Medical students’ skills in image interpretation before and after training: A comparison between 3rd-year and 6th-year students from two different medical curricula

Medical Students' Progress in Detecting and Interpreting Visual and Auditory Clinical Findings

Phenomenon: Detection of visual and auditory clinical findings is part of medical students' core clinical performance abilities that a medical education curriculum should teach, assess, and remediate. However, there is a limited understanding of how students develop these skills. While training physical exam technical skills has received significant attention and emphasis, teaching and assessing medical students' ability to detect and interpret visual and auditory clinical findings skills has been less systematic. Therefore, the purpose of this study is to investigate how medical students' visual and auditory clinical findings skills progress and develop over their four years of undergraduate medical education. This study will provide educators insights that can guide curriculum refinements that lead to improving students' abilities in this area. Approach: A computer-based progress exam was created to measure the longitudinal development of students' abilities to detect and interpret visual and auditory findings. After pilot testing, sixty test items were developed in collaboration with six clinical faculty members and two medical education researchers. The exam includes detection and description of ECG, x-ray, heart sounds, breath sounds, skin lesions, and movement findings. The exam was administered to students at the beginning of each training year since 2014. Additionally, the exam was administered to the Class of 2017 prior to their graduation. Measurement validity and reliability tests were conducted. Descriptive statistics and ANOVA were used to determine progress. Findings: More than 98% of students in four years of training completed the exam each year. The exam instrument had high reliabilities and demonstrated acceptable concurrent validity when compared with other academic performance data. Findings showed that students' visual and auditory clinical findings skills increased each training year until their fourth year. There was no performance improvement between incoming Year 4 students and graduating Year 4 students. While group means increased, class performance did not become more homogeneous across four years. Longitudinal data showed the same performance patterns as the cross-sectional data. Performance of the bottom quartile of graduating fourth-year students was not significantly higher than the performance of the top quartile of incoming first-year students who had not had formal medical training. Insights: A longitudinal study to follow learners' performance in detecting and interpreting visual and auditory clinical findings can provide meaningful insights regarding the effects of medical training programs on performance growth. The present study suggests that our medical curriculum is not effective in bringing all students to a higher level of performance in detecting and interpreting visual and auditory clinical findings. This study calls for further investigation how medical students can develop visual and auditory detection and interpretation skills in undergraduate medical education. There is a need for planned curriculum and assessment of medical students' skills in detecting and interpreting visual and auditory clinical findings.

Exploring the Potential of Undergraduate Radiology Education in the Virtual World Second Life with First-cycle and Second-cycle Medical Students

RATIONALE AND OBJECTIVES

Virtual worlds have a remarkable potential for effective teaching and learning, providing immersive, realistic, and engaging online events. Previous studies have explored online education of health professionals in Second Life (SL), the most widely used virtual world, but none of the previous learning experiences were related to radiology. The purpose of this study was to explore the potential use of SL for undergraduate radiology education and the involvement of students in SL learning activities.

MATERIALS AND METHODS

We delivered a 4-week voluntary undergraduate radiology education program in SL, based on synchronous sessions and asynchronous tasks, with two modalities: introduction to basic radiology for first-cycle (first- to third-year) students and case-based clinical radiology for second-cycle (fourth- to sixth-year) students. Participants completed an evaluation questionnaire about the experiences after the learning program.

RESULTS

Forty-six students (20 first-cycle and 26 second-cycle) participated in this study. They found the contents of the course appropriate (mean ≥ 4.53/5), the initiative interesting, and the environment attractive (mean ≥ 4.32/5), and they were willing to participate in future SL experiences (mean ≥ 4.63/5). All students highly rated the organization, the content, the benefit to their medical education, and the professor (mean ≥ 9.05/10).

CONCLUSION

Online radiology education using SL is feasible and well received by medical students of all year groups. The students participated and engaged in this activity very positively and rated the experience highly. The potential of using SL for radiology education includes promising expectations regarding collaborative learning and gamification.

Teaching Systematic Viewing to Final-Year Medical Students Improves Systematicity but Not Coverage or Detection of Radiologic Abnormalities

PURPOSE

Systematic viewing of images is widely advocated in radiology; it is expected to lead to complete coverage of images and consequently more detection of abnormalities. Evidence on the efficacy of teaching systematic viewing to students is conflicting. The aim of this study was to investigate the effects of teaching systematic viewing to final-year medical students on systematicity of viewing behavior, coverage of the image, and detection.

METHODS

Final-year medical students (n = 60) viewed 10 chest radiographs in a first series before training and another 10 radiographs in a second series after training. Between series, students were taught basic chest radiographic viewing, in either a systematic or a nonsystematic manner. With eye tracking, systematicity (Levenshtein distances), coverage (percentage of image viewed), and detection (sensitivity and specificity) were measured.

RESULTS

In a mixed two-by-two design, significantly higher sensitivity was found after training compared with before training (F_1,55 = 6.68, P = .012, η_p² = .11) but no significant effect for type of training (F_1,55 = 1.24, P = .30) and no significant interaction effect (F_1,55 = 0.12, P = .73). Thus, training in systematic viewing was not superior to training in nonsystematic viewing. A significant interaction of training type and time of viewing was found on systematicity (F_1,49 = 20.0, P < .01, η_p² = .29) in favor of the systematic viewing group. No significant interaction was found for coverage (F_1,49 = 0.43, P = .51) or specificity (F_1,55 = .124, P = .73).

CONCLUSIONS

Both training types showed similar increases in sensitivity. Therefore, it might be advisable to pay less attention to systematic viewing and more attention to content, such as the radiologic appearances of diseases.

What We Do and Do Not Know about Teaching Medical Image Interpretation

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.

A combination of traditional learning and e-learning can be more effective on radiological interpretation skills in medical students: a pre- and post-intervention study

BACKGROUND

The ability to interpret an X-Ray is a vital skill for graduating medical students which guides clinicians towards accurate diagnosis and treatment of the patient. However, research has suggested that radiological interpretation skills are less than satisfactory in not only medical students, but also in residents and consultants.

METHODS

This study investigated the effectiveness of e-learning for the development of X-ray interpretation skills in pre-clinical medical students. Competencies in clinical X-Ray interpretation were assessed by comparison of pre- and post-intervention scores and one year follow up assessment, where the e-learning course was the 'intervention'.

RESULTS

Our results demonstrate improved knowledge and skills in X-ray interpretation in students. Assessment of the post training students showed significantly higher scores than the scores of control group of students undertaking the same assessment at the same time.

CONCLUSIONS

The development of the Internet and advances in multimedia technologies has paved the way for computer-assisted education. As more rural clinical schools are established the electronic delivery of radiology teaching through websites will become a necessity. The use of e-learning to deliver radiology tuition to medical students represents an exciting alternative and is an effective method of developing competency in radiological interpretation for medical students.