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      E-learning for chest x-ray interpretation improves medical student skills and confidence levels

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          Abstract

          Background

          Radiology is an important aspect of medicine to which medical students often do not receive sufficient exposure. The aim of this project was to determine whether the integration of an innovative e-learning module on chest x-ray interpretation of the heart would enhance the radiological interpretive skills, and improve the confidence, of first year graduate entry medical students.

          Methods

          All first-year graduate entry (all students had a prior university degree) medical students at the University of Limerick ( n = 152) during academic year 2015–16 were invited to participate in this study. An assessment instrument was developed which consisted of 5 radiological cases to be interpreted over a designated and supervised 15-min time period. Students underwent a pre-, mid- and post-intervention assessment of their radiology interpretative skills. An online e-module was provided following the pre-test and additional practice cases were provided following the mid-intervention test. Assessment scores and confidence levels were compared pre-, mid- and post-intervention.

          Results

          The overall performance (out of a total score of 25) for the 87 students who completed all three assessments increased from 13.2 (SD 3.36) pre-intervention to 14.3 (SD 2.97) mid-intervention to 15.8 (SD 3.40) post-intervention. This change over time was statistically significant ( p < 0.001) with a medium effect size (eta-squared = 0.35). Increases from pre- to post-intervention were observed in each of the five areas assessed, although performance remained poor in diagnosis post-intervention. Of the 118 students who provided feedback after the intervention, 102 (86.4%) stated that they would recommend the resource to a colleague to improve their interpretative skills.

          Conclusions

          This study suggests that early exposure to e-learning radiology modules is beneficial in undergraduate medical school curricula. Further studies are encouraged to assess how long the improvement may last before attrition.

          Electronic supplementary material

          The online version of this article (10.1186/s12909-018-1364-2) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          Assessment drives learning: an unavoidable truth?

          The debate around which factors drive medical students' learning is ongoing and controversial. What is the influence of an assessment's weighting on the motivation of students to study the particular subject? One medical school in London is in a unique position to investigate this question. At our institution, the weighting of Anatomy within the overall scheme of assessment has changed twice in recent years, a trend of increased weighting. This enabled a comparative investigation into the effect these changes have had on the students' motivation to learn Anatomy. A five-point Likert-scale questionnaire survey was used to evaluate students. A section within a broad survey of Anatomy teaching and learning at our institution was dedicated to the evaluation of the amount of weighting Anatomy received within the assessment structure and the effect this had on students' motivation toward learning the subject. Increasing Anatomy's weighting within the scheme of assessment produced a dramatic increasing trend toward students' motivation to learn Anatomy. The weighting of Anatomy has a profound effect on students' motivation to learn it. Although multifactorial and complex in nature, medical students' self-reported drive to study a subject is directly influenced by the weighting of the subject in the overall scheme of assessment.
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            Summative assessments are more powerful drivers of student learning than resource intensive teaching formats

            Background Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students. Methods A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material. Results Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance. Conclusions Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation.
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              Integrating Radiology and Anatomy Teaching in Medical Education in the UK--The Evidence, Current Trends, and Future Scope.

              This review article presents the current evidence of the importance of integrating radiology and anatomy in medical education in the UK, a recommendation by a number of key anatomy, education, and radiology organizations. Current evidence highlights that on average only 5% of total teaching time in medical education is dedicated to radiology. Often, radiology teaching does not adequately fulfill students' learning needs and potentially leaves them underprepared for medical practice. Benefits of integrating radiology and anatomy include improved clinical application of anatomy, an increase in student's interest in anatomy, and ultimately improved radiological interpretation. Various modalities exist for the integration of radiology and anatomy, facilitated by the vast portability of radiological images. It appears that combining radiological resources with traditional anatomy teaching methodology in a blended approach is most beneficial.
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                Author and article information

                Contributors
                shauna.wentzell@medportal.ca
                lisa.moran@ul.ie
                Julian.Dobranowski@niagarahealth.on.ca
                levinsa@mcmaster.ca
                ailish.hannigan@ul.ie
                colum.dunne@ul.ie
                deirdre.mcgrath@ul.ie , Deirdre.mcgrath@ul.ie
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                12 November 2018
                12 November 2018
                2018
                : 18
                : 256
                Affiliations
                [1 ]Graduate Entry Medical School, University of Limerick, Limerick, Ireland
                [2 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Faculty of Health Sciences, , McMaster University, ; Hamilton, ON Canada
                Author information
                http://orcid.org/0000-0002-8666-7556
                Article
                1364
                10.1186/s12909-018-1364-2
                6233516
                30419883
                757b633c-be2f-4b1c-a0e8-24cb9b9a1369
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 18 September 2017
                : 30 October 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Education
                e-learning,radiology,undergraduate curriculum,online resource,medical curriculum,medical students,x-ray interpretation,chest x-ray,modules

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