Rationale and Objectives
The principles of Collins’ cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach.
Materials and Methods
The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding.
Results
Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R 2 from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students’ radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice.
Conclusions
The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.
Introduction
Radiological imaging is widely acknowledged as an essential element of modern medical practice. Accordingly, increasing attention has been given to the importance of preparing medical students to become responsible users of medical imaging by including radiology in the curriculum. Methods of teaching radiology range from stand-alone clerkships composed of dedicated blocks of time, to longitudinal or vertically integrated clerkships in which content is distributed throughout the year and coordinated with other topics . The primary rationale for favoring a vertically integrated approach is that it promotes context-specific learning with relevant radiology material presented alongside corresponding clinical conditions and patient contact .
Presenting material in a vertically integrated manner fosters durable learning by making the material relevant to students’ practical, real-life clinical work . These same precepts form the foundation of Collins’ cognitive apprenticeship theory, which emphasizes purposeful practice of target skills within the functional context of their use . The cognitive apprenticeship model promotes active problem solving and transfer of conceptual knowledge from the abstract stage to the phase of successful execution of the target task in a practical, authentic framework. This model is germane to all types of cognitive learning, including clinical medical education. According to this learning framework, preexisting cognitive skills are reinforced by repeated attempts to execute the target process under the guidance of an expert practitioner. Performance of the targeted task in successive approximations of proficiency replicates the gradual growth of expertise, similar to what occurs in a traditional apprenticeship.
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Materials and Methods
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Curriculum Development
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Case Selection
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Table 1
Number of Cases and Sample Case Topics for Radiology Curriculum, Sorted by Corresponding Clinical Clerkship
Clerkship Number of Cases Sample Case Topics Medicine 8
Surgery 8
Family Medicine 6
Pediatrics 6
OB-Gyn 6
Neurology 4
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Case Presentation
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Faculty Feedback
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Participation
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Student Performance
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Curriculum Evaluation
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Quantitative Analysis
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Qualitative Analysis
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Results
Curriculum Development
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Curriculum Evaluation
Quantitative Analysis
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Table 2
Multiple Regression Models of Relationships of Independent Variables to Radiology Examination Score
Independent Variables in Model F R 2 Change R 2 B__t Model 1: Basic Science Examination Score 47.94 \* .16 .40 6.9 \* Model 2: Basic Science Examination Score
Number Radiology Cases Answered 47.6 \* .28 .12 \* .33
.35 6.0 \*
6.3 \*
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Qualitative Analysis
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Table 3
Dominant Themes Found by Analysis of 37 Student Survey Responses
Theme area Number of Positive Comments Number of Negative Comments Self-paced design (Sub-themes: flexibility, regularity, and deliberate practice) 57 0 Receiving feedback from faculty 50 3 Clinical relevance of radiology cases 23 0 Gaining confidence in interpreting radiological images 15 0 Transfer of conceptual knowledge to actual practice 9 0
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Theme 1. Self-Paced Design of Cases
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Theme 2. Receiving Feedback from Faculty
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Theme 3. Clinical Relevance of Radiology Cases
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Theme 4. Gaining Confidence in Interpreting Radiological Images
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Theme 5: Transfer of Conceptual Knowledge to Actual Practice
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No matter what field you go into you will encounter radiology of some sort and you won’t always be able to wait for the radiologist to write you a nice neat report. There will be times that you have to act autonomously and practicing these skills will help build upon my abilities to do so.
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Discussion
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Curriculum Development
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Curriculum Evaluation
Quantitative Analysis
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Qualitative Analysis
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Conclusions
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Acknowledgements
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Appendix 1
8-Question Anonymous Survey Administered to Mandatory Year Students Regarding Their Opinions of the Radiology Curriculum
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