Sunday 9 June 2013

Use of learning resources by Residents in Radiology: Correlating individual learning preferences with Actual Use, Linking this with Clinical Performance Requirements (On the job Emergency and Outpatient Radiology Reporting), and Determining how this can guide the provision of a personalized educational profile with advice for effective and efficient learning strategies, and How this can help teachers more effectively and efficiently present online case based material to fulfil training objectives for competency, proficiency and mastery performance - Qualitative Interview (Semi-Structured), Grounded Theory Method

Background literature

(google search - "learning preferences of residents in radiology")

Acad Rad 2007 Survey of residents use of textbooks, journals, internet

J Digit Imaging 2006 Radiologists' preference for just in time learning and full / pdf

Learning styles in radiology CAR report

RSNA 2012 poster Moving to the Digital Age of Radiology Education: A Survey of Learning Resources at an Academic Institution

Insights Imaging 2011 Radiology teaching for junior doctors: their expectations, preferences and suggestions for improvement

Radiographics 2001 Do Computers Teach Better? A Media Comparison Study for Case-based Teaching in Radiology

Acad Rad 2001 The case-based radiology teaching conference for residents: beneficial effect of previewing cases and using answer sheets

Radiology, 2005 Radiology Education in the Digital Era


AJR, 2013Worldwide Utilization of a Web-Based Learning Tool for Pediatric Radiology

RSNA 2003 An international web-based curriculum in paediatric radiology

Radiology Education: The Scholarship of Teaching and Learning 2004 Using the world wide web to develop competencies around the globe

Society of Thoracic Radiology Resident Curriculum Web Resource Initiative

        Instruction for authors

        Sample cases


American Journal of Neuroradiology Special Collections and Case Collections

        Case of the week archive by diagnosis

        Classic case archive pictorial index


eLearning resources for Radiology - Dr Jawad Khan, Radiology Registrar, Severn School of Radiology

R-ITI Radiology - Integrated Training Initiative

Journal of the American College of Radiology JACR Portal

Dreyfus 1980 5 stage model of the mental activities involved in directed skill acquisition (original paper PDF)

Novice to Expert: The Dreyfus Model of Skill Acquisition (table) 2005

Dreyfus model of skill acquisition, Wikipedia (see hyperlinked resources)

Krupinski 2013 Characterizing the development of visual search expertise in pathology residents viewing whole slide images

Crowley 2003 Development of Visual Diagnostic Expertise in Pathology - An Information-processing Study

Taylor 2007 A review of research into the development of radiologic expertise: Implications for computer based teaching

Vine 2012 Cheating experience: Guiding novices to adopt the gaze strategies of experts expedites the learning of technical laparoscopic skills

Clark 2012 The impact of different types of prior knowledge on science text comprehension



Qualitative Interview (Semi-structured)

The purpose of these interviews and related questionnaire is to allow me to develop a deeper understanding of your learning preferences and requirements as a radiologist-in-training, and to further refine the case based teaching and learning material that has been made available to you via the learning radiology blogs.These resources can be used as part of your radiology residency program. I have a long standing interest in the use of technology enhanced learning (eLearning) in medical education and radiology training, and these short evaluation sessions will focus the content and presentation of the case based online teaching and learning material to more closely match your training requirements and learning needs.

Please note that your responses to the following interview and questionnaire will be anonymised, and any dissemination, presentation or discussion of your response, or the aggregated responses of your peers will be anonymised. Our departmental postgraduate training committee members are aware that these discussions are taking place (HOD, PG training director, Neuroradiology section chief).

(for example, as I have discussions with each of you, your responses will be reflected in the questionnaire by anonymous symbols --> @, #, ~, %, ^, &, *, +, ?, !, <, > ...... all 30 plus MOs, residents/BSTs/ASTs in our department)



(example of radiology resident cohort - note that there is no correlation between list of residents and anonymised Q and A below, obtained at separate distant date from time of list above)


Semi-structured questions

Which year of radiology residency are you in?


Tell me about your professional experience before entering radiology?

post HO #(30hrs)
@(10)
~ (300hrs)
%(50hrs)
^(30hrs)
&(100hrs)
*(30)
+(30)
?(30)
!(30)
<(30)
>(30)
??(30)
@@(10)
##(0)

How have you found the learning experience and training environment in the radiology department?

