3D virtual reality simulation in radiography education: The students' experience

Medical imaging and radiation science students' use of artificial intelligence for learning and assessment

INTRODUCTION

Artificial intelligence has permeated all aspects of our existence, and medical imaging has shown the burgeoning use of artificial intelligence in clinical environments. However, there are limited empirical studies on radiography students' use of artificial intelligence for learning and assessment. Therefore, this study aimed to gain an understanding of this phenomenon.

METHODS

The study used a qualitative explorative and descriptive research design. Data was obtained through five focus group interviews with purposively sampled undergraduate medical imaging and radiation science students at a single higher education institution in South Africa. Verbatim transcripts of the audio-recorded interviews were analysed thematically.

RESULTS

Three themes and related subthemes were developed: 1) understanding artificial intelligence, 2) experiences with the use of artificial intelligence with the subthemes of the use of artificial intelligence in theoretical and clinical learning and challenges of using artificial intelligence, and 3) incorporation of artificial intelligence in undergraduate medical imaging and radiation sciences education with the subthemes of student education, ethical considerations and responsible use and curriculum integration of artificial intelligence in relation to learning and assessment.

CONCLUSION

Participants used artificial intelligence for learning and assessment by generating ideas to enhance academic writing, as a learning tool, finding literature, language translation and for enhanced efficiency. Simulation-based artificial intelligence supports students' clinical learning, and artificial intelligence within the clinical departments assists with improved patient outcomes. However, participants expressed concerns about the reliability and ethical implications of artificial intelligence-generated information. To address these concerns, participants suggested integrating artificial intelligence into medical imaging and radiation sciences education, where educators need to educate students on the responsible use of artificial intelligence in learning and consider artificial intelligence in assessments.

IMPLICATIONS FOR PRACTICE

The study findings contribute to understanding medical imaging and radiation sciences students' use of artificial intelligence and may be used to develop evidence-based strategies for integrating artificial intelligence into the curriculum to enhance medical imaging and radiation sciences education and support students.

Insights into enhanced learning through virtual reality

INTRODUCTION

This study investigates the impact of Immersive Virtual Reality (VR) on learning outcomes in radiography training using Virtual Medical Coaching's X-Ray Pro VR software. VR offers immersive experiential learning that may enhance academic performance and professional preparedness.

METHODS

The study involved 130 students from two consecutive cohorts: one using traditional training methods and the other using VR software. We employed a mixed-methods approach, integrating quantitative measures of academic performance and clinical competency with qualitative insights into student engagement, enjoyment, and stress levels. The VR group used Virtual Medical Coaching simulation software, while the traditional group used physical simulation machines (Siemens Healthineers) to practice positioning anthropomorphic manikins, adjusting exposure settings, and handling X-ray equipment. Data were collected at four points: immediately post-training and at 1 month, 3 months, and 8 months follow-up.

RESULTS

The VR cohort showed significantly higher knowledge retention, work readiness, and lower stress levels compared to the traditional cohort. Among the participants trained in VR, a vast majority (59 out of 65) reported a high level of satisfaction with the immersive nature of the training, emphasizing its realism and direct applicability to clinical scenarios. Quantitative analysis revealed superior performance metrics for the VR group across all measured time points (p < 0.001). Qualitative feedback highlighted enhanced engagement and enjoyment among VR-trained students.

CONCLUSION

The results of this study clearly indicate that VR training significantly enhances learning outcomes in radiography education. The VR cohort exhibited higher knowledge retention, work readiness, student engagement, and enjoyment, along with lower stress levels and higher confidence compared to the traditional cohort. These findings support the integration of VR into professional training curricula to improve student performance and engagement.

Diagnostic radiography workforce expectations of learners against the 2023 HCPC standards of proficiency: Results of a UK Delphi study

INTRODUCTION

The UK Health and Care Professions Council revised the Standards of Proficiency for diagnostic radiographers in 2023 to reflect modern practices and service needs. This will impact on the training and assessment of learners throughout their programmes in order to support them to meet the threshold standards.

METHODS

A Delphi survey was distributed to UK diagnostic radiographers to ascertain the stage of training in which they expect each standard of proficiency to be demonstrated by the learner.

RESULTS

Ninety-four diagnostic radiographers responded to the survey and 58.5% (n = 55) completed the second round of the survey. Participants agreed on the stage of pre-registration training that 74.9% of standards should be met. However, for 19.6% of standards there was no consensus. In 5.5% of standards participants expected these to be met one year post qualification.

CONCLUSION

Agreement of when three quarters of the new Standards would be expected to be met during pre-registration training could support practice placement learning and assessment. However, there is some uncertainty around the Standards and the ability to provide appropriate resources, support, and expertise to enable learners to meet them.

IMPLICATIONS FOR PRACTICE

The consensus of expectations could inform stage appropriate learning opportunities aligned to the 2023 HCPC Standards within practice placements, and a standardised assessment, should the appetite be established. However, the UK diagnostic radiography profession still has some work to do in aligning expectations with the statutory regulatory body requirements and preparing all staff to support learners to meet all threshold standards at point of qualification.

Diagnostic radiography clinical resources in a workplace-based learning setting

INTRODUCTION

Workplace-based learning (WBL) is a method that combines theoretical knowledge with practical experience, promoting learner autonomy. Diagnostic radiography students in South Africa face challenges due to inconsistencies in clinical resources from the public and private sectors. Insufficient clinical resources can negatively impact students' competence and confidence in their skills. This study explored diagnostic radiography students' understanding of clinical resources.

METHODS

A qualitative exploratory-descriptive and contextual study with 21 participants at a single Higher Education institution (HEI) in South Africa was conducted through one-on-one semi-structured interviews on Microsoft Teams. The data collection tool was an interview guide. Students' narratives were transcribed and analysed using thematic analysis.

