Radiology education 2.0--on the cusp of change: part 1. Tablet computers, online curriculums, remote meeting tools and audience response systems

Elevating Radiology Education Research Through a Dedicated Research Fellowship: Adding Professional Identity as Essential for Success

RATIONALE AND OBJECTIVES

Education research has been undervalued in radiology, with few radiology journals having dedicated space for such research and barriers to production including dedicated time, resources, grant funding, and mentorship. As radiologists, we have an opportunity to study education in our unique learning environments and create more effective ways to teach that are grounded in established education theory, solid assessment methodologies, and a focus on merit as well as worth.

MATERIALS AND METHODS

The growth of education research in our field requires a two-pronged approach; We must cultivate leaders in education research from within our specialty, and continue to submit high quality work to radiology journals to increase exposure of the reviewers and readership to education methodologies.

RESULTS

We have created the first radiology education research fellowship to this end. This manuscript details the fellowship creation process, the first education research fellow experience, and in-depth analysis of the inaugural year via a qualitative program review.

CONCLUSION

We were successful in supporting an inaugural fellow in attaining the knowledge and skills to become a productive education researcher. Beyond this, the fellowship experience was a catalyst in developing her unique professional identity as an education master which will further raise the status of education research in pediatric radiology.

Web-Based Radiology Learning Module Design: The Author Perspective

RATIONALE AND OBJECTIVES

Over recent years, e-learning has become an integral component of radiology education. While demands for innovative, interactive e-learning resources have increased, the availability of viable solutions have not kept pace. As a result, many educators are authoring their own e-learning content. This study describes the six-year experience of faculty clinician educators and residents who participated in this authoring process.

MATERIALS AND METHODS

From 2014 to 2020, 62 radiology faculty and residents created a total of 89 peer reviewed web-based learning modules. Authors were given instructions and materials to support their design process. Following completion of their module(s), authors were asked to complete an anonymous and voluntary survey on their perspective.

RESULTS

Hundred percent of survey respondents reported that they enjoyed creating their module and 97.8% would recommend the experience to others. Reported educational value of authoring a learning module was 4.18 per 5, with 65% of resident authors reporting that they felt more likely to retain the information they learned through authoring a module rather than reading a chapter on the same topic. A total of 77.3% of respondents reported that the experience would make them more likely to teach medical students in the future.

CONCLUSION

With the appropriate resources and support, radiology faculty and residents succeed in authorship of innovative e-learning modules for medical student learners. In addition to enhancing subject matter knowledge and satisfying Accreditation Council for Graduate Medical Education requirements for teaching and scholarly activity, authorship provides mentoring opportunities and cultivates interest in medical student education.

Technologic optimization of a virtual disease focused panel during the COVID pandemic and beyond

Since the beginning of the COVID-19 pandemic, several service fields have opted for virtual work as much as possible, in order to decrease the spread of the virus. Although several articles have now addressed the key issues in telecommunications and medical education, none have described the digital or virtual functionality of a professional society disease focused panel (DFP) or inter-institutional collaborations. This is extremely important as we believe that the virtual functioning of the DFP will be the new norm for years to come. In this article, we highlight the limitations in the functioning of DFP brought forth due to the ongoing pandemic, while also providing the digital technologic solutions to adapt and also maintain or increase its productivity.

Radiology, Mobile Devices, and Internet of Things (IoT)

Radiology by its nature is intricately connected to the Internet and is at the forefront of technology in medicine. The past few years have seen a dramatic rise in Internet-based technology in healthcare, with imaging as a core application. Numerous Internet-based applications and technologies have made forays into medicine, and for radiology it is more seamless than in other clinical specialties. Many applications in the practice of radiology are Internet based and more applications are being added every day. Introduction of mobile devices and their integration into imaging workflow has reinforced the role played by the Internet in radiology. Due to the rapid proliferation of wearable devices and smartphones, IoT-enabled technology is evolving healthcare from conventional hub-based systems to more personalized healthcare systems. This article briefly discusses how the IoT plays a useful role in daily imaging workflow and current and potential future applications, how mobile devices can be integrated into radiology workflows, and the impact of the IoT on resident and medical student education, research, and patient engagement in radiology.

