Teaching Critical Thinking in Graduate Medical Education: Lessons Learned in Diagnostic Radiology

Influence of residency discipline and seniority on traumatic musculoskeletal radiographs interpretation accuracy: a multicenter study

OBJECTIVES

Imaging studies are a significant and integral part of the initial assessment of patients admitted to the emergency department. Developing imaging diagnostic abilities early in residency is of paramount importance. The purpose of this study was to evaluate and compare diagnosis accuracy of common musculoskeletal X-rays (XR) between residency disciplines and seniority.

METHODS

A multicenter study which evaluated orthopedic surgery, emergency medicine (EM), and radiology residents, through a test set of common MSK XR. Residents were classified as "beginner" or "advanced" according to postgraduate year per residency. Residents were asked to answer whether the radiograph shows normal or pathological findings (success rate) and what is the diagnosis ("diagnosis accuracy"). Residents' answers were analyzed and assessed compared to experts' consensus.

RESULTS

A total of 100 residents (62% beginners) participated in this study. Fifty-four were orthopedic surgeons, 29 were EM residents and 17 were radiologists. The entire cohort's overall success rate was 88.5%. The overall mean success rates for orthopedic, EM, and radiology residents were 93.2%, 82.8%, and 83.3%, respectively, and were significantly different (p < 0.0001). Orthopedic residents had significantly higher diagnostic accuracy rates compared with both radiology and EM residents (p < 0.001). Advanced orthopedic and EM residents demonstrated higher diagnostic accuracy rates compared to beginner residents (p = 0.001 and p = 0.03, respectively).

CONCLUSION

Orthopedic residents presented higher diagnosis accuracy of MSK imaging compared to EM and radiology residents. Seniority had a positive effect on diagnosis accuracy. The development of an educational program on MSK XR is necessary to enhance the competency of physicians in their daily practice.

A Qualitative Study of Pediatric Residents' Experiences at Morning Report

Objectives

Morning Report is a prevalent classroom learning activity in residency programs. Yet, its contribution to resident education remains unclear. Our objective was to explore pediatric residents' perceptions of the purpose of Morning Report as well as their experiences at Morning Report both as learners and resident presenters.

Methods

We performed a qualitative study with a grounded theory approach using semi-structured focus groups of pediatric residents (November 2016-July 2017) from a large academic health center. We analyzed data with the constant comparative method, generating codes using an iterative approach and collecting data until reaching saturation. We identified major themes and resolved disagreements by consensus.

Results

Twenty-six residents participated in five focus groups. Data analysis yielded four themes: Morning Report is Multipurpose, Socialization and Engagement Influence the Learning Environment, Potential for Emotional Discomfort, and Barriers to Prioritizing Morning Report Attendance. Residents felt the primary purpose of Morning Report was acquiring medical knowledge, but also acknowledged Morning Report's added benefits of providing an opportunity for socialization and a mental reprieve before work rounds. Residents felt Morning Report was educational when engaged in interactive discussion; however, it was challenging to meet the differing needs in this mixed learner level format. Some resident learners were hesitant to participate due to fears of being judged, and some resident presenters perceived a need to be topic experts. Clinical responsibilities and exhaustion following busy service rotations often precluded Morning Report attendance.

Conclusion

Pediatric residents described numerous purposes of Morning Report, including opportunities for valuable learning. Self-perceived learning was positively influenced by engagement and a sense of connection and challenged by emotional discomfort at times. Future work can explore how to best promote engagement and foster a safe learning environment.

Applicability of Concept Maps to Assess Higher Order Thinking in the Context of Indian Medical Education: An Analytical Study in the Subject of Physiology

INTRODUCTION

Concept mapping is a multidimensional tool that has been put to little use in India. We designed this study to check its applicability for assessing higher-order thinking in the subject of Physiology.

METHODS

This interventional analytical study was carried out among 65 students of Phase I of MBBS in the year 2021. The students were sensitized to the technique and were given a practice session. On a pre-informed date, an assessment of a topic taught to them was done using concept mapping and a multiple-choice question (MCQ) based test. Feedback on the technique was taken from the students. The statistical tests used were test of normality - Kolmogorov-Smirnov Test, significance of association - Wilcoxon Signed Rank test, correlation - Spearman's correlation, and agreement - Bland Altman Analysis. The discrimination index was calculated for both concept mapping and MCQ based tests, separately. Percentages were calculated for feedback questionnaire items. The data were analysed using Microsoft Excel (2019) and an online calculator. P-values <0.05 were considered statistically significant.

RESULTS

Students scored more in concept mapping. There was a significant difference in the scores of the students on the two tests (Wilcoxon Signed-Rank test, Z=-2.66, p=0.008) and a weakly positive non-significant correlation between them (Spearman's correlation coefficient, r_s=0.07 p=0.60). Bland Altman's Analysis showed agreement in the scores of the students in the two tests. The mean score of the students in the two tests increased, so did the difference in the scores in the two tests. The discrimination index of concept mapping (0.28) was higher than that of the MCQ-based test (0.18). Most of the students agreed on the advantages of concept mapping in the feedback.

