Building medical education and research capacity in areas of conflict and instability: experiences of the OxPal Medlink in the occupied Palestinian territories

Medical education and research capacity are often neglected in areas of conflict and instability. Physical and geographical barriers to accessing clinical learning environments, lack of dedicated teaching hospitals and frequent economic sanctions may all stunt the growth of a robust teaching culture in such regions. Here, we focus on the unique geopolitical situation of the occupied Palestinian territories and present our experiences with the OxPal MedLink, a web-based distance-learning collaboration which aims to address the educational needs of Palestinian medical students.     

Blended learning in medical education: use of an integrated approach with web-based small group modules and didactic instruction for teaching radiologic anatomy

RATIONALE AND OBJECTIVES: To describe the development of and assess student satisfaction with a blended learning method for teaching radiologic anatomy that integrates web-based instruction with small group and didactic teaching. MATERIALS AND METHODS: In 2002 the teaching of radiologic anatomy to first-year medical students was changed from group learning (20-30 students with a preceptor and films at a viewbox) to a blended learning model that included a brief didactic introduction followed by small group (7-8 students) web-based structured learning modules with rotating lab instructors. In 2003 the modules were changed to include self-study cases prior to the lab, follow-up cases, and twice-weekly optional review sessions. Students and lab instructors were surveyed for their response to the content and design of the sessions. RESULTS: Course surveys in 2001, with a response rate of 84%, showed 58 negative comments regarding inconsistency between various instructors. Individual response rates for 2002 for radiologic anatomy teaching sessions (RadLab) surveys ranged from 56%-81%, dropping as the course progressed. All RadLabs were rated "very useful" or "useful," except the cardiovascular lab, which was not designed as an interactive module. In 2003, after redesign of the cardiovascular lab in the same format as the other labs, all RadLabs were rated 2.4 or better (useful). CONCLUSION: An integration of computers with small and large group didactic instruction allow optimal use of faculty, conform to accepted theories of adult learning, and are well-accepted by students.     

医学影像存档与通讯系统在影像诊断教学中的初步应用

目的 评价医学影像存档与通讯系统(picture archiving and communication systems，PACS)在医学影像诊断教学中的应用价值。方法 利用GE PACS和天助公司的放射信息管理系统(radiology information system，RIS)、终端图文工作站等硬件、软件配置，构建大屏幕多媒体阅片室，设置典型影像教学片库，开辟电子学习室，直接从PACS调取图像制作多媒体幻灯教学课件和制备考试题库。结果 成功完成了各项构建，在PACS设置的教学分类片库中积累了有价值的影像资料近5000例，改变了传统的影像教学方法，实现了影像教学的实时化、多样化，在影像诊断教学和实习中获得一致好评，提高了教学质量。结论 PACS有利于提高医学影像诊断学的教学质量，值得完善和推广。     

E-learning tools for education: regulatory aspects, current applications in radiology and future prospects

PURPOSE: E-learning, an abbreviation of electronic learning, indicates the provision of education and training on the Internet or the World Wide Web. The impact of networks and the Internet on radiology is undoubtedly important, as it is for medicine as a whole. The Internet offers numerous advantages compared with other mass media: it provides access to a large amount of information previously known only to individual specialists; it is flexible, permitting the use of images or video; and it allows linking to Web sites on a specific subject, thus contributing to further expand knowledge. Our purpose is to illustrate the regulatory aspects (including Internet copyright laws), current radiological applications and future prospects of e-learning. Our experience with the installation of an e-learning platform is also presented. MATERIALS AND METHODS: We performed a PubMed search on the published literature (without time limits) dealing with e-learning tools and applications in the health sector with specific reference to radiology. The search included all study types in the English language with the following key words: e-learning, education, teaching, online exam, radiology and radiologists. The Fiaso study was referred to for the regulatory aspects of e-learning. RESULTS: The application of e-learning to radiology requires the development of a model that involves selecting and creating e-learning platforms, creating and technologically adapting multimedia teaching modules, creating and managing a unified catalogue of teaching modules, planning training actions, defining training pathways and Continuing Education in Medicine (CME) credits, identifying levels of teaching and technological complexity of support tools, sharing an organisational and methodological model, training the trainers, operators' participation and relational devices, providing training, monitoring progress of the activities, and measuring the effectiveness of training. Since 2004, a platform--LiveLearning--has been used at our university: this is a Web-oriented application, that is, an Internet software solution that users can access through a Web browser. The pages displayed by the browser are dynamically generated through interaction with a database that collects both data required for the application to work and data related to the courses provided. There are different approaches to developing applications that use databases to store information. The selected approach is based on a modular three-level architecture divided into presentation level, intermediate level, and data level. The LiveLearning platform includes modules to manage multimedia contents and to interface with the streaming server so that the student can access the training contents directly from the platform interfaces. Furthermore, the platform offers its users different modules: Teaching Units, Documents, Forums, and Chats. By appropriately combining these modules, customised training can be devised based on specific requirements. CONCLUSIONS: The increasing diffusion of continuous education will reduce the costs of e-learning and make this training method, which helps keep pace with technological progress, more attractive, with significant professional gains for radiologists.     

