The field of academic radiology has historically integrated new technologies in innovative ways to educate more efficiently and effectively. To date, the majority of articles discussing technology and radiologic education focus on information transmission, interactive computer-aided instruction, or facilitation of testing ( ).
Impediments of medical student education in the field of radiology have been recounted in numerous articles. Some cite increasing clinical workload for academic radiologists and the lack of incentives to make education a priority ( ). Others describe precedents set by medical school curricula that marginalize radiology during the preclinical and clinical years ( ). Despite this, radiologists and nonradiologists alike believe radiology needs to play an increasing role in medical education ( ).
Gunderman et al ( ) explored different aspects of technology facilitating medical student education. They divided radiology content into information, knowledge, and understanding. While effective use of technology becomes increasingly more difficult with higher forms of learning, they explained that understanding represents the highest and most desirable educational objective.
Simulation of the radiology resident experience offers active participation for students, which enhances understanding ( ). Traditional medical student education in radiology involves passive learning through observing staff and resident readouts. Applying the constructivist theory of education in radiology, simulation provides “understanding through practice in realistic situations” ( ). However, few computer-based simulation models have been designed for radiology ( ), likely secondary to the complexity of the task.
Voice recognition dictation (VRD) has been a growing component of radiology and affords the opportunity to simulate the radiology work experience. A new test environment using a nationally recognized VRD system was created for the purpose of this study to allow medical students to generate dictated reports. To our knowledge, no similar system has been previously employed as a radiology educational tool. We describe our experience implementing such a program as a component of a 4-week radiology clerkship for fourth-year medical students, with the objective of determining feasiblity and educational benefit by student survey.
Materials and methods
Subject Selection
In the academic year of 2005–2006, 54 of 112 fourth-year medical students at our institution enrolled by lottery into a 4-week radiology clerkship, and similar total numbers are anticipated for the 2006–2007 academic year. The study took place between November 2005 and August 2006, and before initiation, the study received exemption status from the Creighton University Institutional Review Board regarding the Federal Policy for Protection of Human Subjects. Five separate cohorts of students were enrolled for a 1-month period, which equated to 33 students enrolled in the study of a total of 46 students rotating through radiology during that time span. Periods of enrollment were determined by the presence of the primary inverstigator for at least 3 weeks of the rotation and participation was required for all students on selected months. One student did not complete the required dictations or questionaire, for a total of 32 tested subjects. Of those subjects, two students were on exchange from the Dominican Republic. Thirteen students categorized themselves as pursuing a radiology residency, 18 as pursuing a non-radiology residency, and 1 as undecided. Twenty-two students reported prior dictation experience (non-VRD), whereas 10 reported no such experience.
Radiology Clerkship
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Preparation of Teaching Cases
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Voice Recognition Dictation
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Case Administration and Dictation
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Student Evaluation of Exercise
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Results
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Table 2
Student Responses to Time Allocation of Viewbox Instruction During Rotation ( n = 32)
Number of Students <10 min/wk 10–30 min/wk 30–60 min/wk >60 min/wk One-on-one viewbox instruction related to study From resident 7 3 13 9 From attending 14 8 9 1 One-on-one viewbox instruction unrelated to study From resident 3 4 15 10 From attending 9 12 9 2 Group viewbox instruction unrelated to study <2 hr/wk 2–4 hr/wk 4–6 hr/wk >6 hr/wk From resident 5 9 9 9 <1 hr/wk 1–2 hr/wk 2–3 hr/wk >3 hr/wk From attending 6 11 6 9
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Table 3
Student Ratings of Study Components ( n = 29)
Component Rating ⁎ Average Rating 1 2 3 4 5 Number of Students Dictation experience 1 5 7 11 5 3.5 One-on-one instruction 13 10 4 1 1 1.9 Exposure to classic radiology cases 11 9 6 3 0 2.0 Medical problem-solving 2 2 7 6 12 3.8 Guided study time 2 3 6 6 12 3.8
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Discussion
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Table 4
Student Comments
This was a great teaching tool. The most helpful part was looking at them on our own and then going over them with the resident. Dictating was helpful in making us think how to describe the findings. I think this is a good exercise. It makes you carefully go over a case, therefore remember it better than if you just sat with a resident and looked at the case with him or her. [VRD] can be difficult to use at times. Almost faster to type. Exercise helpful though. 50–75% rating on question #3 secondary to time spent correcting [VRD] errors, not lack of value. If I had to choose I would say yes to the cases and no to the voice recognition. I enjoyed the cases and going over them with various residents and attendings. I didn’t have any feelings of the dictations re: liking it and its usefulness. I thought that the cases were helpful but that dictating wasn’t necessarily benefiting us a lot at this stage of the training (but interesting to see/try out once). Getting to practice dictation was fun. Appreciate instruction from residents. It was nice to get experience with dictating because it takes a little practice before you feel comfortable (minimally). Practicing allows us to get a good feel about how to word things. Makes you think more about what you’re actually saying or interpreting. This was a beneficial, if frustrating, exercise. It forces us to pay closer attention to what is actually included in a radiology report. I also very appreciated the instruction on how to present a radiology case orally. The computer system was frustrating. Having to repeatedly log in/log out, restart, and many times type in responses were a source of angst. Dictations were very helpful and should definitely be a core of the radiology rotation. It definitely lets us be more proactive as opposed to just watching other people read/dictated all day. Cases were very helpful. Allowed for individual reading of films and independent research of potential findings. Resident and attending instruction was easy to obtain and very helpful. Cases made you look beyond the obvious for any findings. I felt that this was the best learning experience I did in this rotation. If anything, I would have liked more. It would have been better if there was a place to look at the films while I dictated. I feel my dictations would have been better. There seems to be differing opinions between the attendings and residents about significant findings. Sometimes there wasn’t a unified answer to the cases. Overall a great experience. Please incorporate more classic cases or easy ones; even if not part of the original bone cases. I think it will boost our confidence overall. But then again I am going into psych. I enjoyed doing the cases, however, I felt like it was a bother/inconvenience for the staff/residents to staff each individual student out. Otherwise, it was very educational. Did not benefit from noon conference a great deal, a lot was above my head. Would have liked a set time slot or amount of time to have instruction instead of having to go find someone or ask. Loved the voice recognition exercise and would recommend continuing it. Great rotation! The cases were good. It provided a focus/guide for learning some of the basics of Radiology, since we did not get feedback on the dictation aspect—I don’t think that part of the experience was helpful. One of the hardest parts about radiology is describing what you see—so feedback would have been helpful. The cases would also have been better if we had a “mini-lecture” to point out some of the basics for each week (ie, what to look for with chest films, bone films, abdomen). Overall, a good experience. This was a valuable part of the rotation that added a different aspect to the clerkship. It allows students to view films, establish a diagnosis individually and see how their interpretation matches with attending/resident interpretation. The voice recognition aspect also provides an insight on the radiology experience. The viewbox exercise was very helpful and I enjoyed seeing classic cases. Despite only two sets it was very helpful. May do some abdominal and/or CT/MRI of head films also. At first, I was not supportive of doing cases, but once I realized it was a more relaxed, nonguided exercise, I enjoyed it and gained from it more. Please continue to keep it like that, so students can focus more on learning rather than feel the need to perform well.
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Acknowledgments
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