Rationale and Objectives
The study is designed to evaluate the effectiveness of an active form of resident instruction, cooperative learning, and the residents’ response to that form of instruction.
Materials and Methods
The residents dictated three sets of reports both before and after instruction in radiology reporting using the cooperative learning method. The reports were evaluated for word count, Flesch-Kincaid grade level, advancement on clinical spectrum, clarity, and comparison to prior reports. The reports were evaluated for changes in performance characteristics between the pre- and postinstruction dictations. The residents’ response to this form of instruction was evaluated by means of a questionnaire.
Results
The instruction was effective in changing the resident dictations. The results became shorter ( P < .035), more complex ( P < .0126), and demonstrated increased advancement on clinical spectrum ( P < .0204). The resident response to this form of instruction was positive. One hundred percent or respondents indicated enjoyment working with their groups. Seventy-five percent stated they would like to participate in more cooperative learning activities. The least positive responses related to the amount of time devoted to the project. Sixty-three percent of respondents stated that the time devoted to the project was appropriate.
Conclusion
Cooperative learning can be an effective tool in the setting of the radiology residency. Instructional time requirements must be strongly considered in designing a cooperative learning program.
Gunderman ( ) has likened the radiology residency to the training skilled journeymen receive. The craft is learned mostly on the job with independent study and formal instruction adding to the skill base. Faculty instruction of residents has traditionally fallen into two categories. The first is the traditional lecture. This has two subdivisions. There is the didactic lecture in which the active lecturer dispenses information to the passive students. There is also the “hot-seat conference” in which the instructor acts as the expert and a resident responds to his questions. In this setting, one student is active and the other students are observers. In either setting most of the residents are in a passive role. The second category is informal, “view box,” teaching in which a faculty member dispenses instruction to the resident in either a one on one or one to small group fashion.
In each of the above attending-resident interactions, the model is that of a master passing knowledge to the apprentice. Gunderman has questioned the appropriateness of this model. He concludes the result of this environment is a resident that regards science as a “received body of facts, a collection of information, the sum total of the contents of all radiology textbooks” ( ). Rather than this mindset, he feels the residency should be “conceived of as an invitation to discovery.” Gunderman ( ) further states that the educational environment should be learner-centered rather than teacher-centered. Collins ( ) offers a similar opinion indicating that the learner should be the active participant with the instructor acting as a facilitator.
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Materials and methods
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Before the study, three imaging studies were selected to serve as the test material. These studies were stripped of their identifying material and loaded onto the university picture archiving and communication system. Two of the three cases had comparison studies and the comparisons were included. A clinical history was attached to the images. The residents were then informed that they would be involved in a project relating to radiology reports and were asked to independently dictate reports for the studies in their usual fashion. The reports were transcribed using Microsoft Word.
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Table 1
Report Scoring Worksheet
ID number: ________________________ Case number: _____________________ Response to clinical history: Advancement on position of clinical spectrum _____ Clearly and definitively advanced position (5 points) Advanced position in a hedged fashion (4 points) Advanced position in an indirect fashion required interpretation by clinician (3 points) Question addressed but only descriptive information given (2 points) Question not addressed directly, information in report would aid clinician (1 point) Report of limited value in clinical situation (0 points) Report clarity: Definite statements (no qualifiers) _____ Probable Statements (compatible, consistent) _____ Possible Statements (suggest, consider possibility of, question of) _____ Comparison studies: _____ Comparisons made both in description and impression (5 points) Comparison made either description or impression (4 points) Comparison study listed but no comparisons made (2 points) Comparison film available but not mentioned (0 points) Comparison mentioned but date not given (Subtract 1 point from score) No comparison available (NA)
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Results
Attendance
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Survey Results
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Table 2
Selected Response Resident Evaluations
Check the Cell that Represents Your Response Strongly Agree Agree Disagree Strongly Disagree N/A Group interaction brought out insights into the radiology report that I would not have recognized on my own. 2 11 3 1 I enjoyed working with the members of my group. 2 14 1 The group bonded and there was a strong sense of group solidarity and teamwork. 3 11 1 2 If I missed a session the other members of my group brought me “up to speed.” 2 8 1 6 The responsibility for teaching and learning was more on the group rather than on the attending. 2 15 The experience increased my appreciation for the other members of my group. 1 13 2 1 The activity improved my ability to write an effective radiology report. 2 10 3 1 1 The amount of time spent on the project was appropriate. 1 9 5 1 1 I will receive more long term benefit from this activity than I would have received from attending lectures on radiology reports. 2 9 4 1 1 I was able to attend most of the sessions. 2 10 3 1 1 I would like to participate in more cooperative learning activities. 1 11 2 2 1 My overall response to this type of teaching is positive. 12 3 2
Comment: One survey returned but not filled out. The resident indicated he or she had not been able to attend the lectures.
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Selected Response Evaluations
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Response to the Group Environment
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Effectiveness of the Group as a Teaching Instrument
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Time Constraints of the Project
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Overall Response to Cooperative Learning
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Open-ended Responses
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Cooperative Learning Experience
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Improvements in Cooperative Learning
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Potential Uses for Cooperative Learning in Radiology Residency
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Other Comments
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Assessment of Radiology Reports
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Table 3
Effect of Cooperative Learning on Report Characteristics
Before Instruction After Instruction Median SD Median SD_P_ Value Word count 165 78 134 69 .0035 Grade level 11.70 0.48 11.86 0.30 .0126 Clinical spectrum 3.33 1.03 3.67 0.82 .0204 Definitive statements 0.828 0.114 0.863 0.124 .0937 Comparisons 3.11 1.84 3.22 1.69 .6608
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Discussion
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