Reshaping Radiology Precall Preparation: Integrating a Cloud-Based PACS Viewer Into a Flipped Classroom Model

Preparing residents for the on-call experience in Radiology is one of the most important aspects of education within a training program. Traditionally, this preparation has occurred via a combination of case conferences and didactic lectures by program faculty, daily teaching at the workstation, and precall assessments. Recently, a blended curricular model referred to as the flipped classroom has generated a lot of attention within the realm of graduate medical education. We applied this technique to resident precall education in the subspecialty of Neuroradiology, and surveyed the participants about their perceptions of the course. The structure, implementation, and web-based platform used to create the flipped classroom experience is described herein.     

Evaluation of web-based instruction for anatomical interpretation in maxillofacial cone beam computed tomography

OBJECTIVES: To evaluate the effectiveness of a web-based instruction in the interpretation of anatomy in images acquired with maxillofacial cone beam CT (CBCT). METHODS: An interactive web-based education course for the interpretation of craniofacial CBCT images was recently developed at our institution. Self-evaluation modules on correlative anatomical features were also included to support the learning process. Three e-learner groups were selected to evaluate the effectiveness of the educational modules. The three groups were (1) oral health specialists (OHSs) (comprising periodontologists, prosthodontists, orthodontists and maxillofacial surgeons); (2) third grade (DS3) and (3) first grade (DS1) undergraduate dental students. The assessment modules that were part of the interactive web-course content were administered after delivery of the course material. In addition, each group received a computer affinity questionnaire to quantify the extent of knowledge about computers and a perception questionnaire to assess their attitudes toward the web-course. RESULTS: The OHS group yielded significantly better scoring results in the post-course test than the pre-course test. However, no statistically significant differences in test scores were found for both undergraduate student groups (DS1 and DS3). All groups presented a highly positive attitude towards the web-course, as was demonstrated by the post-course perception questionnaire. CONCLUSIONS: The present CBCT educational course is an effective didactic method for teaching OHSs the anatomical interpretation of CBCT multiplanar reformatted images and, for undergraduate students, it was found to be as effective as conventional educational methods in dentistry. The efficacy of a web-based educational course requires further evaluation.     

Fallbasiertes interaktives ?PACS-learning��

Purpose

Medical curricula are currently being reformed in order to establish superordinated learning objectives, including, e.g. diagnostic, therapeutic and preventive competences. This requires a shifting from traditional teaching methods towards interactive and case-based teaching concepts. Conceptions, initial experiences and student evaluations of a novel radiological course Co-operative Learning In Clinical Radiology (CLICR) are presented in this article.

Materials and methods

A novel radiological teaching course (CLICR course), which combines different innovative teaching elements, was established and integrated into the medical curriculum. Radiological case vignettes were created for three clinical teaching modules. By using a PC with PACS (Picture Archiving and Communication System) access, web-based databases and the CASUS platform, a problem-oriented, case-based and independent way of learning was supported as an adjunct to the well established radiological courses and lectures. Student evaluations of the novel CLICR course and the radiological block course were compared.

Results

Student evaluations of the novel CLICR course were significantly better compared to the conventional radiological block course. Of the participating students 52% gave the highest rating for the novel CLICR course concerning the endpoint overall satisfaction as compared to 3% of students for the conventional block course. The innovative interactive concept of the course and the opportunity to use a web-based database were favorably accepted by the students. Of the students 95% rated the novel course concept as a substantial gain for the medical curriculum and 95% also commented that interactive working with the PACS and a web-based database (82%) promoted learning and understanding.

Conclusion

Interactive, case-based teaching concepts such as the presented CLICR course are considered by both students and teachers as useful extensions to the radiological course program. These concepts fit well into competence-oriented curricula.     

