Resident learning and knowledge retention from resident-prepared chest radiology conferences

Impact of a focused trauma course on retention of provider skills, knowledge and confidence at a regional hospital in the Dominican Republic

INTRODUCTION

Road traffic accidents are a public health epidemic, causing significant morbidity and mortality in low- and middle-income countries. The Dominican Republic (DR) ranks among the highest road traffic fatality rates in the world. There is no formalized trauma curriculum in the DR. A short trauma course was implemented at a San Pedro de Macoris, DR hospital with pre-, post- and retention evaluation of the knowledge, skills and confidence of the providers.

METHODS

A 4-day trauma course was developed for medical students and residents. On days 1 and 4, providers completed pre- and post-training assessments consisting of a 40-question written exam, 1 simulation case and a trauma confidence questionnaire. Simulation cases were evaluated using a critical actions checklist and a non-technical skills scale (TNOTECHS). Assessments were repeated in 2 months to evaluate for knowledge, skill and confidence retention. A repeated measures ANOVA model was used to evaluate pre-, post- and retention training differences in the written exam, non-technical skills and critical actions scores. Confidence scores were assessed using a cumulative logistic regression model.

RESULTS

A total of 65 people participated (36 medical students, 22 EM and 7 family medicine residents). Of the 65 participants, 39, 22 and 21 participants had complete scores for pre-post, pre-retention and post-retention comparisons respectively. Mean test scores for the written exam were 37.2, 63.5 and 52.2 for pre, post and retention results respectively. Comparisons between pre and post as well as pre and retention showed statistically significant differences (p=0.0001). Mean TNOTECHS total scores were 15.8, 21.3 and 20.8 for pre-, post- and retention results respectively with a significant difference found between pre- and post- training and pre- and retention training (p <0.05). Simulation mean checklist scores were 57.7%, 67.8% and 74.1% for pre-, post- and retention training respectively with a significant difference established between pre- and retention scores (p<0.05). Provider opinion that their ED patients received best care possible and patients' needs were identified and addressed showed statistically significant increases.

CONCLUSION

A short trauma course can improve trauma specific knowledge, skills and confidence with significant retention at two months. A longitudinal trauma curriculum may bolster retention.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.

Resident versus faculty member simulation debriefing

BACKGROUND

Near-peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Near-peer teaching is effective in graduate medical education, but has not been compared with faculty member teaching in resident simulation METHOD: Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre-simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post-simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers.

RESULTS

Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post-simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors.

CONCLUSION

Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.

Radiology-Pathology Conference: Reviving the Art of Oral Case Presentation in Residency

RATIONALE AND OBJECTIVES

To improve resident oral case communication and preparatory skills by providing residents an opportunity to prepare for and conduct a new interdisciplinary Radiology-Pathology (Rad-Path) conference series.

MATERIALS AND METHODS

To assess whether conference goals were being achieved, we surveyed trainees and attendings in the radiology and pathology departments. Percentages were examined for each variable. Mann-Whitney U test for ordinal variable significance was applied to determine statistical significance between radiology trainee and attending survey responses.

RESULTS

Most surveyed radiology trainees (57.1%) strongly agreed or agreed with: "I wish I felt more comfortable with oral presentations." Sixty-five percent of radiology attendings (34 of 52) either agreed or strongly agreed that the residents should be more comfortable with oral case presentations. Of resident Rad-Path conference presenters, 69% (9 of 13) either agreed or strongly agreed that the conference improved their confidence and/or ability to present case information orally. Of responders who attended at least one Rad-Path conference in person, 83% of residents (19/23) and 61% (17/28) of attendings agreed or strongly agreed that the conference improved their ability to formulate a differential diagnosis. Using the Mann-Whitney U test, no significant difference was found between radiology trainees and attendings' responses.

CONCLUSIONS

Our Rad-Path correlation conference was specifically designed and structured to provide residents with focused experience in formal oral case preparation and presentation. We consider our conference a success, with 69% of resident presenters reporting that the Rad-Path conference improved their confidence and/or ability to present case information orally.

