In one of
my previous posts, I mentioned the gap that exists between the high potential
of teaching in radiology at the medical school level and the existing
curriculum. Multiple national surveys suggest that students prefer small-group
or a one-on-one style of learning, so called the socractic method, over
the lecture-based didactic teaching; however, most the medical imaging
education given prior to residency comes from a classroom or from
non-radiologists during clinical rotations. I also identified some barriers to
curriculum development from radiologists and other departments. Unfortunately,
many of these barriers, such as lack of time, funding and perceived value, will
require major renovations in programs and beliefs. At the same time, more
research in pilot programs using the new styles of teaching needs to be done to
demonstrate its value. All of this will require time. Given that the traditional
form of teaching, i.e. in a classroom, isn’t going to change any time soon, it
may be just as valuable in the meantime to look for ways to improve on it
rather than to start a revolution.
One thing
is clear: the current method of teaching radiology in medical school is not
effective. At the University of Toronto, radiology is introduced during first
and second year through 4 or 5 afternoons of lectures. Attendance was not taken
and no tests were conducted on the subject. In tying in my first blog post,
there was minimal attention from the class and even less motivation to learn. Simply
put, there was little to no engagement to learning. But who can blame them? In
reflecting after having done 3 months of radiology electives, I’ve realized
that radiology is such an esoteric topic compared with the rest of medicine. Much
of it is unintuitive and even the nomenclature used in the field require
several years of training to master. Unsurprisingly, there was very little intrinsic
motivation to learn. Combined with the lack of extrinsic motivation, this
creates a poor learning environment indeed. Ironically, we couldn’t even
objectively measure what we learned since there was no exam although
anecdotally, I could recall several instances where the deficiencies were
apparent.
So what changes
could be made? An obvious and relatively simple answer would be to start
administering exams. I recall histology, which shares many characteristics of a
specialty with radiology such as the high degree of specialization, was equally
as mundane at the time. However, because there was a (relatively difficult)
exam at the end of the week, we all fervently studied for it and there are
still many histology concepts I remember. Whether my knowledge retention is due
to the studying or other factors is unclear. However, the other issue with
providing education of any kind is that ideally, students learn from an
internal motivation rather than because they fear failing an exam. Although not
definitive, many studies suggest that intrinsic motivations result in better
long-term education and that extrinsic motivations may actually negatively
affect intrinsic motivations. Therefore, strategies to improve teaching should
also aim to increase genuine interest in the subject. Since material generally
stays the same, increasing interest really boils down to the delivery.
In
exploring ways to improve delivery, I was reminded of the idea of using
technology, specifically Student Response Systems (SRS), in presentations.
Essentially they use devices such as clickers that take real-time input from
the class and either summarizes the results in graph form or directly displays
the results on a projector. From what I
could recall, in all lectures where I was given a clicker, I felt more engaged
and retained the information better. But what does the literature say? Caldwell
in 2007 showed that the use of clickers in a mathematics course (controlled for
instructor, semester, curriculum and the approximate number of students)
increased the frequency of A’s, decreased the frequency of D’s and F’s and
reduced the rate of withdrawal. Heaslip in 2012 similarly found that use of an SRS
increased the class average for most of his modules by 8%. While it certainly
isn’t an exact science, SRS’s certainly do seem to be an effective way to engage
students in lecture material.
For my
presentation, I would definitely like to try out using an SRS to increase
participation and interest. Particularly, I feel that teaching in radiology,
being a more unfamiliar subject, would greatly benefit from its usage. Fundamentally,
I feel SRS’s introduce some motivation into the classroom either through
innovation, competition or fun. I would like to give it a shot and I do have a
specific one in mind…
-DW
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