Rethinking Radiology: An Active Learning Curriculum for Head Computed Tomography Interpretation

Leonardo Aliaga, Samuel Owen Clarke, Leonardo Aliaga, Samuel Owen Clarke

Abstract

Introduction: Head computed tomography (CT) interpretation is a vital skill for emergency physicians. Existing literature shows poor concordance between emergency physicians and radiologists in head CT interpretation. Prior studies have used passive learning methods to address this knowledge gap. We created an active learning curriculum for teaching head CT interpretation to emergency medicine (EM) residents and compared its effectiveness to a passive learning strategy.

Methods: We conducted a prospective, randomized controlled study of EM residents at a single institution. Three educational sessions were delivered over a three-month period via video conference. The active learning cohort (ALC) scrolled through head CT teaching cases we designed on Pascbin, a web-based radiology picture archiving and communication system. The passive learning cohort (PLC) watched instructional videos that scrolled through the same cases. Both cohorts were given equal time to review the cases and ask an instructor questions. Residents took pre-intervention and post-intervention tests on head CT interpretation. We analyzed scores using paired and unpaired t-tests.

Results: Forty-two residents took the pre-intervention test. Mean pre- and post-test scores for the ALC were 43.8% and 59.0% (P <0.001), and for the PLC were 41.7% and 45.3% (P = 0.29). The difference in ALC and PLC post-test scores was statistically significant (P = 0.009) with a large effect size (Cohen's d = 1.34).

Conclusion: Our active learning head CT curriculum using Pacsbin showed superior learning outcomes when compared to a passive learning strategy and required no additional time or resources. This intervention offers a more effective and learner-centric method for implementing radiology curricula in EM residency programs.

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure
Figure
Pre- and post-intervention test scores for passive and active learning cohorts.