Quantitative Study of the Characteristics of Effective Internal Medicine Noon Conference Presentations

Background Increasing demands on residents' time have made it critically important to maximize the effectiveness of didactic activities and motivate independent study. Objective Our aim was to correlate characteristics of noon conferences with internal medicine (IM) residents' ratings of perceived effectiveness and intent to pursue independent reading. Methods We assessed characteristics of each noon conference by direct observation using predetermined metrics. We surveyed IM residents to assess their perception of the conference's effectiveness and their intention to pursue additional reading. A variety of modeling techniques were used to discern meaningful correlations of effectiveness and motivation. Results A total of 649 evaluations of 29 conferences were submitted by 153 of 185 (83%) residents in the program. Median effectiveness score was 6 (on a scale of 1 to 7). Clinicopathological conferences had 0.55-point higher effectiveness scores than traditional conferences (P = .011). In multivariable analyses focusing on traditional conferences, summary statement inclusion was significantly associated with 0.43-point higher effectiveness scores (P = .016), and having resident speakers was associated with 0.50-point higher effectiveness scores than unfamiliar faculty (P = .045). Conferences with higher effectiveness scores had significantly higher proportions of respondents indicating intention to read. Conclusions This is the first study to quantitatively assess correlations of high effectiveness ratings of noon conferences in a residency program. Intention to read improved with increasing effectiveness scores of conferences, suggesting residents are more inclined to pursue self-directed learning when topics are well presented. Considering these attributes in designs of didactic sessions may enhance their educational value.

Pedagogical Approaches to Diagnostic Imaging Education: A Narrative Review of the Literature

OBJECTIVE

The purpose of this study was to examine literature on how radiology is taught and learned by both radiology residents and undergraduates in the health professions.

METHODS

A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references.

RESULTS

Of the 4716 unique abstracts reviewed by the author, 91 were found to be relevant to the purpose of this study. The literature retrieved reported pedagogical approaches to teaching radiology including the following: problem solving, technology as teacher, independent learning tools, visiting lectureships, case based teaching, and conferences. There was some exploration of the relative effectiveness of educational formats. Suggestions for future research identify 7 areas of relative consistency.

CONCLUSION

Radiology is a clinical skill that requires integration science, clinical information, clinical experiences, and information recorded on diagnostic imaging studies. The research in this area focuses on problem solving, the use of algorithm/scripts, introducing uncertainty in clinical scenarios, incorporating technology in learning environments, active learning techniques, and methods of independent learning. Although the literature in this area is still in its infancy, the research examining the relative effectiveness of these various educational formats is often contradictory, suggesting that this is a complex area of study with numerous factors influencing student learning.

Assessment of Medical Students’ Knowledge Retention in a Diagnostic Radiology Course: Lecture Attendees versus Absentees

Introduction: To compare class attendees versus absentees in their ability to retain knowledge during a diagnostic radiology course. Materials and Methods: This study recruited 146 fourth- year medical students who attended a diagnostic radiology course from February 2004 to June 2004. Eight unit tests were conducted. Questions for each test covered content taught in the prior class. Another examination (which students were not aware of beforehand) was conducted in June, and the questions for this examination included content from all lectures in the course. The class attendance rates were measured separately 6 times during the course. Students who were present on the last of these dates were categorised as attendees (group A students) and those who were absent were categorised as absentees (group B). Results: The average class attendance was 76.8% and the lowest attendance was 56.8%. For the unit tests, the average score of group A students (80.7 ± 7.3) was significantly higher than that of the group B students (76.2 ± 8.8) (P = 0.001). However, in the unanticipated examination, there was no significant difference in the scores between group A (68.1 ± 10.3; range, 36-92) and group B students (65.5 ± 13.5; range, 28- 88) (P = 0.19). Self-learning time was related to the unit test scores (P = 0.001) but not to the unanticipated examination scores (P = 0.27). Conclusion: Students who frequently attend classes or study for longer can retain their knowledge over a short period of time, but there is no difference in knowledge retention between class attendees and absentees at the end of a 4-month course. Key words: Absentees, Attendees, Knowledge retention, Radiology

Learning clinical neurophysiology: gaming is better than lectures

We sought to find evidence for generalizability of a game and team oriented educational intervention in clinical neurophysiology in a neurology residency program. A prospective educational intervention was studied in a single neurology residency program and compared with a historical control. Seventeen PGY 2-4 residents studied neurophysiology in 2004-2005. The historical control was 20 PGY 2-4 residents from 1998 to 2002. The neurophysiology educational intervention consisted of weekly presentations, followed by a game show-type oral quiz which was team-based and required all residents to participate. The control group attended faculty-prepared didactic lectures. Outcome measures were percent correct subset neurophysiology Residency Inservice Training Examination scores. United States Medical Licensing Examination step 1 scores were also compared between the groups. Data were analyzed with analysis of variance methods accounting for multiple measurements. The mean+/-standard error neurophysiology subset percent correct Residency Inservice Training Examination score was 63.6+/-4.12 for the intervention group and 49.4+/-2.35 for the control (P=0.002). There was no difference in United States Medical Licensing Examination step 1 scores between the two groups (P=0.11). We found evidence for generalizability of the effectiveness of a team-oriented educational intervention in clinical neurophysiology with gaming and oral quizzing in improving subset Residency Inservice Training Examination performance compared with faculty prepared didactics.