Virtual Read-Out: Radiology Education for the 21st Century During the COVID-19 Pandemic

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Video-conference platforms (VCPs) have rapidly become utilized in the current COVID-19 pandemic to promote social distancing.

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Radiology trainee education, as regulated by the ACGME, necessitates active learning based on image review and VCPs can facilitate and support this.

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Patient protected health information and HIPAA requirements must be adhered to even with VCPs and many platforms have the appropriate security measures to comply.

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Tools within the VCP permit two-way interaction, screen control/sharing, and annotation features, which enable appropriate education even in a remote setting.

Technologic advances have resulted in the expansion of web-based conferencing and education. While historically video-conferencing has been used for didactic educational sessions, we present its novel use in virtual radiology read-outs in the face of the COVID-19 pandemic. Knowledge of key aspects of set-up, implementation, and possible pitfalls of video-conferencing technology in the application of virtual read-outs can help to improve the educational experience of radiology trainees and promote potential future distance learning and collaboration.

Introducing Online Continuing Education in Radiology for General Practitioners

The aim of this study was to determine whether e-learning as a new teaching methodology was acceptable for general practitioners in continuous education courses of radiology. Generally, these courses are face-to-face with the corresponding time and place limitations. To overcome these limitations, we transformed one of these courses to an online one evaluating its acceptance. The course was about thorax radiology and it was delivered to 249 participants. The experiment was carried out in two phases: Phase 1, as a pilot testing with 12 general practitioners (G1), and Phase 2, with 149 general practitioners (G2), 12 radiologists (G3) and 76 medical residents (G4). All participants evaluated the course design, the delivering e-learning platform, and the course contents using a five-point Likert scale (satisfaction level from 1 to 5). Collected data was analysed using t, Mann-Whitney U and Kruskal-Wallis tests. In Phase 1, the rounded scores of all questions except one surpassed 3.5. In Phase 2, all the rounded scores surpassed 4.0 indicating that a total agreement on all items was achieved. All collected impressions indicate the high acceptance of the proposed methodology.

Impact of antiphospholipid syndrome iBook on medical students' improvement of knowledge: An international randomized controlled study

OBJECTIVE

iBook on Antiphospholipid Syndrome (APS) did not exist before our work, and hence the utility of an Apple iBook as a teaching method in APS for medical students has never been assessed. Our objective was to evaluate medical students' improvement of knowledge and satisfaction with an interactive APS iBook, in comparison with conventional teaching methods.

METHODS

An iBook designer with the guidance of a medical team developed the APS iBook in both French and English. Second-year medical students, naïve of APS knowledge, were enrolled from two institutions. For the "teaching intervention", participants were randomly assigned to three groups: a) APS iBook with interactive capability; b) printed copy of the APS iBook material; and c) classroom lecture presentation of the APS iBook material by a physician-scientist experienced in APS. The participants filled a standardized medical questionnaire about APS before and after teaching interventions to determine the relative change of knowledge. Participants were asked to fill out a standardized satisfaction survey. After 20 weeks of the intervention, recall capability of students was tested.

RESULTS

A total of 233 second-year medical students were enrolled (iBook group: 73; print group: 79, and lecture group: 81). Relative change of knowledge was not different between the iBook group and the printed material group; additionally, it was significantly higher in the lecture group than the two other methods. Satisfaction was significantly higher in both the lecture and the iBook groups than the print group, on several dimensions including overall quantitative satisfaction, subjective enhanced knowledge, interactivity, quality of content, comprehensibility, and pleasure of learning. Recall capability of students (n=109, 47%) was not significantly different among groups.

CONCLUSION

The APS iBook is as effective as printed material in improving medical student's knowledge, although a classroom lecture was the most effective method when compared to self-learning methods. Among self-learning methods, medical students are more satisfied with the APS iBook, whereas the recall capability was not different among groups. These results suggest that the APS iBook will help medical students in their curriculum and increase the awareness of APS among the community.

Making Learning Fun: Gaming in Radiology Education

With continued technologic advances, it is not surprising that gaming techniques are increasingly being used in radiology residency programs. This comprehensive review on gaming in radiology education offers insight into the importance of gaming, types of games and principles utilized in gaming, as well as applications that are inherent in artificial intelligence and continued medical education. The advantages and disadvantages of gaming will be considered, as well as barriers to successful adoption of gaming.