RESULTS

Thematic analysis revealed four themes: Theme one: Defining clinical resources in WBL; Theme two: Experiences with clinical resources in WBL; Theme three: Accessibility of clinical resources in WBL and Theme four: Defining clinical resources in WBL.

CONCLUSION

Clinical resources are essential for radiography learning, promoting skills development and independent work. Balancing these resources with other activities is crucial for a comprehensive WBL experience. However, unequal access can hinder learning. Alternative solutions should be explored for specialised imaging techniques. Integrating simulation and collaborative practice between clinical practices and HEIs can enhance students' preparedness for real-world scenarios.

The effect of non-immersive virtual reality radiographic positioning simulation on first-year radiography students' image evaluation performance

INTRODUCTION

Optimal radiographic image quality is critical because it affects the accuracy of the reporter's interpretation. Radiographers have an ethical obligation to obtain quality diagnostic images while protecting patients from unnecessary radiation, including minimizing rejected and repeated images. Repeated imaging due to positioning errors have increased in recent years.

METHODS

This study evaluated the effectiveness of non-immersive virtual reality (VR) simulation on first-year students' evaluation of positioning errors on resultant knee and lumbar spine images. Crossover intervention design was used to deliver radiographic image evaluation instruction through traditional lecture and guided simulation using non-immersive VR to 33 first-year radiography students at a single academic institution located across four geographic program locations. Pre- and post-test knowledge assessments examined participants' ability to recognize positioning errors on multiple-choice and essay questions.

RESULTS

Raw mean scores increased on multiple choice questions across the entire cohort for the knee (M = 0.82, SD = 3.38) and lumbar spine (M = 2.91, SD = 3.69) but there was no significant difference in performance by instructional method (p = 0.60). Essay questions reported very minimal to no raw mean score increases for the knee (M = 0.27, SD = 2.78) and lumbar spine (M = 0.00, SD = 2.55), with no significant difference in performance by instructional method (p = 0.72).

CONCLUSION

Guided simulation instruction was shown to be as effective as traditional lecture. Results also suggest that novice learners better recognize image evaluation errors and corrections from a list of options but have not yet achieved the level of competence needed to independently evaluate radiographic images for diagnostic criteria.

IMPLICATIONS FOR PRACTICE

Non-immersive VR simulation is an effective tool for image evaluation instruction. VR increases access to authentic image evaluation practice by providing a simulated resultant image based off the students' applied positioning skills.

How to run successful tutor-training programs for radiographers: A systematic review and considerations for future perspectives

INTRODUCTION

Healthcare professions differ from each other, therefore need different approaches in teaching clinical practices. While teaching and learning designs for medical students are widely present on databases, few information is available for radiographers. The aim of this research is to define tools and knowledge needed to develop successful tutor-training programs that can be cross-cutting and inter-disciplinary for radiography profession, taking inspiration from other healthcare professions' programs since the paucity of evidence for radiographers.

METHODS

A systematic review (PubMed/Embase) was performed according to the PRISMA checklist. Original articles on learning environment related to healthcare practitioners were included. Inclusion criteria comprehended articles covering design and frameworks of peer-assisted-learning (PAL) programs and training-the-trainer (TTT) curricula, skills required to become tutors, tips to install successful tutor-training programs along with benefits for tutors involved. From 1618 retrieved articles, after two selection rounds, 15 articles met the inclusion criteria.

RESULTS

Out of the 15 articles, none is addressed to radiographers and only 7 % (1/15) to other healthcare professions, opposed to the 93 % (14/15) addressed to medical students. All articles discuss feedback providing, 66 % (10/15) debates which the best behaviour to maintain towards students is to maximize learning, and 46 % (7/15) inform about the importance of briefing and de-briefing activities. An identical percentage (46 %, 7/15) underlines the advantages of tutoring experiences. 11 articles (73 %) enhance that tutors aren't adequately trained to carry out tutoring activities.

DISCUSSION

Through curricula designed on TTT and PAL programs, radiographers are provided with necessary teachings and frameworks to set up effective training paths. Few institutes promote educational tutor-training courses, even though these are beneficial both for tutors and students, consolidating professionals' knowledge and maximizing students' practical skills.

CONCLUSION

Offering tutor-training curricula contributes to the development of radiographers as teachers, providing them with guiding principles to improve their formative skills towards future colleagues, therefore optimizing efficacy and effectiveness of programs.

Fostering the development of research literacy and exposure to current issues in radiography: Experience of a co-designed journal club

INTRODUCTION/BACKGROUND

Journal clubs are an effective learning activity that can fulfill the continuing professional development requirements for diagnostic radiographers. For students, journal clubs can support the development of critical appraisal skills and identify opportunities to implement evidence-based practice. This educational perspective aims to describe a co-designed journal club program, which was integrated into a 9-week part-time work integrated learning on-campus placement program for diagnostic radiography students.

METHODS

The framework for the journal club program was co-designed by students and academics. The benefits and limitations of the program were analysed and discussed in relation to the collaborative aspect of the task, the nature of the program and the focus on continuing professional development.

DISCUSSION

Journal club activities provided ample opportunities for students to engage with current issues in radiography. The flexibility and practicality of the program contributed to student engagement, but were also considered a challenge to wide participation in the weekly journal club discussion. A co-designed journal club activity can facilitate reflective practice, independent learning and critical thinking. Whilst the significance of the journal club was not extensively assessed in its first implementation, it has the potential to improve student research literacy skills and critical appraisal.

