10.1016/j.acra.2014.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/07/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Radiology practice has become increasingly based on volumetric images (VIs), but tests in medical education still mainly involve two-dimensional (2D) images. We created a novel, digital, VI test and hypothesized that scores on this test would better reflect radiological anatomy skills than scores on a traditional 2D image test. To evaluate external validity we correlated VI and 2D image test scores with anatomy cadaver-based test scores. MATERIALS AND METHODS In 2012, 246 medical students completed one of two comparable versions (A and B) of a digital radiology test, each containing 20 2D image and 20 VI questions. Thirty-three of these participants also took a human cadaver anatomy test. Mean scores and reliabilities of the 2D image and VI subtests were compared and correlated with human cadaver anatomy test scores. Participants received a questionnaire about perceived representativeness and difficulty of the radiology test. RESULTS Human cadaver test scores were not correlated with 2D image scores, but significantly correlated with VI scores (r = 0.44, P < .05). Cronbach's α reliability was 0.49 (A) and 0.65 (B) for the 2D image subtests and 0.65 (A) and 0.71 (B) for VI subtests. Mean VI scores (74.4%, standard deviation 2.9) were significantly lower than 2D image scores (83.8%, standard deviation 2.4) in version A (P < .001). VI questions were considered more representative of clinical practice and education than 2D image questions and less difficult (both P < .001). CONCLUSIONS VI tests show higher reliability, a significant correlation with human cadaver test scores, and are considered more representative for clinical practice than tests with 2D images.
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Affiliation(s)
- Cécile J Ravesloot
- Department of Radiology, University Medical Center Utrecht, Room E01.132, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | - Anouk van der Gijp
- Department of Radiology, University Medical Center Utrecht, Room E01.132, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | | | - Josephine C B M Huige
- Department of Radiology, University Medical Center Utrecht, Room E01.132, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Koen L Vincken
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christian P Mol
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle T ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan P J van Schaik
- Department of Radiology, University Medical Center Utrecht, Room E01.132, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
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Ravesloot CJ, van der Schaaf MF, van Schaik JPJ, ten Cate OTJ, van der Gijp A, Mol CP, Vincken KL. Volumetric CT-images improve testing of radiological image interpretation skills. Eur J Radiol 2015; 84:856-61. [PMID: 25681136 DOI: 10.1016/j.ejrad.2014.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Current radiology practice increasingly involves interpretation of volumetric data sets. In contrast, most radiology tests still contain only 2D images. We introduced a new testing tool that allows for stack viewing of volumetric images in our undergraduate radiology program. We hypothesized that tests with volumetric CT-images enhance test quality, in comparison with traditional completely 2D image-based tests, because they might better reflect required skills for clinical practice. MATERIALS AND METHODS Two groups of medical students (n=139; n=143), trained with 2D and volumetric CT-images, took a digital radiology test in two versions (A and B), each containing both 2D and volumetric CT-image questions. In a questionnaire, they were asked to comment on the representativeness for clinical practice, difficulty and user-friendliness of the test questions and testing program. Students' test scores and reliabilities, measured with Cronbach's alpha, of 2D and volumetric CT-image tests were compared. RESULTS Estimated reliabilities (Cronbach's alphas) were higher for volumetric CT-image scores (version A: .51 and version B: .54), than for 2D CT-image scores (version A: .24 and version B: .37). Participants found volumetric CT-image tests more representative of clinical practice, and considered them to be less difficult than volumetric CT-image questions. However, in one version (A), volumetric CT-image scores (M 80.9, SD 14.8) were significantly lower than 2D CT-image scores (M 88.4, SD 10.4) (p<.001). The volumetric CT-image testing program was considered user-friendly. CONCLUSION This study shows that volumetric image questions can be successfully integrated in students' radiology testing. Results suggests that the inclusion of volumetric CT-images might improve the quality of radiology tests by positively impacting perceived representativeness for clinical practice and increasing reliability of the test.
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Affiliation(s)
- Cécile J Ravesloot
- Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands.
| | - Marieke F van der Schaaf
- Department of Pedagogical and Educational Sciences at Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands.
| | - Jan P J van Schaik
- Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands.
| | - Olle Th J ten Cate
- Center for Research and Development of Education at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
| | - Anouk van der Gijp
- Radiology Department at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, Room E01.132, The Netherlands.
| | - Christian P Mol
- Image Sciences Institute at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
| | - Koen L Vincken
- Image Sciences Institute at University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
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