Two prospective educational interventions in a neurology residency: effect on RITE performance

BACKGROUND

To evaluate the effect of 2 educational interventions on Residency In-service Training Examination (RITE) scores. Two prospective educational interventions were studied in 2 consecutive neurology resident cohorts from a single program and compared with a historical control. Fourteen PGY 2-4 residents studied neuropharmacology in 2002-2003. Fifteen PGY 2-4 residents studied neuroanatomy in 2003-2004. The historical control were 20 PGY 2-4 residents from 1998-2002. Neuropharmacology educational intervention: residents prepared weekly presentations with weekly written quizzes, with quiz results available to the individual resident and program director. Neuroanatomy educational intervention: resident prepared weekly presentations, but quizzes were team based and oral, requiring resident participation.

CONTROL GROUP

attended faculty prepared didactic lectures. Outcome measures were percent correct and yearly change in subset RITE scores. Data was analyzed with analysis of variance methods accounting for multiple measurements.

REVIEW SUMMARY

The mean +/- standard error neuropharmacology subset percent correct RITE score was 43.3 +/- 1.94 for the intervention group and 47.3 +/- 1.91 for the control (P = 0.96), while the mean yearly percent correct change was 4.8 +/- 2.43 for the intervention group and 3.5 +/- 1.67 for the control (P = 0.71). The mean neuroanatomy subset percent correct RITE score was 60.3 +/- 3.54 for the intervention group and 50.9 +/- 3.04 for the control (P = 0.02), with a mean yearly percent correct change of 22.4 +/- 5.77 for the intervention group and 9.4 +/- 1.52 for the control (P = 0.02).

CONCLUSION

A team-oriented intervention with oral quizzing resulted in improved subset RITE performance.

Effectiveness and student perceptions of standardized radiology clerkship lectures: a comparison between resident and attending radiologist performances

RATIONALE AND OBJECTIVES

The authors' objective in this study was to determine whether radiology residents can effectively substitute for attending radiologists in delivering standardized lectures to medical students, without a decline in student performance on examinations or perception of the clerkship lectures.

MATERIALS AND METHODS

Between September 2001 and July 2002, 40 3rd- and 4th-year medical students in the radiology clerkship at Rhode Island Hospital were given 11 standardized PowerPoint presentations. Half of the students were lectured by attending radiologists, and the other half were given the same lectures by radiology residents. At the end of each lecture, students completed surveys regarding their perceptions of the lecture. At the end of each clerkship, a written examination was administered to the students. The results of the surveys and the written examinations were then analyzed to determine whether there were significant differences between the perceptions and performances of these two student groups.

RESULTS

There was no significant difference regarding the perceived overall lecture quality and no significant difference in final examination performance between the two student groups. Lectures by residents were perceived as having an environment in which students felt more comfortable asking questions. Attending radiologist lecturers, however, were perceived to have a greater ability to answer student questions, as well as to ask more appropriate questions of students.

CONCLUSION

Radiology residents were as effective overall as attending radiologists at presenting standardized lecture material to medical students, with no difference in student perception of overall lecture quality or in student performance on examinations.

Curriculum in radiology for residents: what, why, how, when, and where

Developing a curriculum in chest radiology should follow the same general principles that are used when developing a curriculum in any subspecialty area of radiology. A curriculum is more than a "list of topics" with which a resident should be familiar after 4 years of training. It includes objectives and goals, content, faculty, methods, and evaluation. Numerous resources are available for those who are charged with developing a curriculum in chest radiology. In addition to faculty members in the department, whose input during development can ensure successful implementation of the curriculum, organizations (i.e., ACR, APDR, STR) already have begun to develop "model" curricula. Attending the annual meeting of the Association of American Medical Colleges is a way to meet and hear from professionals who develop and oversee curriculum development at their medical schools, and another important resource available at some medical schools is the Office of Medical Education. The faculty within such offices are uniquely qualified to assist with curriculum and faculty development, especially for those areas in which radiology faculty traditionally are less experienced, such as development of valid and reliable assessment forms and construction of behaviorally based objectives.