CONCLUSION

A perceived benefit of the journal club activity was the collaboration within groups who were tasked to present each week. Evaluation of the level of engagement with the program as well as its ability to improve critical analytical skills and data interpretation in the future is essential.

The Scope of Virtual Reality Simulators in Radiology Education: Systematic Literature Review

Background

In recent years, virtual reality (VR) has gained significant importance in medical education. Radiology education also has seen the induction of VR technology. However, there is no comprehensive review in this specific area. This review aims to fill this knowledge gap.

Objective

This systematic literature review aims to explore the scope of VR use in radiology education.

Methods

A literature search was carried out using PubMed, Scopus, ScienceDirect, and Google Scholar for articles relating to the use of VR in radiology education, published from database inception to September 1, 2023. The identified articles were then subjected to a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-defined study selection process.

Results

The database search identified 2503 nonduplicate articles. After PRISMA screening, 17 were included in the review for analysis, of which 3 (18%) were randomized controlled trials, 7 (41%) were randomized experimental trials, and 7 (41%) were cross-sectional studies. Of the 10 randomized trials, 3 (30%) had a low risk of bias, 5 (50%) showed some concerns, and 2 (20%) had a high risk of bias. Among the 7 cross-sectional studies, 2 (29%) scored "good" in the overall quality and the remaining 5 (71%) scored "fair." VR was found to be significantly more effective than traditional methods of teaching in improving the radiographic and radiologic skills of students. The use of VR systems was found to improve the students' skills in overall proficiency, patient positioning, equipment knowledge, equipment handling, and radiographic techniques. Student feedback was also reported in the included studies. The students generally provided positive feedback about the utility, ease of use, and satisfaction of VR systems, as well as their perceived positive impact on skill and knowledge acquisition.

Conclusions

The evidence from this review shows that the use of VR had significant benefit for students in various aspects of radiology education. However, the variable nature of the studies included in the review reduces the scope for a comprehensive recommendation of VR use in radiology education.

What do the revised UK standards of proficiency mean for diagnostic radiography training? A regional radiographer focus group study

INTRODUCTION

Revisions to the UK Health and Care Professions Council (HCPC) standards of proficiency for diagnostic radiographers came into effect on September 1st 2023. Changes include an increase of proficiencies in CT and extended to MRI imaging. As workforce support the development of learners to meet stage outcomes in practice, this study aimed to understand the radiographers' expectations of future learners' training to meet the new standards of proficiency.

METHODS

Snowball sampling was used to invite practice educators/student supervisors and department leads within the 21 NHS Trusts in the North East and Yorkshire region providing diagnostic radiography practice placements. Online focus groups used a semi structured topic guide to explore the expectations of student performance during different stages of their training, and on different types of pre-registration programmes. Participants views were sought on considerations for appropriate assessment. Thematic analysis was supported by NVivo software.

RESULTS

Fifteen diagnostic radiographers across 11 NHS trusts participated in 5 focus groups in November 2022. The findings showed consistency in expectations of student performance in projectional radiography, patient care and communication. Participants felt some standards of proficiency were beyond threshold competency, or current practices were a barrier in supporting learning. Participants felt assessment over a period and range of examinations in the clinical environment gave a fairer picture of student performance.

CONCLUSION

There is uncertainty and perceived barriers in supporting future diagnostic radiography training in the practice setting.

IMPLICATIONS FOR PRACTICE

Further work will be needed to identify and support appropriate learning opportunities and stage outcomes if learners are to meet the breadth of HCPC standards of proficiency with some consistency.

July 2021 civil unrest: South African diagnostic radiography students' experiences

Background

South Africa (SA), in 2021, experienced a wave of civil unrest following political events that led to mass looting and the destruction of property. Civil unrests, among other disruptions, have been seen to cause ripple effects on healthcare education, particularly for radiography students who undergo work integrated learning within hospitals and universities, even during these times of unrest.

Aim

This study aimed to explore and describe the undergraduate diagnostic radiography students' experience of the civil unrest that occurred in SA in 2021.

Setting

The study was conducted across five universities in South Africa, offering the diagnostic radiography programme.

Methods

A qualitative, interpretive phenomenological design was employed as it enabled the researchers to facilitate focus group interviews to gain insight into the lived experiences of the students during this time.

Results

Four themes emerged from the study data, namely: (1) Negative effects on students' emotional and psychological well-being, (2) Academic and clinical support mechanisms during disruptions, (3) The influence of disruptions on clinical training, (4) Recommendations to support students for future disruptions.

Conclusion

The participants from this study described the negative effects that the civil unrest had on their emotional and mental well-being. There is a need for increased support mechanisms during times of disruptions from universities across South Africa.

Contribution

The findings highlight the ripple effects that disruptions, such as civil unrests, have on radiography students. This can assist universities to relook at their institutional support structures, in order to enhance the current support given to students across universities in times of disruptions.

Using virtual reality simulation for training practical skills in musculoskeletal wrist X-ray - A pilot study

OBJECTIVES

Using virtual reality (VR), students of radiography can practice acquisition and positioning of musculoskeletal radiographs and get immediate feedback on their performance within the simulator. The purpose of this study was to assess usability of a newly developed VR simulator and to explore self-perceived clinical readiness (SPCR) of radiography students before and after training acquisition of wrist radiographs in the VR simulator.

MATERIAL AND METHODS

A prospective methodology was applied where the students (n = 10) estimated their own SPCR in regard to acquisition of wrist radiographs pre- and post-VR training. A questionnaire on usability, realism, and educational value of the simulator was answered post-VR training. Usability and SPCR scores were calculated. The student's paired t-test was applied to explore the impact of VR training on SPCR.

