Rationale and Objectives
As medical imaging continues to grow as a central modality by which physicians of all specialties visualize anatomy, so, too, is its role in medical student education. However, no study to our knowledge has attempted to categorize the necessary cognitive skills. Here, we assess a tool to identify those skills and their possible hierarchical nature that reflects deeper understanding of radiological anatomy.
Materials and Methods
We adapted the revision of Bloom’s Taxonomy of Educational Objectives to create examination questions and teaching points for normal radiological anatomy in a medical anatomy course in 2008. All six previously established levels of cognitive processes were adapted, ranging from Remembering to Create. Reliability and validity were assessed.
Results
Of 102 eligible students, 98 (98%) consented to participate, and 108 examination questions were assessed. Cronbach α assessing reliability ranged from poor (.197) to moderate (.571) with most categories being moderate. Score means for the levels of cognitive processes were statistically distinct [F(4, 102) = 180.63, P < .001] and tended to decrease as the level of cognitive process increased [Spearman ρ(5) = −.800, P = .104], consistent with a valid hierarchical structure.
Conclusions
A radiological anatomy adaptation of the revised taxonomy demonstrated generally adequate reliability and acceptable validity to establish evaluations that test different depths of cognitive processes. This is a critical first step to create a fundamental curricular tool by which medical imaging education—both normal and pathological—may be taught and assessed in the future.
Radiology as a specialty is at a crossroads concerning its role in undergraduate medical education. National-level discussions of what constitutes core medical imaging knowledge, who is most effective at instruction, and whether a radiology clerkship should be required are all under consideration. Moreover, the Alliance of Medical Student Educators in Radiology recently published a recommended radiology curriculum for US medical schools and is currently creating a national database of radiology test questions for students in both preclinical and clinical courses . It is critical during this fundamental juncture that medical imaging assessments are validated, test a range of skills and depth of knowledge, and promote effective learning to optimize patient care in the long term .
It is well established in both the general higher education and medical education communities that assessment is one of the strongest influences on learning . For example, a statistically significant difference in student study patterns was observed recently when a UK program changed medical student examination emphases . In addition, the benefits of aligning curricular components, from course objectives to assessments, have long been well established in the education community .
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Table 1
Six Categories of the Cognitive Process Dimension with Radiological Anatomy Examples
Adapted from ANDERSON\ KRATHWOHL\AIRASIAN\CRUIKSHANK\MAYER\PINTRICH\RATHS\WITTROCK, A TAXONOMY FOR LEARNING, TEACHING, AND ASSESSING: A REVISION OF BLOOM’S TAXONOMY OF EDUCATIONAL OBJECTIVES, ABRIDGED EDITION, 1st,©2001 . Printed and Electronically reproduced by permission of Pearson Education, Inc., Upper Saddle River, New Jersey.
Category Cognitive Process Radiological Anatomy Example Remember ∗ Recognizing Recognize the orientation of the image. Recalling Recall structures: point and label. Understanding † Interpreting “In which direction was this chest x-ray taken?” exemplifying Give examples of markers to distinguish anatomical structure location. Classifying “Classify the categories into which the different shades of gray in a radiograph belong.” Summarizing “Write a short summary of structures deviated in a tension pneumothorax.” Inferring “Infer which structure shown would most likely be impacted by ischemia to the SMA [superior mesenteric artery].” Comparing Compare pathology to normal images. Explaining “Explain why this axial chest CT slice is at T4.” Apply ‡ Executing “What arteries does a RBC [red blood cell] traverse in traveling from the heart to the right brachial artery?” Implementing N/A Analyze § Differentiating Distinguish the different parts of structures, such as “label the ascending aorta in an AP [anteroposterior] x-ray.” Organizing Organize these CT [computed tomographic] slices in correct order. Attributing N/A Evaluate ¶ Checking “Is this lung size normal?” Critiquing “How could patient position cause air in the peritoneal cavity to not be visualized in this (KUB) image?” Create ∗∗ Generating “What could cause this acute structural abnormality?” Planning With a chest x-ray: “In what plane (coronal, sagittal, or axial) would you best visualize the left main bronchus?” Producing N/A
N/A, not available.
†† A similar—but not identical—image may have been previously viewed.
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Materials and methods
Participants and Study Design
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Adapted Taxonomy Selection and Implementation
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Statistical Analysis
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Results
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Table 2
Cognitive Process Reliability Tests
No. (N = 108) Mean Student Score (% ± SD) Cronbach α Cronbach α if Least-Correlated Item Deleted I: Remember 27 77.8 ± 1.87 .571 .589 II: Understanding 25 79.3 ± 1.87 .505 .519 III: Apply 14 ∗ 67.7 ± 2.59 .325 .388 IV: Analyze 31 68.5 ± 2.39 .560 .579 V: Evaluate 1 N/A N/A N/A VI: Create 10 64.5 ± 2.12 .197 .236
N/A, not applicable; SD, standard deviation.
No. refers to number of examination questions.
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Discussion
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Limitations
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Conclusion and future implications
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Acknowledgments
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