Evaluating Factors and Resources Affecting Ranking of Diagnostic Radiology Residency Programs by Medical Students in 2016-2017

RATIONALE AND OBJECTIVES

Recent changes in radiology curriculum and access to residency program information, including the introduction of various online resources and the Interventional Radiology integrated pathway, may influence the rank list order of medical student applicants. The purpose of this study is to assess factors that affect the rank lists of medical students applying to our radiology residency program in the 2016-2017 academic year.

MATERIALS AND METHODS

After IRB approval, an anonymous online 19 question survey was emailed to 622 applicants to our diagnostic radiology and/or interventional radiology integrated pathway. Applicants ranked 35 unique factors that may influence their residency rank list order from 1 (not important at all) to 5 (very important), listed their top five 'very important' factors, and ranked various sources of information used to learn about residency programs. General applicant demographic questions were also included.

RESULTS

Response rate was 18.8% (117/622). The 5 most important factors affecting applicant ranking of programs are perceived happiness of the residents and faculty (4.69), fellowship and job placement of recent graduates (4.34), interactions with programs' current residents (4.33), stability of the department and program (4.29), and geographic location of the program (4.27). The top 5 resources for learning about residency programs were interactions with current residents at the program (4.47), program director (3.87), and interviewing faculty (3.87). Individual program websites were ranked more highly than internet message boards and forums as an information source.

CONCLUSION

Medical students consider a large number of factors and resources in determining their rank lists, with factors encountered during the interview day playing a significant role in shaping the applicants' view of a residency program.

Toward Data-Driven Radiology Education-Early Experience Building Multi-Institutional Academic Trainee Interpretation Log Database (MATILDA)

The residency review committee of the Accreditation Council of Graduate Medical Education (ACGME) collects data on resident exam volume and sets minimum requirements. However, this data is not made readily available, and the ACGME does not share their tools or methodology. It is therefore difficult to assess the integrity of the data and determine if it truly reflects relevant aspects of the resident experience. This manuscript describes our experience creating a multi-institutional case log, incorporating data from three American diagnostic radiology residency programs. Each of the three sites independently established automated query pipelines from the various radiology information systems in their respective hospital groups, thereby creating a resident-specific database. Then, the three institutional resident case log databases were aggregated into a single centralized database schema. Three hundred thirty residents and 2,905,923 radiologic examinations over a 4-year span were catalogued using 11 ACGME categories. Our experience highlights big data challenges including internal data heterogeneity and external data discrepancies faced by informatics researchers.

Improving Abnormality Detection on Chest Radiography Using Game-Like Reinforcement Mechanics

RATIONALE AND OBJECTIVES

Despite their increasing prevalence, online textbooks, question banks, and digital references focus primarily on explicit knowledge. Implicit skills such as abnormality detection require repeated practice on clinical service and have few digital substitutes. Using mechanics traditionally deployed in video games such as clearly defined goals, rapid-fire levels, and narrow time constraints may be an effective way to teach implicit skills.

MATERIALS AND METHODS

We created a freely available, online module to evaluate the ability of individuals to differentiate between normal and abnormal chest radiographs by implementing mechanics, including instantaneous feedback, rapid-fire cases, and 15-second timers. Volunteer subjects completed the modules and were separated based on formal experience with chest radiography. Performance between training and testing sets were measured for each group, and a survey was administered after each session.

RESULTS

The module contained 74 cases and took approximately 20 minutes to complete. Thirty-two cases were normal radiographs and 56 cases were abnormal. Of the 60 volunteers recruited, 25 were "never trained" and 35 were "previously trained." "Never trained" users scored 21.9 out of 37 during training and 24.0 out of 37 during testing (59.1% vs 64.9%, P value <.001). "Previously trained" users scored 28.0 out of 37 during training and 28.3 out of 37 during testing phases (75.6% vs 76.4%, P value = .56). Survey results showed that 87% of all subjects agreed the module is an efficient way of learning, and 83% agreed the rapid-fire module is valuable for medical students.

CONCLUSIONS

A gamified online module may improve the abnormality detection rates of novice interpreters of chest radiography, although experienced interpreters are less likely to derive similar benefits. Users reviewed the educational module favorably.

The development of a learning management system for dental radiology education: A technical report

PURPOSE

This study was conducted to suggest the development of a learning management system for dental radiology education using the Modular Object-Oriented Dynamic Learning Environment (Moodle).