RESULTS

The students (90%) reported that the simulator was realistic and they thought that it could contribute to learning. The pre- and post-SPCR scores were 75 (95% confidence interval [CI]: 54-96) and 77 (95% CI: 59-95), respectively. There was no significant difference (P = 0.4574) between the pre- and post-SPCR scores.

CONCLUSION

Results indicated that the concept of training acquisition and positioning of wrist radiographs in a VR simulator is feasible with positive feedback from the students. The SPCR scores improved slightly, although not statistically significant, after completion of the training session.

Student perceptions of the use of three-dimensional (3-D) virtual reality (VR) simulation in the delivery of radiation protection training for radiography and medical students

BACKGROUND

VR simulation-based learning is increasingly used in healthcare education to prepare students for clinical practice. This study investigates healthcare students' experience of learning radiation safety in a simulated interventional radiology (IR) suite.

METHOD

Radiography students (n = 35) and medical students (n = 100) were introduced to 3D VR radiation dosimetry software designed to improve the learners' understanding of radiation safety in IR. Radiography students underwent formal VR training and assessment, which was complemented with clinical placement. Medical students practiced similar 3D VR activities informally without assessment. An online questionnaire containing Likert questions and open-ended questions was used to gather student feedback on the perceived value of VR-based radiation safety education. Descriptive statistics and Mann-Whitney U tests were used to analyse Likert-questions. Open-ended question responses were thematically analysed.

RESULTS

A survey response rate of 49% (n = 49) and 77% (n = 27) was obtained from radiography and medical students respectively. Most respondents (80%) enjoyed their 3D VR learning experience, favouring the in-person VR experience to online VR. 73% felt that VR learning enhanced their confidence across all relevant learning outcomes. Whilst confidence was enhanced across both cohorts, VR learning had a greater impact on confidence levels amongst medical students with respect to their understanding of radiation safety matters (U = 375.5, p < 0.01). 3D VR was deemed a valuable assessment tool.

CONCLUSION

Radiation dosimetry simulation-based learning in the 3D VR IR suite is perceived to be a valuable pedagogical tool by radiography and medical students and enhances curricula content.

Extended Reality in Diagnostic Imaging-A Literature Review

The utilization of extended reality (ER) has been increasingly explored in the medical field over the past ten years. A comprehensive analysis of scientific publications was conducted to assess the applications of ER in the field of diagnostic imaging, including ultrasound, interventional radiology, and computed tomography. The study also evaluated the use of ER in patient positioning and medical education. Additionally, we explored the potential of ER as a replacement for anesthesia and sedation during examinations. The use of ER technologies in medical education has received increased attention in recent years. This technology allows for a more interactive and engaging educational experience, particularly in anatomy and patient positioning, although the question may be asked: is the technology and maintenance cost worth the investment? The results of the analyzed studies suggest that implementing augmented reality in clinical practice is a positive phenomenon that expands the diagnostic capabilities of imaging studies, education, and positioning. The results suggest that ER has significant potential to improve diagnostic imaging procedures' accuracy and efficiency and enhance the patient experience through increased visualization and understanding of medical conditions. Despite these promising advancements, further research is needed to fully realize the potential of ER in the medical field and to address the challenges and limitations associated with its integration into clinical practice.

Inclusion of cross-sectional and radiological images for better understanding of musculoskeletal anatomy and decreasing the risk of adverse events during dry needling in undergraduate physiotherapy students

Since there is an increasing rate of physiotherapists using invasive procedures during the clinical practice, understanding the cross-sectional anatomy and radiological images is essential for ensuring patients' safety during these interventions. Therefore, the aim of this study was to analyze the students' opinion of including cross-sectional and radiological images to traditional methodologies, to evaluate whether these additional resources improve their ability to identify musculoskeletal structures in radiological images and their understanding of neurovascular and visceral structures related with specific muscles to be avoided during invasive procedures. First-year undergraduate physiotherapy students were enrolled in the study. A brief online survey asking about their opinion about the use of cross-sectional and radiological images as complementary resources was built. In addition, two open-answer tests (before and after the inclusion of these resources) were conducted to evaluate their ability to identify correctly musculoskeletal structures in magnetic resonance and ultrasound images and to evaluate their awareness of high-risk structures related with specific muscles. One-hundred-thirty-two students returned the online survey and one-hundred-forty-eight completed all the tests. In general, students opined cross-sectional images to be of utility for learning anatomy (81.8%) and radiological images (93.9%) and felt they benefited from cross-sectional and ultrasound images (78.0%). All tests showed significant improvements after the inclusion of these complementary resources (all, p < 0.001) except for trunk structures in MRI (p = 0.777). The implementation of anatomical cross-sectional and radiological images resulted in better understanding of radiological images and better cognition of possible risk during invasive procedures.

The Supervisees' Perspectives Concerning the Clinical Supervision of Radiologic Sciences Students at Clinical Sites: Implications and Future Directions

INTRODUCTION

Clinical supervision (CS) is essential to practice-based learning in radiology. The assessment of the effectiveness of CS is essential to ensure the success of the process and to provide high-quality patient care.

PURPOSE

This study aimed to evaluate the CS of both Diagnostic Radiography (DR) and Nuclear Medicine (NM) technology students studying at Kuwait University.

METHODS

The Manchester Clinical Supervision Scale-26 (MCSS-26©) was distributed electronically to 90 third and fourth year students from Radiologic Sciences department. Ethical approval was obtained from the Health Sciences Centre (HSC) Ethical Committee and all the participants provided electronic informed consent. Data are presented as mean ± SD.

RESULTS

Seventy responses were collected from DR and NM (response rate 78%, DR: n= 51, NM: n=19). Overall, the mean CS score from the MCSS was 67.7±11.3, n=70. CS in NM scored more effective than that in DR with a p=0.037 (72.3±10.1, 66.0±11.3, respectively).

