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“Flipping” the Introductory Clerkship in Radiology

Posted May 31, 2015 Updated Apr 10, 2023
By Lily M. Belfi MD , Roger J. Bartolotta MD , Ashley E. Giambrone PhD , Caryn Davi MS , Robert J. Min MD MBA
10 min read

Rationale and Objectives

Among methods of “blended learning” (ie, combining online modules with in-class instruction), the “flipped classroom” involves student preclass review of material while reserving class time for interactive knowledge application. We integrated blended learning methodology in a “flipped” introductory clerkship in radiology, and assessed the impact of this approach on the student educational experience (performance and perception).

Materials and Methods

In preparation for the “flipped clerkship,” radiology faculty and residents created e-learning modules that were uploaded to an open-source website. The clerkship’s 101 rising third-year medical students were exposed to different teaching methods during the course, such as blended learning, traditional lecture learning, and independent learning. Students completed precourse and postcourse knowledge assessments and surveys.

Results

Student knowledge improved overall as a result of taking the course. Blended learning achieved greater pretest to post-test improvement of high statistical significance ( P value, .0060) compared to lecture learning alone. Blended learning also achieved greater pretest to post-test improvement of borderline statistical significance ( P value, .0855) in comparison to independent learning alone. The difference in effectiveness of independent learning versus lecture learning was not statistically significant ( P value, .2730). Student perceptions of the online modules used in blended learning portions of the course were very positive. They specifically enjoyed the self-paced interactivity and the ability to return to the modules in the future.

Conclusions

Blended learning can be successfully applied to the introductory clerkship in radiology. This teaching method offers educators an innovative and efficient approach to medical student education in radiology.

The current model of medical education in the United States has been challenged in recent years on issues of quality and efficiency. In Cooke’s 2010 publication, which has been dubbed “the second Flexner Report,” shortcomings of the current system are described in terms of inefficiency, inflexibility, and lack of learner centeredness . Many of the ongoing efforts for curriculum reform reflect a shift from the current teacher-centered product-based approach to a learner-centered process-based approach to medical education . In recent years, the “flipped classroom” (FC) model has become a leading strategy to facilitate this transition from passive to active and more integrated learning. This method, also referred to as “blended learning,” uses the delivery of instructional content before class (eg, videos and readings), with class time reserved for interactive application of knowledge (case-based learning, audience response activities) . In effect, the educator’s role shifts from one of dispenser of information to facilitator of learning . Since the development of the Khan Academy in 2006, the use and efficacy of FC in nonmedical education have been well established . However, there is limited evidence on the utilization of this teaching format in medical education, and none so far to our knowledge in the setting of a radiology clerkship for medical students . Therefore, the purpose of this study is to determine the effectiveness of “flipping” the introductory clerkship in radiology.

Materials and methods

Course Description

The introductory clerkship in radiology at our institution is a subset of a larger Introduction to Medicine Clerkship. Medical students are enrolled in this clerkship between their second and third years before clinical rotations. The current class had 101 students. The curriculum design for our clerkship was based in large part on the Alliance of Medical Student Educators in Radiology National Medical Student Curriculum in Radiology . For this iteration of the clerkship, we were allotted 12 hours of teaching time over 3 days. Because of time constraints, this allotment had been reduced from prior years, in which we were allotted 20 hours of teaching time. Clerkship administrators requested that we omit pediatric radiology and women’s imaging from the didactic portion of the course (due to the incorporation of these subjects in subsequent third-year clinical rotations), so we decided to teach these subjects entirely via online learning modules (independent learning group).

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Offloaded Content

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RadCasts

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RadTorials

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RadGames

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Interactive Clinical Anatomy and Radiology Utilization Simulator

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In-class Student-centered Learning

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Data Collection

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Data Analysis

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Results

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Table 1

Improvement between Pretests and Post-tests for Each Learning Method

Learning Method Pretest Average % Correct (minimum–maximum) Post-test Average % Correct (minimum–maximum) % Improvement_P_ Value Blended learning 47 (8–86) 73 (45–96) 26 .0048 Independent learning 36 (19–61) 53 (24–78) 17 .0753 Lecture learning 58 (39–93) 68 (44–98) 10 .1618

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Table 2

Comparison of Pretest to Post-test Improvement between the Different Learning Methods

Learning Method % Improvement_P_ Value Blended learning 26 .0855 Independent learning 17 Blended learning 26 .0060 Lecture learning 10 Independent learning 17 .2730 Lecture learning 10

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Table 3

Mean Percentage of Correct Answers on the Post-test for Each Learning Method

Learning Method Post-test, Mean % Correct ± SD Blended learning 0.73 ± 0.15 Independent learning 0.53 ± 0.18 Lecture learning 0.68 ± 0.18

SD, standard deviation.

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Table 4

Comparison of Differences of Mean Percentage of Post-test Correct Answers between the Learning Methods in a Pairwise Fashion

Learning Method Blended Learning Independent Learning Independent learning_d_ = 0.20, P = .0091 Lecture learning_d_ = 0.05, P = .4051d = 0.15, P = .1731

d , difference in mean percentage correct answers between the two groups; P , P value for the mean differences between the two groups.

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Table 5

Results From Postclerkship Survey Where Students Were Asked to Choose Which Learning Environment They Preferred During the Clerkship

Preferred Learning Environment_n_ (%) Classroom: interactive 33 (34.7) Self-directed with faculty presence 20 (21.1) Self-directed 18 (18.9) Combination of all the above 16 (16.8) Classroom: traditional 8 (8.4)

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Discussion

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Appendix 1

Radiology Clerkship Schedule.

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Open full size image

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Appendix 2

Sample Knowledge Assessment Questions.

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Academic Radiology, Volume 22, Issue 6
Journals General Radiology
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