MATERIALS AND METHODS

Moodle is a well-known and verified open-source software-learning management system (OSS-LMS). The Moodle software was installed on a server computer and customized for dental radiology education. The system was implemented for teaching undergraduate students to diagnose dental caries in panoramic images. Questions were chosen that could assess students' diagnosis ability. Students were given several questions corre-sponding to each of 100 panoramic images.

RESULTS

The installation and customization of Moodle was feasible, cost-effective, and time-saving. By having students answer questions repeatedly, it was possible to train them to examine panoramic images sequentially and thoroughly.

CONCLUSION

Based on its educational efficiency and efficacy, the adaptation of an OSS-LMS in dental school may be highly recommended. The system could be extended to continuing education for dentists. Further studies on the objective evaluation of knowledge acquisition and retention are needed.

Use of Twitter Polls to Determine Public Opinion Regarding Content Presented at a Major National Specialty Society Meeting

PURPOSE

The aim of this study was to evaluate the feasibility of using Twitter polls to assess public opinion regarding session content at a national specialty society meeting.

METHODS

Twitter polls allow users to embed multiple-choice questions within tweets and automatically aggregate responses. Two radiologists attending the 2016 annual meeting of the ACR posted a Twitter poll containing the hashtag #ACR2016 during 10 meeting sessions addressing socioeconomics/advocacy, patient experience, and social media/informatics (20 polls total). Each poll contained a question asking for an opinion regarding the session's content. Polls were open for responses for 24 hours.

RESULTS

The average number of responses per poll was significantly higher for the user with the larger number of Twitter followers (24.3 ± 14.4 versus 11.2 ± 9.8, P = .015). A total of 57% of respondents agreed that radiologists' payments should shift to value-based payments, and 86% agreed that radiologists should routinely survey their patients to monitor quality; however, 83% disagreed with basing physician payments on patient satisfaction scores. A total of 85% disagreed that the artificial intelligence supercomputer Watson will entirely replace radiologists. A total of 76% agreed that social media can drive business at less cost than standard marketing. A total of 56% agreed with the direction of the ACR's advocacy and regulatory efforts, whereas 74% considered the ACR's advocacy efforts to be moderately or very useful for their practice. A total of 50% planned to change their practice on the basis of keynote remarks by Dr Ezekiel Emanuel.

CONCLUSIONS

Twitter polls provide a free and easy infrastructure to potentially capture global public sentiment during the course of a medical society meeting. Their use may enrich and promote discussions of key session content.

Interactive learning in oral and maxillofacial radiology

PURPOSE

The use of electronic tools in teaching is growing rapidly in all fields, and there are many options to choose from. We present one such platform, Learning Catalytics™ (LC) (Pearson, New York, NY, USA), which we utilized in our oral and maxillofacial radiology course for second-year dental students.

MATERIALS AND METHODS

The aim of our study was to assess the correlation between students' performance on course exams and self-assessment LC quizzes. The performance of 354 predoctoral dental students from 2 consecutive classes on the course exams and LC quizzes was assessed to identify correlations using the Spearman rank correlation test. The first class was given in-class LC quizzes that were graded for accuracy. The second class was given out-of-class quizzes that were treated as online self-assessment exercises. The grading in the self-assessment exercises was for participation only and not accuracy. All quizzes were scheduled 1-2 weeks before the course examinations.

RESULTS

A positive but weak correlation was found between the overall quiz scores and exam scores when the two classes were combined (P<0.0001). A positive but weak correlation was likewise found between students' performance on exams and on in-class LC quizzes (class of 2016) (P<0.0001) as well as on exams and online LC quizzes (class of 2017) (P<0.0001).

CONCLUSION

It is not just the introduction of technological tools that impacts learning, but also their use in enabling an interactive learning environment. The LC platform provides an excellent technological tool for enhancing learning by improving bidirectional communication in a learning environment.

Ultrasound Tutorials in Under 10 Minutes: Experience and Results

OBJECTIVE

The objective of the present study was to validate the use of web-based tutorials to teach technical skills in pediatric ultrasound.