5; 4

How do you prefer to learn?

active + feedback;
exploratory;
exploratory;
try + feedback (%),
peer to peer (^)
lecture(&)
self-paced(*)
OTJ/JIT-->peer d/c-->answer/senior(+)
textbooks/1st principles/theory-->r/v cases, compare/reports, feedback on day to day
OTJ-->look up-->answer/senior(!)
lecture/face to face or video(<)
case review series(>)
case review+feedback, work thru then d/c with Con(1st)
case review/problem-->look up myself(##)

What experiences have you found most useful in your training?
d to day case discussion (3); range; hot seat tut/call, EMD-->independent, variety-->F/U, post call D/C
feedback (positive and negative, emotional cpt/accountability), informal case based sharing, QA sessions
no specific one, different strengths/purpose(!)
rv then d/c with consultant(<)
quiz and drill, FRCR sets (>)
quiz and drill, FRCR sets(##)

Why do you find these experiences helpful?
authentic, applicable, know what is needed/cognitive load(*), immediate feedback(>), how does C think(@@), identify weak areas-->look up(#)

     Special requests ... i wish ...

annotation/arrows/answers/discussion/approach/what to look out for (@, #)
journal article access (~)

introductory course/orientation series (%)
one to one assigned supervisor/teacher (^)

more didactic lectures (&)

knowledge/resource/case repository (*)

more direct/immediate/more detailed feedback day to day

more reporting/more feedback

pre-screened day to day reporting list (!)

?(<)

short take home points like IDK HK (what is relevant, from experts, tips, take home, focus) (>)

work thru 5 or 6 cases, then rv with Con

?(##), long pause ... SGH style digital film library with short description


Questionnaire/Semi-structured interview

Which year of residency are you in?

- MO  @, #
- Year 1 %, ^
- Year 2 ~, ?
- Year 3 !, <, >, ??
- Year 4 &, +, @@
- Year 5 *, ##
- Year 6

How much experience have you had in neuroradiology?

- 6 weeks or less @, #, ~, %(2 scans), ^(<20 scans)
- 12 weeks + (12 to 18wks), ?, <(12 to 18)
- 18 weeks >
- 24 weeks &, ##(24 to 30)
- 30 weeks or more *, !, @@


How confident are you in accurately recognising and diagnosing neuroradiology problems that you might encounter

- On call?

1- not confident
2 - somewhat confident ~, +, ? (2 to 3, supplemented by 4 month NNI elective)
3 - confident that I will not miss anything major, will look up anything I don't recognise regularly &, !, <, >
4 - very confident, but will still look up anything I am not sure of not more than once to twice a day (*), @@(3.5), ##
5 - extremely confident, rarely encounter any conditions I do not recognise, rarely look up unusual conditions


- Day to day neuroradiology rotation?

1- not confident %
2 - somewhat confident ~ (2.5), ^, +(2.5), ?(2.5)
3 - confident that I will not miss anything major, will look up anything I don't recognise regularly &, !, <, >, @@, ##
4 - very confident, but will still look up anything I am not sure of not more than once to twice a day (*)
5 - extremely confident, rarely encounter any conditions I do not recognise, rarely look up unusual conditions



How well has your residency experiences prepared you for

- Call?

1 - not at all
2 - some preparation
3 - adequate preparation ~(3.5, includes self prep, review of EMD cases + reports), &, +, ?, !, >
4 - good preparation *, <, @@
5 - excellent preparation ##


- Day to day neuroradiology rotation?

1 - not at all
2 - some preparation +(2.5), ?(2.5), >
3 - adequate preparation  &, !, <, @@
4 - good preparation *, ##
5 - excellent preparation



How well do you feel that review of thematic neuroradiology cases will prepare you for

- Call?

1 - not at all
2 - some preparation +(2.5)
3 - adequate preparation
4 - good preparation < (pic, rf, jit, spectrum), >, @@
5 - excellent preparation  *, ?, !, ##


- Day to day neuroradiology rotation?

1 - not at all
2 - some preparation
3 - adequate preparation  <(3 to 4)
4 - good preparation   @, #, ^ if thematic, +(range), >, @@(4.5)
5 - excellent preparation ~ (mimics, ddx, range) %, *, ?, !, ##


Do feel that your neuroradiology training can be shortened by 20% by the deliberate use of these online cases?

