Learning Retention in Radiograph Interpretation

Optimizing Skill Retention in Radiograph Interpretation: A Multicentre Randomized Control Trial

Learning retention after the deliberate practice of radiograph interpretation may be challenging for image types which are common enough to be clinically relevant but not so common that proficiency can be sustained through clinical practice. This is especially relevant for radiographs such as paediatric elbow films (EXR) that carry high risks for the patient if pathology is missed. Building on prior research in this area, this study will develop an innovative computer learning application for paediatric EXR interpretation. After an initial learning period, this study will quantitatively determine the rate of skill decay and the optimal timing for refresher-education.

Study Overview

• Status: Completed
• Conditions: Fractures, Bone
• Intervention / Treatment: Other: Testing

Detailed Description

Objectives Learning retention after the deliberate practice of radiograph interpretation may be challenging for image types which are common enough to be clinically relevant but not so common that proficiency can be sustained through clinical practice. This is especially relevant for radiographs such as paediatric elbow films (EXR) that carry high risks for the patient if pathology is missed. Building on our prior research in this area, this study will develop an innovative computer learning application for paediatric EXR interpretation. After an initial learning period, this study will quantitatively determine the rate of skill decay and the optimal timing for refresher-education.

Design A prospective cohort design with purposive sampling will be used to develop the EXR education intervention. A four arm randomized control trial will be used to test for the outcomes of skill decay and optimal timing of refresher education.

Setting The education intervention will be developed at two tertiary care children's hospitals. Study participants will include physicians from two large paediatric education networks in the United States (Paediatric Outcomes in Simulation Education) and Canada (Paediatric Emergency Research Canada).

Statistical analysis For the primary analysis, a four-group multi-level model with time-points nested within participants will be used. Secondary analyses will include a time series approach within each block of 20 test EXR to check for sequential effects, and between each block to determine whether we can efficiently model skill decay curves that can separate the underlying learning attrition curve from the effects of "boluses" of education.

Conclusion This study anticipates that learners will increase their learning of elbow radiographs by participating in the deliberate practice of radiographs, with skill decay over time that will be mitigated by refresher education. The results will allow evidence based recommendations regarding refresher education for learning from item banks of radiographs.

• Study Type: Interventional
• Enrollment (Actual): 233
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Pediatric and emergency medicine residents enrolled in an accredited residency in Canada and the United States

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Learning and Assessment at 12 months; Study participants will complete an 80 case learning set followed by a 20-case post test. The study intervention in this group is a 20-case test at 12 months.
Experimental: Testing Every Two Months; Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests without any feedback at 2, 4, 6, 8, 10, 12 months.	Other: Testing; Participants either received 20 case testing with or without feedback
Experimental: Low Bolus Feedback; Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests at 2, 4, 6, 8, 10, 12 months. At 6 months, the 20-case post-test will be delivered with feedback.	Other: Testing; Participants either received 20 case testing with or without feedback
Experimental: High Bolus Feedback; Study participants will complete an 80 case learning set followed by a 20-case post test. Study participants in this group will receive the following study interventions: 20-case post tests at 2, 4, 6, 8, 10, 12 months. At 4, 8, and 12 months, the 20-case post-test will be delivered with feedback.	Other: Testing; Participants either received 20 case testing with or without feedback

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuray	The percent of cases that were diagnosed correctly by the study participants	12 months after learning intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accuracy	The percent of cases that were diagnosed correctly by the study participants	2, 4, 6, 8, 10 months
Experience Curve	Learning and forgetting curve for each group by linking learning curve parameters (y-intercept, slope) with the amount of forgetting (T12 score).	12 months

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Collaborators: New York University; St. Justine's Hospital
• Investigators: Principal Investigator: Kathy Boutis, The Hospital for Sick Children

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2014
• Primary Completion (Actual): June 15, 2016
• Study Completion (Actual): June 15, 2016

Study Registration Dates

• First Submitted: December 2, 2017
• First Submitted That Met QC Criteria: December 6, 2017
• First Posted (Actual): December 13, 2017

Study Record Updates

• Last Update Posted (Estimated): November 22, 2023
• Last Update Submitted That Met QC Criteria: November 21, 2023
• Last Verified: December 1, 2017

More Information

Terms related to this study

• Keywords: Education (Medical); Retention
• Additional Relevant MeSH Terms: Wounds and Injuries; Fractures, Bone
• Other Study ID Numbers: 1000028986

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No