Medical education is in the midst of a revolution. From undergraduate to graduate training programs to Continuing Medical Education, articles appear regularly in the lay press as well as scholarly publications indicating that the old ways of teaching are no longer working ( ). It is clear that the new generation of learners is asking for things that prior generations of teachers may not be prepared to provide. The days of passive didactic delivery of information in a large auditorium are over, whether we oldsters know it or not. The only reason this method is still used so extensively in Continuing Medical Education is probably due to the average age of the audience, and because the old way of teaching is so easy to arrange. Medical students and other millennials would not stand for the format of most Continuing Medical Education courses, with hour after hour of didactic slides in large, noninteractive settings.
Sadly, we have put the cart well before the horse in many ways in terms of medical educational goals. The types of tests we administer to students have a huge impact on the way they want to learn and the way they study. The “Step” exams for medical students have become a major motivator for students to skip class and cram test-worthy facts into their heads ( ). The new MCQ format of the Radiology board exam has had a similar effect on the way residents want to study and what they think is important ( ). No longer is the ability to recognize, describe, and formulate a plan for managing a complex case the goal. The goal is to know as many “testable” facts as possible about a laundry list of diseases culled from question banks and various other study guides.
Many medical schools are seeing dramatic drops in attendance for standard lectures, and many have dramatically curtailed this teaching format. The Liaison Commission for Medical Education, the accrediting body for medical schools, limit the number of hours of traditional lecture that are acceptable for medical students, and requires more emphasis on group learning and interactive methods. It behooves us as academic radiologists to become aware of the alternatives to traditional teacher-centered delivery of information. In the modern world of asynchronous preparation and focus on active learning for in-person interactions, we can do better. In order to best serve our trainees, we need to fulfill both of their needs—to enable them to pass their credentialing exam, but also to be able to apply that knowledge in complex, real world situations. The traditional “noon didactic slide conference” approach does neither.
The article by Richardson and colleagues ( ) in this issue tackles this topic in great depth, and should serve as a stimulus for teachers of medical students, residents, and fellows to explore beyond the nearly-universal linear slide set approach. As noted in the Abstract for this article, the liaison Commission for Medical Education requires all faculty (residents and fellows included) who teach medical students to have training in effective teaching methods. The Association of University Radiologists, through their Radiology Research Alliance Task Force on Noninterpretive Skills has taken on the task of providing information on new teaching methods for radiologists and trainees that include the topics discussed in detail in this article: (1) audience response systems, (2) distance-learning methods, (3) flipped classrooms and (4) active learning approaches for teaching.
Audience response systems have been around for many years, initially implemented using “clickers”, or remote units for inputting responses to multiple choice questions, keyed to identify the learner for purposes of grading and evaluation. These systems have undergone a revolution with the introduction of “clickerless” solutions, using WiFi-enabled devices to input answers. Question formats are no longer limited to multiple choice but may include short answer, free text entry, as well as heat maps (identify the lesion) questions using images, which are particularly relevant for education on imaging. Questions can be added to teaching sessions on the fly, and responses can be shared with the group. Learners can work in teams to input answers and competition can be used to further engage students. This article includes information about the history of audience response systems as well as a review of a number of newer technologies. In addition, the authors review pedagogical methods to provide a more varied menu of teaching approaches, such as the “inverted” case presentation (moving from a diagnosis to a description of findings), or “progressive refinement” cases (giving learners more and more facts as a case unfolds, both to guide their thinking but also to better simulate the actual evolution of clinical cases in the real world).
In the section on Distance Learning, the authors focus primarily on conferencing systems allowing real-time communication of conferences to distant sites. They discuss such options as sharing audio, video, and screens, which have become more important in the era of consolidation of healthcare systems where trainees may be scattered at many different sites. The article includes a listing of software programs as well as a detailed discussion of such hardware issues as selection and placement of microphones. Another vital section deals again with pedagogy, with discussion of ways to increase interactions with distant site viewers, advantages of seeing cases from different locations, and potential spin-offs from those sessions, such as publication of ebooks or websites from the shared case material.
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References
1. “Medical students are skipping class in droves–and making lectures increasingly obsolete”, Orly Nadell Farber – STAT – Aug 14. www.statnews.com
2. “Who needs lectures? Vermont medical school chooses other ways to teach”, Felice J. Freyer, Boston Globe, Metro section, 8/20/18. ( www.bostonglobe.com )
3. Sajedi P., Salamon N., Hostetter J., et. al.: Reshaping radiology precall preparation: integrating a cloud-based PACS viewer into a flipped classroom model. Curr Probl Diagn Radiol 2018; Jul 29S0360-0188(18):30153-1. Epub ahead of print
4. Langdorf M.I., Anderson C.L., Navarro RE, et. al.: Comparing the results of written testing for Advanced Cardiac Life Support teaching using team-based learning and the ‘flipped classroom’ strategy. Cureus 2018; 10: pp. e2573.
5. Gunderman R.B., Shaffer K.: Building a tree from the leaves down: a challenge for contemporary educators. Acad Radiol 2018; 25: pp. 1359-1360.
6. Sivaraja R.T., Curci N.E., Johnson E.M., et al. A review of innovative teaching methods, Acad Radiol Web-1979R1.