MATERIALS AND METHODS

A series of 10 video tutorials, each of which was less than 10 minutes long, was created to improve the education of radiology trainees in terms of their ultrasound technique. Pediatric radiology fellow trainees from our institution in the United States and radiology resident trainees from our partner institution in Ethiopia were invited to participate in the study. Validation of the video tutorials was performed using two learning modules that focused on the renal bladder and the right upper quadrant (RUQ). Pretest and posttest skill and confidence assessments were also conducted. After watching the tutorials, the trainees completed questionnaires that assessed the reach, appeal, and learning effectiveness of the modules.

RESULTS

Ten fellow trainees and eight resident trainees participated in the study. The fellows were invited to evaluate both the RUQ and the renal bladder learning modules, whereas the residents evaluated the RUQ module only. Before reviewing the RUQ module, the fellows had performed a median of four RUQ ultrasound examinations, whereas the residents had performed a median of 400 RUQ ultrasound examinations. After the trainees viewed the learning module, the median skills test scores of the fellows increased from 20 to 37.5 (highest possible score, 45) (p < 0.01), and those of the residents increased from 38 to 40 (highest possible score, 40) (p = 0.04). With a total possible score of 15, the median confidence score improved from 8 to 11 for fellows (p < 0.01) and from 13.5 to 14.5 for residents (p = 0.04). After the fellows viewed the renal bladder learning module, their median skills test scores increased from 20 to 37.5 (highest possible score, 40) (p < 0.01), and their median confidence score increased from 8.5 to 11 (highest possible score, 15) (p = 0.01). Trainees gave the tutorials positive ratings overall.

CONCLUSION

Radiology fellow trainees and resident trainees with disparate backgrounds in ultrasound showed significant improvement in their technical skills in pediatric ultrasound and confidence after viewing the tutorials. The web-based design of the tutorials allows integration of international pediatric radiology training communities.

A new e-learning platform for radiology education (RadEd)

One of the key elements of e-learning platforms is the content provided to the students. Content creation is a time demanding task that requires teachers to prepare material taking into account that it will be accessed on-line. Moreover, the teacher is restricted by the functionalities provided by the e-learning platforms. In contexts such as radiology where images have a key role, the required functionalities are still more specific and difficult to be provided by these platforms. Our purpose is to create a framework to make teacher's tasks easier, specially when he has to deal with contents where images have a main role. In this paper, we present RadEd, a new web-based teaching framework that integrates a smart editor to create case-based exercises that support image interaction such as changing the window width and the grey scale used to render the image, taking measurements on the image, attaching labels to images and selecting parts of the images, amongst others. It also provides functionalities to prepare courses with different topics, exercises and theory material, and also functionalities to control students' work. Different experts have used RadEd and all of them have considered it a very useful and valuable tool to prepare courses where radiological images are the main component. RadEd provides teachers functionalities to prepare more realistic cases and students the ability to make a more specific diagnosis.

How Turkish radiology residents access information related to their profession in this social media and smartphone era

Purpose

To evaluate the frequency of mobile technology and social media usage among radiology residents and their access to professional information.

Materials and methods

A questionnaire consisting of 24 questions prepared using Google Drive was sent via e-mail to 550 radiology residents throughout the country. Of the 176 participating residents, 74 completed the survey via the internet, and 102 completed it at three different national radiology meetings. Response rates and its relationship with responses given to different questions were assessed.

Results

Hundred two male and 74 female residents participated in the survey. 141 (81.3%) residents thought that they had appropriate internet access in their department. The number of residents using a smartphone was 153 (86.9%). The android operating system (70, 45.8%) was the preferred operating system of respondants. Only 24 (15.7%) of the smartphone users thought that there were enough radiology related applications. “Radiology assistant” (18.9%), “Radiopedia” (7.8%) and “Radiographics” (7.8%) were the most utilized applications. Of the smartphone users, 87(56.9%) stated that they used cell phones in order to find radiological information, and the most used web pages were Google (165, 93.8%), Radiopaedia.org (129, 73.3%), Radiologyassistant.nl (135, 76.7%), and Pubmed (114, 64.8%). Social media usages were as follows: None (10, 5.7%), Facebook (139, 79%), Twitter (55, 31.3%), Google + (51, 29%) and YouTube (44, 25%).

Conclusion

While smartphone usage rates among the residents were high, the use of radiology specific applications was not common. Social media usage was very common among residents.