Effectiveness of resident-prepared conferences in teaching imaging utilization guidelines to radiology residents

RATIONALE AND OBJECTIVES

The authors evaluated the effectiveness of a resident-prepared conference series for teaching imaging utilization guidelines to radiology residents.

MATERIALS AND METHODS

Brown University radiology residents (n = 17) gave 61 presentations on imaging utilization to their colleagues during 16 1-hour conferences. The residents were later examined on the topics presented and surveyed about their familiarity with the American College of Radiology appropriateness criteria, their exposure to issues of cost-effectiveness, and their degree of confidence in providing imaging consultation. The same examination and survey were administered to control residents from the University of Wisconsin (n = 14) and the Oregon Health Sciences University (n = 14). Scores were compared by using linear regression and Wilcoxon rank sum tests.

RESULTS

Controlling for years in radiology residency, residents at Brown scored on average 16.0% (standard error = 2.2%) higher than residents at the other universities (P < .001). Controlling for institution, 3rd- and 4th-year residents scored on average 7.4% (standard error = 2.1%) higher than 1st- and 2nd-year residents (P = .001). Brown residents expressed more familiarity with American College of Radiology appropriateness criteria and appeared to have more exposure to cost-effectiveness issues in conferences than residents at Wisconsin or Oregon Health Sciences University (P < .005). Residents from the three universities did not differ in their level of confidence in providing imaging consultation.

CONCLUSION

Resident-prepared conferences are an effective means of teaching imaging utilization guidelines to residents, but they do not affect the residents' perception of their ability to provide imaging consultation.

Medical students and radiology residents: can they learn as effectively with the same educational materials?

RATIONALE AND OBJECTIVES

The purpose of this study was to evaluate the effectiveness of resident-prepared, independent-learning materials for teaching chest radiology to medical students.

MATERIALS AND METHODS

Students from three U.S. medical schools enrolled in radiology clerkships between March 1998 and June 1998 were randomly divided into control (n = 27) and experimental (n = 31) groups. The experimental group studied 12 chest radiology independent-learning cases (intervention) used to teach radiology residents in a previous study. Both groups took a 36-item, multiple-choice test (previously used to test radiology residents) on three occasions (before intervention [pretest], 1 day after intervention [posttest], and 2-4 weeks after intervention [final examination]). Student scores were then compared with resident scores.

RESULTS

Mean scores were similar across institutions at pretest, but increases at posttest and final examination scores differed across time, school, and group (P < .005). Mean differences in scores between experimental and control groups at pretest, posttest, and 2-4-week final examination were -0.22, 9.79, and 9.14, respectively, demonstrating increased performance at posttesting that remained present (though slightly attenuated) 2-4 weeks later. Comparing performance, residents had mean pretest scores of 19.2 and students of 14.1, a five-point difference attributable to the residents' greater experience. Both residents and students gained approximately nine points at posttest. At final examination, the difference between residents and students was only 1.4 points, suggesting the experimental program (teaching materials) brought students close to the long-term retention shown by residents.

CONCLUSION

Independent study of resident-prepared chest radiology teaching cases increased medical student knowledge for at least 2 or 4 weeks after instruction. Although starting at lower knowledge levels, students experienced gains in knowledge comparable to those of residents, suggesting the same materials can be used to teach both students and residents.

Chest radiology case exchange program: a paradigm for resident teaching and independent resident learning

RATIONALE AND OBJECTIVES

The purpose of this study was to test the effectiveness of resident-prepared, independent learning cases in teaching residents chest radiology.

MATERIALS AND METHODS

Three 2nd-year residents (one each from the University of Wisconsin, the Oregon Health Sciences University, and the University of Michigan) prepared four chest radiology teaching cases each (total, 12 cases). Radiology residents from each institution were randomly divided into control (n = 30) and experimental (n = 35) groups. Residents from both groups took a pretest of 36 multiple-choice questions covering the material from the 12 teaching cases. Residents in the experimental group reviewed these cases independently, and both groups took the same test (posttest) immediately after the teaching cases had been reviewed and again 3 months later (final test).

RESULTS

Test scores were similar across institutions (P > .05) but differed across time and treatment groups (experimental vs control) (P < .0001). Mean differences in test scores between the experimental and control groups at pretest, posttest, and final test were -0.4, +9.0, +4.0, respectively, demonstrating increased performance at posttesting that was still present (though somewhat attenuated) 3 months later at final testing.

CONCLUSION

Independent study of resident-prepared chest radiology teaching cases increases the resident's knowledge for as long as 3 months after instruction.