Rationale and Objectives
The aim of the study was to ascertain the learning curves for the radiology residents when first introduced to an anatomic structure in magnetic resonance images (MRI) to which they have not been previously exposed to.
Materials and Methods
The iliolumbar ligament is a good marker for testing learning curves of radiology residents because the ligament is not part of a routine lumbar MRI reporting and has high variability in detection. Four radiologists, three residents without previous training and one mentor, studied standard axial T1- and T2-weighted images of routine lumbar MRI examinations. Radiologists had to define iliolumbar ligament while blinded to each other’s findings. Interobserver agreement analyses, namely Cohen and Fleiss κ statistics, were performed for groups of 20 cases to evaluate the self-learning curve of radiology residents.
Results
Mean κ values of resident–mentor pairs were 0.431, 0.608, 0.604, 0.826, and 0.963 in the analysis of successive groups ( P < .001). The results indicate that the concordance between the experienced and inexperienced radiologists started as weak (κ <0.5) and gradually became very acceptable (κ >0.8). Therefore, a junior radiology resident can obtain enough experience in identifying a rather ambiguous anatomic structure in routine MRI after a brief instruction of a few minutes by a mentor and studying approximately 80 cases by oneself.
Conclusions
Implementing this methodology will help radiology educators obtain more concrete ideas on the optimal time and effort required for supported self-directed visual learning processes in resident education.
Radiology is a specialty with a pivotal role in diagnosis and treatment of patients. Because of the multifaceted and rapidly evolving nature of the specialty, radiology also requires training and learning throughout the entire career .
Radiology residency is an apprenticeship during which the resident learns through observation, instruction, and implementation of the knowledge into practice and continuous repetition . The radiology residency education has 3 components: curriculum, instruction, and assessment. Curriculum is the sum of all knowledge and skills which residents are required to master to achieve clinical competency. Instruction is how the sum of knowledge and abilities is transferred from the teacher to the learner. From a behaviorist point of view, instruction is the way information is presented to the learner and how this knowledge is practiced by the learner to the perfection. Assessment, in addition to being criterion referenced, objectively determines what and how well the resident has learned .
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Open full size image
Figure 1
T1-weighted axial magnetic resonance image and schematic representation of the iliolumbar ligament seen as a double hypointense band ( arrowheads ) originating from transverse processes of the L5 lumbar vertebra and inserting to the posteromedial aspect of crista iliaca.
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Materials and Methods
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Table 1
Scale for Interpretation of κ Values
κ Agreement <0 Less than chance agreement 0.01–0.20 Slight agreement 0.21–0.40 Fair agreement 0.41–0.60 Moderate agreement 0.61–0.80 Substantial agreement 0.81–0.99 Almost perfect agreement
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Results
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Table 2
Interobserver Agreement for Resident–Experienced Radiologist Pairs in Groups of 20 ( P < .001 for Each Pair per Case Group)
Pairs Versus Cases 1–20 21–40 41–60 61–80 81–100 Resident 1–mentor 0.464 0.583 0.588 0.789 0.889 Resident 2–mentor 0.427 0.655 0.636 0.899 1.000 Resident 3–mentor 0.401 0.587 0.588 0.789 1.000 Mean κ values 0.431 0.608 0.604 0.826 0.963
Table 3
Cumulative Interobserver Agreement for Resident–Experienced Radiologist Pairs ( P < .001 for Each Pair per Case Group)
Pairs Versus Cases 1–20 1–40 1–60 1–80 1–100 Resident 1–mentor 0.464 0.528 0.552 0.605 0.653 Resident 2–mentor 0.427 0.543 0.576 0.646 0.706 Resident 3–mentor 0.401 0.497 0.530 0.587 0.659 Mean κ values 0.431 0.523 0.553 0.613 0.672
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Table 4
Fleiss’ κ Values for Residents When Studying Images From Patients in Groups of 20 ( P < .001 in Each)
Cases 1–20 1–40 1–60 1–80 1–100 Residents 0.775 0.890 0.883 0.922 0.927 Cases 1–20 21–40 41–60 61–80 81–100 Residents 0.775 0.826 0.874 0.863 0.874
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Discussion
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