Capricorn-A Web-Based Automatic Case Log and Volume Analytics for Diagnostic Radiology Residents

RATIONALE AND OBJECTIVES

On-service clinical learning is a mainstay of radiology education. However, an accurate and timely case log is difficult to keep, especially in the absence of software tools tailored to resident education. Furthermore, volume-related feedback from the residency program sometimes occurs months after a rotation ends, limiting the opportunity for meaningful intervention.

MATERIALS AND METHODS

We surveyed the residents of a single academic institution to evaluate the current state of and the existing need for tracking interpretation volume. Using the results of the survey, we created an open-source automated case log software. Finally, we evaluated the effect of the software tool on the residency in a 1-month, postimplementation survey.

RESULTS

Before implementation of the system, 89% of respondents stated that volume is an important component of training, but 71% stated that volume data was inconvenient to obtain. Although the residency program provides semiannual reviews, 90% preferred reviewing interpretation volumes at least once monthly. After implementation, 95% of the respondents stated that the software is convenient to access, 75% found it useful, and 88% stated they would use the software at least once a month. The included analytics module, which benchmarks the user using historical aggregate average volumes, is the most often used feature of the software. Server log demonstrates that, on average, residents use the system approximately twice a week.

CONCLUSIONS

An automated case log software system may fulfill a previously unmet need in diagnostic radiology training, making accurate and timely review of volume-related performance analytics a convenient process.

Results of the 2014 survey of the American Alliance of Academic Chief Residents in Radiology

RATIONALE AND OBJECTIVES

The American Alliance of Academic Chief Residents in Radiology (A³CR²) conducts an annual survey of chief residents in accredited radiology programs in North America. The survey serves as a tool for observing trends and disseminating ideas among radiology programs.

MATERIALS AND METHODS

An online survey conducted through the SurveyMonkey Web site was distributed to chief residents from 187 Accreditation Council on Graduate Medical Education (ACGME)-accredited radiology training programs. A variety of multiple-choice and free-response questions were designed to gather information about residency program details, benefits, chief resident responsibilities, call, preparations for the recent American Board of Radiology Core Examination, implementation of selectives (mini-fellowships), fellowships, health care economics and the job market, and ACGME milestones.

RESULTS

Among those surveyed, 212 unique responses from 136 programs were provided, yielding a 73% response rate. Data were compared to historical data from prior surveys dating back through 2002.

CONCLUSIONS

Programs are increasingly providing 24-hour sonographer coverage, full day routine services on weekends, and 24-hour attending radiologist coverage. The new American Board of Radiology examination format and schedule has driven many changes, including when chief residents serve, board preparation and review, and how the final year of residency training is structured. Despite facing many changes, there is slightly more optimism among chief residents regarding their future job prospects.

Evaluation of use of e-Learning in undergraduate radiology education: a review

PURPOSE

The aim of this review is to investigate the evaluative outcomes present in the literature according to Kirkpatrick's learning model and to examine the nature and characteristics of the e-Learning interventions in radiology education at undergraduate level.

MATERIALS AND METHODS

Four databases (PubMed, MEDLINE, Embase, Eric) are searched for publications related to the application of e-Learning in undergraduate radiology education. The search strategy is a combination of e-Learning and Mesh and non Mesh radiology and undergraduate related terms. These search strategies are established in relation to experts of respective domains. The full text of thirty pertinent articles is reviewed. Author's country and study location data is extracted to identify the most active regions and year's are extracted to know the existing trend. Data regarding radiology subfields and undergraduate year of radiology education is extracted along with e-Learning technologies to identify the most prevalent or suitable technologies or tools with respect to radiology contents. Kirkpatricks learning evaluation model is used to categorize the evaluative outcomes reported in the identified studies.

RESULTS

The results of this analysis reveal emergence of highly interactive games, audience response systems and designing of wide range of customized tools according to learner needs assessment in radiology education at undergraduate level. All these initiatives are leading toward highly interactive self directed learning environments to support the idea of life-long independent learners. Moreover, majority of the studies in literature regarding e-Learning in radiology at undergraduate level are based on participant satisfaction followed by participant results or outcomes either before or after an intervention or both. There was no research particularly demonstrating performance change in clinical practice or patient outcome as they may be difficult to measure in medical education. Thus clinical competences and performances are highly affected by pretentious learning environments.