CONCLUSION

The effectiveness of CS has been evaluated in third and fourth year students across the two divisions of RS the department at Kuwait University. This study showed that students value the impact of CS in their professional role and 70% reported being satisfied with the overall CS experience. Limited studies are available that focuses on students' perceptions about clinical supervision; therefore, more studies are needed to evaluate the effectiveness of CS among RS students. Implications for interprofessional education are presented.

Radiography education in 2022 and beyond - Writing the history of the present: A narrative review

OBJECTIVES

The COVID-19 pandemic had a major effect on teaching and learning. This study aimed to describe a range of teaching, learning, and assessment strategies related to radiography education which have become more common due to the pandemic through a narrative literature review.

KEY FINDINGS

Educational change in radiography was accelerated by the disruption caused by the pandemic. Changes included the site and mode of teaching and conducting of assessment. While some of the digital transformation trends were introduced before the pandemic, others were further amplified during this period of time. Alternative solutions such as virtual reality technology, gamification, and technology-enhanced learning were especially salient and have the potential to mitigate challenges brought about by the pandemic. The use of technology in the clinical setting, in assessment, and to facilitate feedback, are important tools for improving learners' clinical skills performance. Collectively, these digital technologies can maximise learning and support mastery of knowledge, skills and attitudes.

CONCLUSION

The pandemic has cast a new light on existing methodologies and pedagogies in education. This review suggests that digital technology is shaping teaching and learning within radiography education and also that educators cannot ignore this digital shift. With the digital trajectory, it would be highly useful to transform approaches to education within radiography to support learning as radiography education moves towards the new normal era.

IMPLICATIONS FOR PRACTICE

Digital technology in education can help improve the learning experience for learners but educators need to be equipped with the technological skills and be adaptable to these changes. Continual sharing of experiences and knowledge among radiography educators is essential. Safety nets need to be in place to ensure digital inclusiveness and that no learner gets left behind due to the digital divide in education.

Supporting radiography clinical placements in Ireland during the COVID-19 pandemic: The practice educators perspective

INTRODUCTION

The COVID-19 pandemic has significantly impacted healthcare services and the clinical learning environment. Several studies have investigated radiography students' experiences of clinical placement during the pandemic; however, few have investigated the Clinical Practice Educator's (CPEs) perspective. CPEs play a pivotal role in supporting clinical education.

METHOD

A qualitative study was conducted using a purposeful sample of twenty-two CPEs, each working in a different Irish hospital. Four semi-structured focus groups were used to gather data. To maintain reasonable homogeneity, CPEs who were new to the role (n = 8) were assigned a separate focus group from experienced CPEs (n = 14). Inductive thematic analysis was applied.

RESULTS

CPEs experienced role expansion, particularly in managerial and administrative aspects of the role. They described arranging COVID-19 vaccinations locally for radiography students and the complexities of student rostering during the pandemic. CPEs perceived the pandemic to have impacted students' emotional wellbeing with 'high anxiety levels' and 'loneliness' being reported. They also perceived issues with clinical readiness and the student transition to clinical practice. Many challenges were faced by CPEs including arranging clinical recovery time for numerous students when sites were already at full capacity, fewer learning opportunities due to decreased patient throughput and range of imaging examinations, social distancing constraints, resistance from staff to student placements, and a shortage of staff for student supervision. Flexibility, communication, and multi-level support helped CPEs to fulfil their role.

CONCLUSION

The results provide insight into how CPEs supported radiography clinical placements during the pandemic and into the challenges faced by CPEs in their role. CPEs supported student placement through multi-level communication, teamwork, flexibility, and student advocacy.

IMPLICATIONS FOR PRACTICE

This will aid understanding of the support mechanisms needed by CPEs to provide quality clinical placements.

Immersive virtual reality for pre-registration computed tomography education of radiographers: A narrative review

To be registered as a medical radiation practitioner, The Medical Radiation Practice Board of Australia (MRPBA) requires radiographers to be capable of performing computed tomography (CT) imaging examinations safely and effectively. Universities meet this requirement by offering practical CT training to radiography students on-campus and during clinical placements. However, institutions face challenges when facilitating on-campus CT practicum. Virtual reality (VR) has been suggested as a possible solution for radiography students to gain CT scanning experience. This narrative review explored relevant literature to investigate the potential for immersive VR to be incorporated into CT practicum. Benefits and limitations of this education technology are examined with resultant recommendations made for integration into the CT curriculum. Results found that VR enhances CT learning for students, increases confidence and raises motivation for the simulated CT task. CT simulation provides a viable alternative in the context of pandemic-imposed restrictions and reduced CT placement duration. However, it remains debatable as to whether immersive VR truly enhances student learning compared with other VR modalities, such as computer-based CT simulation. In addition, a lack of staff training, availability of resources and technical problems were flagged as limitations. We concluded that before immersive VR is integrated into CT education, significant optimisation of the simulation is needed. This includes ensuring VR scenarios are based on learning paradigms and feedback is integrated as part of simulation learning. Engaging clinical partners during the CT VR rollout is imperative to ensure successful transition of students from university learning to clinical placement.

The impact of 3D virtual reality radiography practice on student performance in clinical practice

INTRODUCTION

Simulation-based learning plays an integral role in preparing students for clinical practice. This study investigated the impact of immersive three-dimensional (3D) virtual reality (VR) simulation-based learning on first-year radiography students' performance in the clinical setting.