Yes +, ? (5 for EMD, day to day confidence), !
No ## (day to day still importmant)
Maybe  & (but will increase confidence from 3 to 4 for day to day, and call); *, <, >

How to you feel these cases should be organised and presented?

...... image / wide range / answer (*), (?), (!)
focus on common/centre of spectrum (<)
whole set (>)
X and Y axis, include DDx and examples, approach/process of problem solving
by anatomical location (##)



Please rate each of the following in their relative usefulness in your neuroradiology training?

5 point scale
1-not useful
2-somewhat useful
3-useful
4-very useful
5-extremely useful

Clinical experience/reporting

1-not useful
2-somewhat useful
3-useful  ~ (day to day does not correlate with EMD)
4-very useful  @, #
5-extremely useful


Weekly tutorials

1-not useful
2-somewhat useful
3-useful  @, #
4-very useful ~ (plain films)
5-extremely useful


@ 3,4 h and n, pit, neuro anat, cases / # h and n, pit, cases



Pre-call preparation sessions ~

1-not useful
2-somewhat useful
3-useful  < (3 to 4)
4-very useful
5-extremely useful


FRCR 2A Lectures


1-not useful
2-somewhat useful
3-useful
4-very useful
5-extremely useful



Reading books/journals (hardcopy)

1-not useful ~ (time pressure)
2-somewhat useful
3-useful
4-very useful
5-extremely usefulReading journal articles(online)


Use of online databases (StatDx)

1-not useful
2-somewhat useful
3-useful ~ (3 to 4)
4-very useful
5-extremely useful


Use of online case repositories

1-not useful
2-somewhat useful @
3-useful
4-very useful #(comparison, n and abn, efficiency)
5-extremely useful



When you have a problem case currently, please list the order of actions you take to solve the problem? (from 1st to 4th)

Look up StatDx #(1) ~(2), %(1), ^(2), &(1), *(1), +(1), ?(joint 1), !(joint 1), <(1), >(1), @@(1), ##(2)
1-not useful
2-somewhat useful ~
3-useful @ (ddx - text descriptor), @@, ##
4-very useful # (anatomy), %, ^ (typical example, exemplar), &(access), ?(pic and comparison, DDx), !(key words), <(ddx, pict list, key points), > (match images, ddx)
5-extremely useful  *, +

Ask someone @, # (2), ~ (1), ^(1), %(2), &(3), *(joint 2, variable), +(2), ?(2), !(3), <(2), >(3), @@(4), ##(1)
1-not useful
2-somewhat useful
3-useful *(3.5, depends on person), +, < (whoever is around), >
4-very useful # (reg and above), %(efficient), ^(4.5, answer/stat dx to match), &(AcC and above), ?(depends on problem, person, accessibility/pai sae), !, ##(4 to 5)
5-extremely useful @ (reg and above), @@

Do a literature/online search #(1), ~ (3), % (3), ^(3), &(2), *(joint 2 with ask someone), +(3), ?(joint 1), !(joint 1), <(3), >(2), @@(2) try to work out before asking, ##(Google)
1-not useful @
2-somewhat useful +, <, ##
3-useful % (3.5), ^ (3.5) - not useful unless understand basics, use for further reading, ?, !, >(google)
4-very useful  #, &, *, @@(3.5)
5-extremely useful


Systematic reading of a textbook/ Look up textbook @(1), ~ (4), %(4), ^(4), &(4), *(4), +(4), ?(4), !(4), <(4), >(4), @@(3), ##(4)
1-not useful ~ (Keats)
2-somewhat useful #, &, +, !, >, @@
3-useful - @, % (3.5, framework) ^ (4.5, what is important, foundation, key ideas), < (not at work)
4-very useful  (4.5, what is important, foundation, key ideas), ## (not routine/practical, tedius if not digital)
5-extremely useful


Attending courses and seminars  @,# (not applicable), +(5), ?(5), !(5), <(5), >(5)
1-not useful
2-somewhat useful  %(1.5, attended XR/CT reading course final year MBBS)
3-useful  &(3.5, case review course), *(NNI annual), +(FRCR review course), ?(RadPath), <(RadPath - too wide/broad), > (IDK HK, case based, just right range/depth)
4-very useful ~ (RadPath in July 2013), ^(RadPath, July 2013, XR macro path correlation), !(IDKD), @@(ECR, NNI rv - common conditions/approach), ##(Resnick MSK, but diminishing return further from course)
5-extremely useful