CONCLUSION

The assessment result of concept mapping is better than that of MCQ-based test and it may be included as a teaching-learning and assessment strategy in the context of Indian medical education in the subject of Physiology.

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.

Understanding community family medicine preceptors' involvement in educational scholarship: perceptions, influencing factors and promising areas for action

BACKGROUND

Residency training is increasingly occurring in community settings. The opportunity for community-based scholarship is untapped and substantial. We explored Community Family Medicine Preceptors' understanding of Educational Scholarship (ES), looked at barriers and enablers to ES, and identified opportunities to promote the growth of ES in this setting.

METHODS

We conducted semi-structured interviews with fifteen purposively chosen community-based Family Medicine preceptors in a distributed Canadian family medicine program.

RESULTS

Community Family Medicine Preceptors strongly self-identify as clinical teachers. They are not well acquainted with the definition of ES, but recognize themselves as scholars. Community Family Medicine Preceptors recognize ES has significant value to themselves, their patients, communities, and learners. Most Community Family Medicine Preceptors were interested and willing to invest in ES, but lack of time and scarcity of primary care research experience were seen as barriers. Research process support and a connection to the academic center were considered enablers. Opportunities to promote the growth of ES include recognition that there are fundamental differences between community and academic sites, the development of a mentorship program, and a process to encourage engagement.

CONCLUSIONS

Community Family Medicine Preceptors identify foremost as clinician teachers. They are engaged in and recognize the value of ES to their professional community at large and to their patients and learners. There is a growing commitment to the development of ES in the community.

Twelve tips for conducting educational design research in medical education

Despite a steady growth in educational innovations and studies investigating the acceptance and effectiveness of these innovations, medical education has not realized sufficient improvement in practice and outcomes from these investments. In light of this lack of impact, there has been a growing call for studies that more effectively bridge the gap between research and practice. This paper introduces Educational Design Research (EDR) as a promising approach to address this challenge. Twelve tips are provided to inspire and guide medical educators to conduct EDR to achieve the dual goals of tackling a significant educational problem in a specific context while at the same time advancing the theoretical knowledge that may be used to improve practice elsewhere.

National Board of Medical Examiners and Curriculum Change: What Do Scores Tell Us? A Case Study at the University of Balamand Medical School

OBJECTIVES

This study describes the results of NBME (National Board of Medical Examiners) implementation in Balamand Medical School (BMS) from 2015 to 2019, after major curricular changes were introduced as of 2012. BMS students' performance was compared with the international USMLE step 1 (United States Medical Licensing Examination, herein referred to as step 1) cohorts' performances. The BMS students' NBME results were analyzed over the successive academic years to assess the impact of the serial curricular changes that were implemented.

METHODS

This longitudinal study describes the performance of BMS preclinical second year medicine (Med II) students on all their NBME exams over 4 academic years starting 2015-2016 to 2018-2019. These scores were compared with the step 1 comparison group scores using item difficulty. The t test was computed for each of the NBME exams to check whether the scores' differences were significant.

RESULTS

Results revealed that all BMS cohorts scored lower than the international USMLE step 1 comparison cohorts in all disciplines across the 4 academic years except Psychiatry. However, the results were progressively approaching step 1 results, and the difference between step 1 scores and BMS students' NBME scores became closer and not significant as of year 4.

CONCLUSIONS

The results of the study are promising. They show that the serial curricular changes enabled BMS Med II students' scores to reach the international cohorts' scores after 4 academic years. Moreover, the absence of statistical difference between cohort 4 scores and step 1 cohorts is not module dependent and applies to all clinical modules. Further studies should be conducted to assess whether the results obtained for cohort 4 can be maintained.

Reclaiming magical incantation in graduate medical education

Critical thinking relies upon conceptualization (what is the possible pathophysiology?), analysis (how do I relate an aberration in physiology to the lived experience of illness?), and synthesizing (how do I best intervene?). These cognitive skills are subsumed in the category of reflective competencies and are necessary for developing a differential diagnosis or a plan of care. A vulnerability of teaching medicine through the filter of heuristics is that it may simply recapitulate the teacher's style of cognitive shortcuts. Poorly calibrated heuristics may culminate in systematic errors of judgment. If the aim is to teach critical reasoning in the arena of clinical education, then a new paradigm is called for. Teaching critical reasoning as it applies to medical decision-making begins with recognizing decision scripts.Key Points• Medical heuristics are high-stakes endeavors.• The process of examining the choice of heuristics employed in any given clinical scenario is a meta-reasoning strategy.• Debiasing reduces cognitive errors due to motivated reasoning.