METHODS

A retrospective analysis of first-year radiography clinical assessments was carried out to compare performance pre-and post-introduction of VR. The stage one cohort with no VR education was considered the control group (n = 93). The VR group (n = 98) had seven hours of practice in the immersive VR suite (Virtual Medical Coaching). Experienced clinical tutors assessed first-year students performing an extremity radiographic examination in the clinical setting. Assessment criteria were ranked on a 5-point Likert scale from poor to excellent. Mann Whitney U Tests were applied to compare performance across cohorts.

RESULTS

Students trained with VR performed better across 20 of the 22 assessment criteria. VR-trained students performed significantly better (more ranked as 'very good' or 'excellent') than the control group in the following criteria; positioning patients for X-rays (19% difference) (U = 3525, z = -2.66, p < 0.05), selecting exposure factors (12% difference) (U = 3680, z = -3.13, p < 0.05), image appraisal of patient positioning (27% difference) (U = 3448, z = -2.9, p < 0.05) and image appraisal of image quality (18% difference) (U = 3514, z = -2.6, p < 0.05). Their comprehension of clinical indications, equipment set up and explanation of the procedure was also significantly better (p < 0.05).

CONCLUSION

This is the first study to investigate the translation of VR learning into radiography clinical practice. VR learning had a positive impact on the performance of first-year students in their clinical assessment, especially with respect to patient positioning, exposure parameter selection and image appraisal.

IMPLICATIONS FOR PRACTICE

VR is a valuable educational tool in preparing novice radiography students for clinical practice. It is particularly useful to enhance student knowledge in the areas of patient positioning, exposure factor selection and radiographic image appraisal.

Survey of clinical placements within pre-registration diagnostic radiography programmes in the UK and Ireland

INTRODUCTION

Placement capacity is a challenge in supporting the clinical education of diagnostic radiography students within the UK at a time where growth in the workforce is required if service delivery needs are to be met. COVID-19 has been one of the catalysts in the growth of innovative and simulated clinical placement models. This survey seeks to understand the current picture of clinical education models and the drivers for it.

METHODS

A short online MS Forms survey with mixed question types was distributed to higher education institutions (HEIs) delivering pre-registration diagnostic radiography programmes in the UK and Ireland. Descriptive and thematic analysis of data was undertaken to gain insight into the clinical placement models used.

RESULTS

Responses related to 24 programmes from 17 HEIs were collated. Capacity issues, increased student numbers and ability to achieve the learning outcomes were the drivers for the model and arrangement of clinical placements. Clinical practice hours varied widely across programmes as did the proportion of simulation-based education. Respondents felt an increase in the use of placements in modalities and other settings could further increase training capacity.

CONCLUSION

Opportunities to further change the clinical placement model have been identified which may alleviate some pressure points on capacity. Guidance around clinical practice hours may facilitate a sustainable approach to workforce training. Innovative placement models will require assessment strategies that align in order that students demonstrate relevant capabilities in a range of settings and value varied learning opportunities.

IMPLICATIONS FOR PRACTICE

The collective engagement and innovation of higher education institutions and service providers will be needed to create sustainable quality models of clinical training and assessment to meet diagnostic radiography workforce requirements.

Comparison of virtual reality and physical simulation training in first-year radiography students in South America

INTRODUCTION

The aim of this study was to comparatively evaluate the learning outcomes achieved by first-year radiography students educated with either virtual reality (VR) simulation training or physical simulation training. The implementation of VR has been proposed to enhance learning in radiography students and provide a more effective and efficient approach to simulation. However, the learning outcomes achieved with this approach have not been widely investigated.

METHODS

Through stratified randomisation, 188 radiography students were allocated to one of two matched groups: a VR group (using Virtual Medical Coaching's Radiography simulation) and a physical simulation group (using Philips' X-ray equipment). Both groups were taught 31 radiography views over one 25-week semester. Both groups were assessed in an Objective Structured Clinical Examination (OSCE), using actors as patients in a physical X-ray environment. Assessment was conducted by assigning objective count scores for five assessment criteria.

RESULTS

The VR group achieved shorter OSCE duration and fewer errors in moving equipment and patient positioning: these results were statistically significant (P < 0.00). There was no significant difference in the frequency of errors in radiographic exposure setting between the VR and the physical simulation group. The current findings concur with the limited number of published studies concerning VR simulation in radiography.

CONCLUSIONS

The results of this study demonstrated superior effectiveness and efficiency in the VR group. This provides preliminary evidence to introduce VR simulation in the host institution and provide evidence that it may be possible to replace the use of physical simulation across other years of the degree. Further research investigating these possibilities is warranted.

Effects of three-dimension movie visual fatigue on cognitive performance and brain activity

To further develop three-dimensional (3D) applications, it is important to elucidate the negative effects of 3D applications on the human body and mind. Thus, this study investigated differences in the effects of visual fatigue on cognition and brain activity using visual and auditory tasks induced by watching a 1-h movie in two dimensions (2D) and 3D. Eighteen young men participated in this study. Two conditions were randomly performed for each participant on different days, namely, watching the 1-h movie on television in 2D (control condition) and 3D (3D condition). Before and after watching the 1-h movie on television, critical flicker fusion frequency (CFF: an index of visual fatigue), and response accuracy and reaction time for the cognitive tasks were determined. Brain activity during the cognitive tasks was evaluated using a multi-channel near-infrared spectroscopy system. In contrast to the control condition, the decreased CFF, and the lengthened reaction time and the decreased activity around the right primary somatosensory cortex during Go/NoGo blocks in the visual task at post-viewing in the 3D condition were significant, with significant repeated measures correlations among them. Meanwhile, in the auditory task, the changes in cognitive performance and brain activity during the Go/NoGo blocks were not significant in the 3D condition. These results suggest that the failure or delay in the transmission of visual information to the primary somatosensory cortex due to visual fatigue induced by watching a 3D movie reduced the brain activity around the primary somatosensory cortex, resulting in poor cognitive performance for the visual task. This suggests that performing tasks that require visual information, such as running in the dark or driving a car, immediately after using a 3D application, may create unexpected risks in our lives. Thus, the findings of this study will help outlining precautions for the use of 3D applications.

