Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Can We Teach Smarter, Not Harder?

The time has come for a modern high-quality educational experience that meets the needs (and demands) of learners without increasing the burden on resource-constrained educators.

Have you ever taken a MOOC (a massive open online course)? Multiple non-profit and commercial entities, both domestic and overseas, now provide an ever-growing array of online educational offerings. Most are non-credit courses (with completion certificates) though some offer credit. I have taken four healthcare-related MOOCs. One explored medical education pedagogy. Not all of the material translated well to diagnostic radiology education — but for something that was completely free, took no more than few hours per week over a few weeks, and could fit in with my work and family schedule, the course proved a decent overview of things like social learning theory and Bloom's taxonomy.

So why did I take this MOOC in the first place? As a radiologist at an academic institution, I am expected to educate medical students, residents, and fellows. Unlike the teachers in my children's schools, however, I never formally learned to teach. Instead, the old "see one, do one, teach one" adage applied. Sound familiar?

As medical schools and residency programs undergo changes in curricula and structure, we are no longer expected to just deliver content and test knowledge. In order to get high scores on evaluations, lectures need to be interactive," "fun, and engaging, while at the same time delivering "practical or important content." To do this, we can just add pizzazz to our PowerPoint slides with some animations and better font choices, right? Wrong. 

Contemporary flipped-classroom interactive educational models require more advance preparation and organization than just presenting didactic material. For example, we may need to create short advance reading assignments or podcasts, generate self-study questions embedded in or separate from video didactic instruction sessions (e-learning modules), and include clearly stated key teaching points or objectives. These measures allow learners to engage with the material at a time and location of their choosing. The educator then uses the scheduled classroom time to answer questions, reinforce concepts, test knowledge, and show correlative cases. 

This educational style — stand-alone materials combined with in-class teaching — requires more time and effort from the teacher than a conventional real-time lecture format presented without supplemental instructional resources. Whether this teaching method creates better radiologists remains to be seen. 

Anyone can modify or create teaching materials to accommodate modern educational methodology. Unless you are ahead of the curve and have been doing this all along, however, overhauling course materials and refining instructional methods takes time, especially if we want our teaching to be effective and relevant to our students. What's that you say? Time is the one thing you seem to have less and less of? You are not alone, as you certainly realize. Doing more with less is a mantra in all workplaces today, academic radiology programs included.

But we are being asked to change. What I wonder is this: what should that change be? Is the answer to simply ask all academic radiologists to create their own iBooks, podcasts, quiz questions, etc.? Or maybe we need to look, pardon the cliché, outside the box.

In the January 2016 issue of JACR, Stefan Tigges, MD, and co-authors make a compelling argument that MOOC-like radiology instruction in medical school using a variety of self-study materials plus one week in a radiology program is similarly effective to a dedicated two- to four-week radiology rotation with respect to performance on the Alliance of Medical Student Educators in Radiology (AMSER) standardized examination used by 24 institutions. Effective AND efficient! 

Can imitation of existing successful MOOCs or AMSER-like educational models be translated successfully to residency education? Sure, you can develop an your own mini MOOC based on a national standardized guidelines for what residents will be tested on, for example, as outlined in the American Board of Radiology Core Exam Study Guide

But should you? Increased attending radiologist productivity pressures, such as shorter turn-around time expectations, put the squeeze on time to devote to creating novel educational content. Add to this a general diagnostic radiology residency effectively compressed from four years to three by virtue of the timing of the ABR Core Exam and layer on the pressure to provide more interactive education, and the idea of doing more with less takes on a new meaning: more responsibilities, higher expectations, less time.

What if radiology residencies could get a bigger educational bang for their buck with a nationwide radiology MOOC? Nationally recognized content experts and leaders in education already get together to create board examination questions. If they work together with the support of their specialty societies, they could develop agreed-upon educational materials that were high quality without the need for large quantities of redundant work at the level of individual institutions. A variety of online sources of didactic material, such as subspecialty society educational webpages with curated CME presentations, already exist. This could be a good starting point.

I am at an institution with a small enough residency program that I, as an individual, develop, maintain, update, and teach the entire cardiac CT and MR imaging curriculum for our residents. I would welcome a top-notch highly vetted set of comprehensive materials that I could then supplement with my own. I am not so proud as to think that I as one person could possibly do better than a group of top educators combined. 

I would like to go to an online centralized online resource bank to select from the best lectures and other educational materials contributed from around the country that have been given a seal of approval of sorts. Like journal article submission, the bank could be a little bit competitive, whereby any academic radiologist could upload educational content and the national experts could periodically select new content so that the materials stay up-to-date and are varied enough in format, content, and style to accommodate multiple learning styles. If the role of most radiology educators in individual institutions is not to develop the original content that residents interact with on their own time, then conference time can be used for the interactive flipped-classroom model. Master educators could also create pedagogical materials for attending radiologists who teach medical students and radiology residents, in effect creating a bigger and better cadre of educators.

Are we on the threshold of a paradigm change in radiology education? I believe we are, but only if we are willing to make some bold choices. These may not resemble anything I've imagined in the preceding paragraphs, but the status quo is not an option.

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Wednesday, 26 June 2019

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