References

    1. Alfaro D, Levitt MA, English DK, et al. Accuracy of interpretation of cranial computed tomography scans in an emergency medicine residency program. Ann Emerg Med. 1995;25(2):169–74.
    1. Evans LR, Fitzgerald MC, Mitra B, et al. Emergency department interpretation of CT of the brain: a systematic review. Postgrad Med J. 2017;93(1102):454–9.
    1. Arendts G, Manovel A, Chai A. Cranial CT interpretation by senior emergency department staff. Australas Radiol. 2003;47(4):368–74.
    1. Mucci B, Brett C, Huntley LS, et al. Cranial computed tomography in trauma: the accuracy of interpretation by staff in the emergency department. Emerg Med J. 2005;22(8):538–40.
    1. Khoo NC, Duffy M. “Out of hours” non-contrast head CT scan interpretation by senior emergency department medical staff. EMA - Emerg Med Australas. 2007;19(2):122–8.
    1. Boyle A, Staniciu D, Lewis S, et al. Can middle grade and consultant emergency physicians accurately interpret computed tomography scans performed for head trauma? Cross-sectional study. Emerg Med J. 2009;26(8):583–5.
    1. Gallagher FA, Tay KY, Vowler SL, et al. Comparing the accuracy of initial head CT reporting by radiologists, radiology trainees, neuroradiographers and emergency doctors. Br J Radiol. 2011;84(1007):1040–5.
    1. Levitt MA, Dawkins R, Williams V, et al. Abbreviated educational session improves cranial computed tomography scan interpretations by emergency physicians. Ann Emerg Med. 1997;30(5):616–21.
    1. Perron AD, Huff JS, Ullrich CG, et al. A multicenter study to improve emergency medicine residents’ recognition of intracranial emergencies on computed tomography. Ann Emerg Med. 1998;32(5):554–62.
    1. Jamal K, Mandel L, Jamal L, et al. “Out of hours” adult CT head interpretation by senior emergency department staff following an intensive teaching session: A prospective blinded pilot study of 405 patients. Emerg Med J. 2014;31(6):467–70.
    1. Minkowitz S, Leeman K, Giambrone AE, et al. Emergency radiology “boot camp”: educating emergency medicine residents using e-learning radiology modules. AEM Educ Train. 2017;1(1):43–7.
    1. Pourmand A, Woodward C, Shokoohi H, et al. Impact of asynchronous training on radiology learning curve among emergency medicine residents and clerkship students. Perm J. 2018;22:1–5.
    1. Gaddam DS, Awan OA. Back to the future: shortcomings of an archaic model for radiology lectures. RadioGraphics. 2020;40(4):1196–7.
    1. Winter RO, Picciano A, Birnberg B, et al. Resident knowledge acquisition during a block conference series. Fam Med. 2007;39(7):498–503.
    1. Freeman S, Eddy SL, McDonough M, et al. Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A. 2014;111(23):8410–5.
    1. Deslauriers L, McCarty LS, Miller K, et al. Measuring actual learning versus feeling of learning in response to being actively engaged in the classroom. Proc Natl Acad Sci U S A. 2019;116(39):19251–7.
    1. Ozuah PO, Curtis J, Stein REK. Impact of problem-based learning on residents’ self-directed learning. Arch Pediatr Adolesc Med. 2001;155(6):669–72.
    1. Thomas KG, Thomas MR, York EB, et al. Teaching evidence-based medicine to internal medicine residents: the efficacy of conferences versus small-group discussion. Teach Learn Med. 2005;17(2):130–5.
    1. Graffam B. Active learning in medical education: strategies for beginning implementation. Med Teach. 2007;29(1):38–42.
    1. Shellenberger S, Seale JP, Harris DL, et al. Applying team-based learning in primary care residency programs to increase patient alcohol screenings and brief interventions. Acad Med. 2009;84(3):340–6.
    1. Batalden MK, Warm EJ, Logio LS. Beyond a curricular design of convenience: replacing the noon conference with an academic half day in three internal medicine residency programs. Acad Med. 2013;88(5):644–51.
    1. Wolff M, Wagner MJ, Poznanski S, et al. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med. 2015;48(1):85–93.
    1. Sawatsky AP, Zickmund SL, Berlacher K, et al. Understanding the challenges to facilitating active learning in the resident conferences: A qualitative study of internal medicine faculty and resident perspectives. Med Educ Online. 2015;20(1):27289.
    1. Kim AM, Speed CJ, Macaulay JO. Barriers and strategies: implementing active learning in biomedical science lectures. Biochem Mol Biol Educ. 2019;47(1):29–40.
    1. Hostetter J, Khanna N, Mandell JC. Integration of a zero-footprint cloud-based picture archiving and communication system with customizable forms for radiology research and education. Acad Radiol. 2018;25(6):811–8.
    1. Berge M, Dalane S, Savioli S, et al. Interactive radiology case conference utilizing flipped classroom. American College of Radiology. 2018
    1. Morin CE, Hostetter JM, Jeudy J, et al. Spaced radiology: encouraging durable memory using spaced testing in pediatric radiology. Pediatr Radiol. 2019;49(8):990–9.
    1. Sajedi P, Salamon N, Hostetter J, et al. Reshaping radiology precall preparation: integrating a cloud-based PACS viewer Into a flipped classroom model. Curr Probl Diagn Radiol. 2019;48(5):441–7.
    1. Gomez E, Azadi J, Magid D. Innovation born in isolation: rapid transformation of an in-person medical student radiology elective to a remote learning experience during the COVID-19 pandemic. Acad Radiol. 2020;27(9):1285–90.
    1. Saketkhoo DD, Bhargavan M, Sunshine JH, et al. Emergency department image interpretation services at private community hospitals. Radiology. 2004;231(1):190–7.
    1. DeFlorio R, Coughlin B, Coughlin R, et al. Process modification and emergency department radiology service. Emerg Radiol. 2008;15(6):405–12.
    1. Bransford JD, Brown AL, Cocking RR. How People Learn: Brain, Mind, Experience, and School. Washington, DC: National Academies Press; 2000.
    1. Oppenheimer DM. The secret life of fluency. Trends Cogn Sci. 2008;12(6):237–41.
    1. Carpenter SK, Wilford MM, Kornell N, et al. Appearances can be deceiving: Instructor fluency increases perceptions of learning without increasing actual learning. Psychon Bull Rev. 2013;20(6):1350–6.
    1. Gooding HC, Mann K, Armstrong E. Twelve tips for applying the science of learning to health professions education. Med Teach. 2017;39(1):26–31.

Source: PubMed

3
Suscribir