Simulation-based education for medical radiation students: A scoping review

Simulation-based education is a significant aspect of teaching clinical skills in tertiary medical radiation science programmes, allowing students to experience the clinical setting in a safe environment. As an educational tool, simulation exists in many valid forms including role play, interprofessional simulation and virtual reality simulation. This scoping review looks at the current literature in this field to identify the evidence surrounding simulation-based education for medical radiation students. The purpose of this review is to provide an evidence-based guide for educators, identify gaps in the literature and suggest areas of future research. Data extraction was performed on 33 articles where the interventions could be categorised into either role play simulation, virtual simulation, simulation videos or online learning environments. Most studies demonstrated that simulation could improve clinical competence and increase preparedness and confidence for clinical placement. Student satisfaction remained high throughout the studies; however, it is the view of many that although simulation-based education is a valid and effective tool, it is complementary to and not a replacement for clinical placement.

Radiography education with VR using head mounted display: proficiency evaluation by rubric method

BACKGROUND

The use of head mounted display (HMD)-based immersive virtual reality (VR) coaching systems (HMD-VRC) is expected to be effective for skill acquisition in radiography. The usefulness of HMD-VRC has been reported in many previous studies. However, previous studies have evaluated the effectiveness of HMD-VRC only through questionnaires. HMD-VRC has difficulties in palpation and patient interaction compared to real-world training. It is expected that these issues will have an impact on proficiency. The purpose of this study is to determine the impact of VR constraints in HMD-VRC, especially palpation and patient interaction, on radiographic skills proficiency in a real-world setting.

METHODS

First-year students (n = 30) at a training school for radiology technologists in Japan were randomly divided into two groups, one using HMD-VRC (HMD-VRC group) and the other practicing with conventional physical equipment (RP group) and trained for approximately one hour. The teachers then evaluated the students for proficiency using a rubric method.

RESULTS

In this study, it was found that some skills in the HMD-VRC group were equivalent to those of the RP group and some were significantly lower than those of the RP group. There was a significant decrease in proficiency in skills related to palpation and patient interaction.

CONCLUSIONS

This study suggests that HMD-VRC can be less effective than real-world training in radiographic techniques, which require palpation and patient interaction. For effective training, it is important to objectively evaluate proficiency in the real world, even for HMD-VRC with new technologies, such as haptic presentation and VR patient interaction.

TRIAL REGISTRATION

The study was conducted with the approval of the Ethics Committee of International University of Health and Welfare (Approval No.21-Im-035, Registration date: September 28, 2021).

Impact of classroom-based MASK-ED™ (KRS simulation) on physiotherapy student clinical performance: a randomized cluster trial

BACKGROUND

In physiotherapy there is a growing body of literature exploring the benefits simulation could have in the university-setting, prior to the commencement of work-integrated learning. MASK-ED™ simulation is one form of simulation that could be beneficial for student learning and improve performance in the clinical setting. MASK-ED™ simulation involves an educator donning a silicone mask and portraying a patient role that has been specifically developed to meet learning objectives.

OBJECTIVE

To evaluate the effectiveness of MASK-ED™ simulation compared to role-play with peers for training pre-clinical physiotherapy students.

METHODS

A single-centre, single-blind, cluster randomized trial with concealed allocation, between group post-measures, and intention-to-treat analysis was conducted at an Australian university between February 2018 - January 2021. Participants were 144 physiotherapy students, cluster randomized by tutorial groups (exp n = 70, con n = 74), undertaking their neurological curricula. The experimental group was exposed to MASK-ED™ simulation in five out of a potential thirty-two tutorials (16%) whilst the control continued with role-play with peers. The primary outcome measure was Assessment of Physiotherapy Practice scores from the students' rehabilitation work-integrated learning clinical placement. These were compared between the experimental and control groups using Mann-Whitney U tests. Secondary outcome measures include practical and written examination scores. These were compared between groups via independent t-tests. Participant satisfaction surveys were also administered to the experimental group.

RESULTS

One hundred thirty-two participants' (exp n = 62, con n = 72) results were analyzed. There were no significant differences between the experimental and control groups for Assessment of Physiotherapy Practice scores (p = 0.699-0.995). There were no significant differences found between the groups, across the secondary outcome measures. Participants found MASK-ED™ simulation was somewhat helpful for preparing them for clinical practice, however felt that a group setting was not as effective as a one-on-one encounter would have been.

CONCLUSIONS

MASK-ED™ simulation was no more effective than role-play with peers in preparing physiotherapy students for work-integrated learning. The influence of the design of simulation on effective learning and the number of classroom-based simulation encounters required to impact clinical performance requires further investigation.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.

A narrative review of e-learning in professional education of healthcare professionals in medical imaging and radiation therapy

OBJECTIVES

This literature review attempts to explore the characteristics of e-learning tools used to develop the qualifications and skills of healthcare professionals in medical imaging and radiation therapy, and to promote the effectiveness and acceptance of e-learning through highlighting the outcomes of its implementation where applicable.

KEY FINDINGS

From the literature search in the PubMed and ResearchGate databases we concluded to 21 articles, which were included in the qualitative synthesis. Acceptance of e-learning tools was confirmed. Also, e-learning can be part of healthcare professionals' blended learning. The acquisition of new or improvement of existing knowledge, the improvement of clinical skills and the increase of the self-confidence of healthcare professionals in their daily practice were recorded, as outcomes of the e-learning implementation. The importance of human-computer interaction for the comprehension of theoretical concepts and practical aspects using multimedia was also captured. No significant findings emerged among the 21 articles against the adoption of the e-learning for the training of healthcare professionals. The Internet is the channel used for synchronous and asynchronous interaction of trainees with instructors.

