We are grateful for your inclusion of the letter prepared by Drs Redmond, Healy, Clifford, and Heffernan. We absolutely agree with them about the long-established value of the Socratic method, particularly in our field of diagnostic imaging. Their concern is valid and important, and we did not intend to de-emphasize the value of teaching our radiology residents using the hot-seat method. Indeed, as our colleagues summarize in their well-written letter, our daily work requires that we expeditiously generate a summary of imaging findings, a reasonable differential diagnosis, and an appropriate management strategy. Often this is done while referring clinicians engage us in discussion and then await our conclusions and recommendations. This is a skill that evolves from practice in residency and requires careful supervision from attending radiologists.
In the United States, educators in radiology began to hear a new conversation from residents, following the transition from an oral certifying examination by the American Board of Radiology to a computerized examination. In prior years, senior radiology residents facing the upcoming oral certifying examination enjoyed internal program-specific review sessions wherein attending radiologists would review cases using the hot-seat format, coaching one resident at a time as the remainder of the class observed the case discussions. This was a more intense version, perhaps, of the hot-seat case conferences that were and are part of routine resident teaching sessions throughout the year. However, as the certifying examination became a computerized test, radiology residents began to express anxiety about the unknowns of this sort of test. Residents began asking supervising radiologists for review sessions that incorporated questions similar to what they might see on the examination. As a means of providing the residents with some reassurance during their preparation for the certifying examination, some of us began presenting multiple-choice questions mixed in with more traditional Socratic-type case discussions. The residents relaxed.
We agree with Dr Redmond et al. that radiology residents may benefit from the use of the Socratic method in their training. While fostering critical thinking, the Socratic method also cultivates poise and independence. The additional use of electronic audience response systems offers a means to present a large volume of information to a class of residents preparing for their certifying examination. In our experience, a program such as Nearpod serves several purposes—the use of portable computing devices seems to engage and sustain residents’ attention over longer periods of time, creates a learning environment where residents feel it is safe to make mistakes, and provides the educator with immediate feedback regarding comprehension and misconceptions of their learners.