Rationale and Objectives
We sought to assess how the use of an audience response system (ARS) in medical student radiology instruction affects the self-confidence, ability to gauge mastery, and insights for future preparation in students when they participate as audience members and when they give peer teaching presentations.
Materials and Methods
Twenty-seven medical students discussed radiology case files in groups and used an ARS to present their assigned cases to peers. Students’ views of interactive audience response versus traditional pedagogy were surveyed using a 5-point Likert scale (1, strongly agree; 2, agree; 3, neither agree nor disagree; 4, disagree; 5, strongly disagree).
Results
Students reported that instruction with interactive ARS lectures gave them more confidence to verbally answer questions in subsequent lectures when compared to instruction with standard didactic lectures, where a presenter asks questions and a single student responds (2.35 versus 3.14, p < .024). Students found it easier to gauge their level of mastery of material by answering ARS questions than by hearing classmates’ verbal responses to questions posed in lecture (1.77 versus 2.68, p < .002). When giving peer teaching presentations, students reported that the ARS lecture format helped them to gauge their audience’s level of understanding (1.55, 95% CI [1.27−1.82], p < .001).
Conclusion
Radiology instruction utilizing an ARS can help build students’ confidence, knowledge of self-mastery, and insights for future studying. Similarly, student presenters using an ARS improve their confidence, better gauge their audience, and develop helpful insights for future teaching presentations.
Didactic lectures are a core component of medical student education. They are also commonly used for postgraduate medical education including residency training and continuing medical education ( ). However, didactic lectures demonstrate variable effectiveness as measured by short- and long-term factual recollection ( ) and modification of physician behavior ( ). Medical educators are employing various means to increase the effectiveness of the traditional lecture format. One key feature in effective medical lecturing is audience engagement ( ).
The use of an audience response system (ARS) is one method by which a lecturer can engage an audience ( ). An ARS is an electronic tool that allows the lecturer to pose questions to the audience and then provide the audience and instructor with real-time feedback. During the lecture, the audience is shown a question and an array of multiple-choice answer options. Each participant in the audience registers a response on an ARS keypad ( ). Responses are instantly tallied and displayed on a screen in real-time.
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Materials and methods
Study Design
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Survey Instruments
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Table 1
First-Year Radiology Elective Survey Results
Statement (Mean) Strongly Agree (1) Agree (2) Neutral (3) Disagree (4) Strongly Disagree (5)A. Pre-Elective Survey I understand how radiologists synthesize imaging data with clinical information to form a diagnosis and impact on clinical management. (2.67) 3 8 8 4 1 I am interested in radiology as a specialty. (2.15) 6 12 6 2 0 I am interested in an academic career. (2.35) 6 7 11 2 0 I am interested in teaching as part of my medical career. (1.69) 12 11 2 1 0 During lecture, I feel comfortable responding to a question verbally if I am unsure of the correct answer. (3.83) 1 2 3 12 6 During lecture, I feel comfortable responding to a question with an ARS device that has been assigned to me if I am unsure of the correct answer. (2.27) 5 13 5 2 1 During lecture, I feel comfortable responding to a question with an ARS device that is anonymous if I am unsure of the correct answer. (1.08) 24 2 0 0 0 Hearing my classmates’ verbal responses to lecture questions allows me to gauge my level of mastery of lecture material. (2.68) 4 7 9 3 2 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers allows me to gauge my level of mastery of lecture material. (1.77) 10 13 2 1 0 Receiving my scores from end-of-course examinations allows me to gauge my level of mastery of lecture material. (1.85) 8 15 2 1 0 Hearing my classmate’s verbal responses to lecture questions gives me insight into how I should study for a course. (3.27) 1 7 6 8 4 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers gives me insight into how I should study for a course. (2.38) 2 14 8 2 0 Receiving my scores from end-of-course examinations gives me insight into how I should study for a course. (2.04) 10 7 7 2 0 It will be easy for medical students to generate questions of the appropriate level of difficulty with ARS. (2.40) 2 13 8 2 0 Preparing peer teaching presentations that include ARS questions will be an effective way to learn material. (1.73) 11 11 4 0 0B. Mid-Elective Survey Hearing my classmate’s verbal responses to lecture questions gives me the confidence to verbally answer subsequent questions in lectures or small groups. (3.14) 2 5 4 8 2 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers gives me the confidence to verbally answer subsequent questions in lectures or small groups. (2.35) 4 12 2 5 0 Receiving my scores from end-of-course examinations gives me the confidence to verbally answer subsequent questions in lectures or small groups. (3.23) 2 5 4 8 3 It is easy for medical students to generate questions of the appropriate level of difficulty with ARS. (1.95) 5 13 2 1 0 Seeing students’ responses to ARS questions will help me to feel more comfortable giving my presentation. (2.21) 3 9 7 0 0 Seeing students’ responses to ARS questions will help me to gauge how much my audience understands. (1.59) 7 10 0 0 0 Seeing students’ responses to ARS questions will give me insights into how to prepare for future teaching presentations. (1.80) 4 16 0 0 0C. Post-Elective Survey I understand how radiologists synthesize imaging data with clinical information to form a diagnosis and impact on clinical management. (1.48) 12 8 1 0 0 I am interested in radiology as a specialty. (2.05) 6 8 5 1 0 I am interested in an academic career. (2.29) 4 10 5 1 1 I am interested in teaching as part of my medical career. (1.73) 11 6 5 0 0 Preparing peer teaching presentations that include ARS questions was an effective way to learn material. (1.90) 8 9 2 2 0 It is easy for medical students to generate questions of the appropriate level of difficulty with ARS. (2.00) 4 14 2 1 0 Seeing students’ responses to ARS questions helped me to feel more comfortable giving my presentation. (2.29) 4 8 8 1 0 Seeing students’ responses to ARS questions helped me to gauge how much my audience understands. (1.55) 12 8 2 0 0 Seeing students’ responses to ARS questions gave me insights into how to prepare for future teaching presentations. (1.62) 9 11 1 0 0
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Statistical Analysis
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Results
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ARS Effects on Learners
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Table 2
ARS Effects on Learners
Statement Mean (95% CI)p -ValueConfidence Hearing my classmate’s verbal responses to lecture questions gives me the confidence to verbally answer subsequent questions in lectures or small groups. 3.14 (2.64, 3.64) <0.024 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers gives me the confidence to verbally answer subsequent questions in lectures or small groups. 2.35 (1.94, 2.76) <0.013 Receiving my scores from end-of-course examinations gives me the confidence to verbally answer subsequent questions in lectures or small groups. 3.23 (2.72, 3.73)Mastery Hearing my classmates’ verbal responses to lecture questions allows me to gauge my level of mastery of lecture material. 2.68 (2.24, 3.12) <0.002 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers allows me to gauge my level of mastery of lecture material. 1.77 (1.48, 2.06) <0.712 Receiving my scores from end-of-course examinations allows me to gauge my level of mastery of lecture material. 1.85 (1.57, 2.12)Insight for Future Study Hearing my classmate’s verbal responses to lecture questions gives me insight into how I should study for a course. 3.27 (2.84, 3.70) <0.002 Responding to ARS questions during lecture and immediately seeing the distribution of responses and the correct answers gives me insight into how I should study for a course. 2.38 (2.10, 2.67) <0.165 Receiving my scores from end-of-course examinations gives me insight into how I should study for a course. 2.04 (1.66, 2.42)
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ARS Effects on Presenters
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Table 3
ARS Effects on Presenters
Statement Mean (95% CI)p -Value Seeing students’ responses to ARS questions helped me to feel more comfortable giving my presentation. 2.29 (1.93, 2.64) <0.001 Seeing students’ responses to ARS questions helped me to gauge how much my audience understands. 1.55 (1.27, 1.82) <0.001 Seeing students’ responses to ARS questions gave me insights into how to prepare for future teaching presentations. 1.62 (1.37, 1.87) <0.001
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ARS Implementation
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Table 4
ARS Implementation
Statement Mean (95% CI)p -valueAnonymity During lecture, I feel comfortable responding to a question verbally if I am unsure of the correct answer. 3.83 (3.42, 4.24) <0.001 During lecture, I feel comfortable responding to a question with an ARS device that has been assigned to me if I am unsure of the correct answer. 2.27 (1.89, 2.65) <0.001 During lecture, I feel comfortable responding to a question with an ARS device that is anonymous if I am unsure of the correct answer. 1.08 (0.97, 1.18)Preparing ARS Questions It will be easy for medical students to generate questions of the appropriate level of difficulty with ARS. 2.40 (2.11, 2.69) <0.072 It is easy for medical students to generate questions of the appropriate level of difficulty with ARS. 2.00 (1.70, 2.30)
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Discussion
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Acknowledgments
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