CONCLUSIONS

We concluded that e-learning is an attractive training method, equally or occasionally more effective than the traditional educational methods for the lifelong training of healthcare professionals in the field of medical imaging and radiation therapy. Also, many collaborative web-based applications provide the necessary means to build an e-learning program, according to the training needs of each professional team.

IMPLICATIONS FOR PRACTICE

This new knowledge corroborates the perspective of e-learning beneficial contribution to remote interaction and collaboration of healthcare professionals in medical imaging and radiation therapy. Collaborative web-based tools are already available to decision makers and stakeholders, who want to develop an e-learning program.

Impact of COVID-19 pandemic on radiology education, training, and practice: A narrative review

Radiology education and training is of paramount clinical importance given the prominence of medical imaging utilization in effective clinical practice. The incorporation of basic radiology in the medical curriculum has continued to evolve, focusing on teaching image interpretation skills, the appropriate ordering of radiological investigations, judicious use of ionizing radiation, and providing exposure to interventional radiology. Advancements in radiology have been driven by the digital revolution, which has, in turn, had a positive impact on radiology education and training. Upon the advent of the corona virus disease 2019 (COVID-19) pandemic, many training institutions and hospitals adhered to directives which advised rescheduling of non-urgent outpatient appointments. This inevitably impacted the workflow of the radiology department, which resulted in the reduction of clinical in-person case reviews and consultations, as well as in-person teaching sessions. Several medical schools and research centers completely suspended face-to-face academic activity. This led to challenges for medical teachers to complete the radiology syllabus while ensuring that teaching activities continued safely and effectively. As a result, online teaching platforms have virtually replaced didactic face-to-face lectures. Radiology educators also sought other strategies to incorporate interactive teaching sessions while adopting the e-learning approach, as they were cognizant of the limitations that this may have on students' clinical expertise. Migration to online methods to review live cases, journal clubs, simulation-based training, clinical interaction, and radiology examination protocolling are a few examples of successfully addressing the limitations in reduced clinical exposure. In this review paper, we discuss (1) The impact of the COVID-19 pandemic on radiology education, training, and practice; (2) Challenges and strategies involved in delivering online radiology education for undergraduates and postgraduates during the COVID-19 pandemic; and (3) Difference between the implementation of radiology education during the COVID-19 pandemic and pre-COVID-19 era.

A review of the impact of the COVID-19 pandemic on pre-registration medical radiation science education

Objective

The COVID-19 pandemic has changed traditional ways to provide pre-registration medical radiation science (MRS) (medical imaging and radiation therapy) education. This literature review explores the published pre-registration MRS education curriculum adaptations implemented in response to the pandemic and effects of the adaptations on stakeholders.

Key findings

Eleven articles were identified through a systematic literature search. The included articles covered the pre-registration MRS curriculum adaptations implemented in response to the pandemic in 12 countries of five continents. Through changing content delivery and assessment modes from face-to-face to online, non-practical classes and academic assessments could continue without significant interruptions. However, cancellation/postponement of practical classes and clinical placements was common during COVID-19 lockdown. Simulated learning was used by some institutions to replace some practical classes and placements. Among the stakeholders of MRS education (students, academics and clinical educators), the students were most affected. The main impacts were negative psychological effects and learning experiences. For the academics, they had common concerns about online learning quality and assessment integrity.

Conclusion

This review of the early publications in the first year of the pandemic provides an illustration of the MRS curriculum adaptations implemented in five continents covering both English and non-English speaking countries and their effects on the stakeholders as yet. It is expected that more articles on this area will be published over time and hence allowing a more comprehensive review in the future.

Implications for practice

The included articles show provision of wellbeing support, good planning of online content delivery based on sound pedagogical approaches, implementation of computer-based simulation tools suitable for home-based learning environment and use of authentic online assessments would address the impacts on the students and academics.

Chiropractic students' experiences on the use of virtual radiography simulation: a pilot observational study

BACKGROUND

Virtual radiography provides students with an opportunity to practise their clinical skills in patient positioning and evaluating radiographic images. The purpose of this pilot study was to introduce Projection VR™, a software radiography simulation program, into a student chiropractic program and evaluate its potential application as a teaching and learning tool.

METHODS

Undergraduate chiropractic students, enrolled in a radiographic course (unit within the chiropractic program), were invited to attend a scheduled laboratory where they were introduced to, and undertook purposefully designed activities using the radiography simulation. At the end of this activity, students were asked to complete an online survey (see Virtual Radiography Survey) to describe their experiences of the educational value of the software program. Descriptive statistics were used to evaluate outcomes. Content analysis was performed for free-text comments provided by respondents with key themes provided by the predetermined quantitative categories of the questionnaire.

RESULTS

Responses were received from 44 out of the 47 students who attended the scheduled laboratory (response rate 92%). Overall students were positive about this simulation identifying that it was easy to use (95%) and that they could control the equipment as needed (95%). The main reported benefits included students being enabled to repeat tasks until they were satisfied with the results (98%) and being able to quickly assess images and determine if changes needed to be made (98%). Participants reported improvement in their understanding of the effect of exposure factors on patient radiation dose (93%) as well as their technical image evaluation (84%) and problem-solving skills (80%).

CONCLUSIONS

The results of this study suggest that virtual radiography is a valuable complementary resource in providing chiropractic students with radiographic knowledge and skills.