美国转化医学教育培训特点对我国的启示

转化医学作为新兴交叉学科,在美国临床和转化科学基金项目与各临床和转化科学中心的推动下,实现了覆盖对象广泛、教学资源丰富可及、内容方法灵活多样、评估指标综合创新的特点,培养了学科需要的临床科学家。作者借鉴美国转化医学培训教育领域的一些先进理念和创新做法,对我国的转化医学教育提出加快建立转化医学的教育体系、提高导师培训和督导质量、开发创新性教育内容与方法3点建议。     

Radiography education in 2022 and beyond - Writing the history of the present: A narrative review

ObjectivesThe COVID-19 pandemic had a major effect on teaching and learning. This study aimed to describe a range of teaching, learning, and assessment strategies related to radiography education which have become more common due to the pandemic through a narrative literature review.Key findingsEducational change in radiography was accelerated by the disruption caused by the pandemic. Changes included the site and mode of teaching and conducting of assessment. While some of the digital transformation trends were introduced before the pandemic, others were further amplified during this period of time. Alternative solutions such as virtual reality technology, gamification, and technology-enhanced learning were especially salient and have the potential to mitigate challenges brought about by the pandemic. The use of technology in the clinical setting, in assessment, and to facilitate feedback, are important tools for improving learners' clinical skills performance. Collectively, these digital technologies can maximise learning and support mastery of knowledge, skills and attitudes.ConclusionThe pandemic has cast a new light on existing methodologies and pedagogies in education. This review suggests that digital technology is shaping teaching and learning within radiography education and also that educators cannot ignore this digital shift. With the digital trajectory, it would be highly useful to transform approaches to education within radiography to support learning as radiography education moves towards the new normal era.Implications for practiceDigital technology in education can help improve the learning experience for learners but educators need to be equipped with the technological skills and be adaptable to these changes. Continual sharing of experiences and knowledge among radiography educators is essential. Safety nets need to be in place to ensure digital inclusiveness and that no learner gets left behind due to the digital divide in education.     

Virtual medical student radiology clerkships during the COVID-19 pandemic: Distancing is not a barrier

BackgroundStress on medical education caused by COVID-19 has prompted medical schools to bar their students from onsite education at hospitals and clinics, limiting their educational experiences. Radiology is uniquely positioned to be a virtual rotation during this health crisis and beyond.PurposeTo implement virtual radiology clerkships and evaluate educational outcomes.MethodsWe developed virtual radiology clerkships using best practices from adult education theory; emphasizing self-directed and interactive learning through recommended reading materials, pre-recorded lectures, video conferencing, web-based learning modules from the ACR, as well as multimodality radiology resources to allow students flexibility in their individual approach to the subject matter.ResultsThe mean performance on standardized exams for our cohorts was 75% (range 50–96%), matching the national average of 75%. Surveys of medical students after the clerkship showed positive subjective feedback on the content and structure of the course.ConclusionsUnderstanding of medical imaging is vital for student doctors to have a better understanding of applied anatomy, patient care strategies, appropriate use, and image interpretation. Radiology is uniquely positioned to be taught in a virtual format, or in a combination of online and in-person activities. Standardized examination performance for our institutional virtual radiology clerkships is comparable to performance on traditional courses. Virtual clerkships designed with adult learners in mind can help student doctors prepare for residency and future independent practice as they build knowledge and skills needed to provide high quality patient care.     

Online teaching and learning through the students’ eyes – Uncertainty through the COVID-19 lockdown: A qualitative case study in Gauteng province,South Africa

IntroductionIn South Africa, online learning has been adopted to maintain the momentum of learning. The need for social distancing has resulted in the cancellation of many face-to-face activities that comprised the curriculum within higher education. This study explored the experiences of undergraduate diagnostic radiography students of online teaching and learning during the COVID-19 lockdown period.MethodsA qualitative case study design was adopted. Purposive sampling was employed to select undergraduate diagnostic radiography students at the study institution. One-on-one online interviews were audio recorded with fourteen (n = 14) students from second to fourth year and were transcribed verbatim. Data were analysed through content analysis.ResultsTwo main themes emerged: (1) Maintaining balance in the new ‘normal’; (2) Enablers for an inclusive learning environment. The change in the method of teaching has highlighted the requirements for adequate teaching and learning. The students in the study were of the view that they deserve an equal opportunity to quality online education.ConclusionThe study reveals that the participants were concerned about the transition from face-to-face lectures to the online system. They felt they were required to adjust without adequate consideration of the prerequisites for the process, such as devices and data availability.Implications for practiceRadiography is both technical and theoretical. Therefore, the integration of online teaching and learning could be used to enhance digital literacy within the South African context.     

Assessment of a neuroradiology picture archiving and communication system in clinical practice.

The goal of this study was to determine if our neuroradiology picture archiving and communication system (PACS) is capable of improving the efficiency and function of the management and review of neuroradiologic images. A neuroradiology PACS module developed in our department was evaluated in the clinical environment from February 1990 through July 1991. The overall evaluation focused on three aspects: (1) image delivery performance, (2) system availability, and (3) user acceptance. Image delivery performance was evaluated by analyzing the time spent on each modularized task with both the film-based system and the PACS system. The system availability was examined by observing the downtime occurrence and uptime probability of individual hardware components in the PACS module. User acceptance was evaluated through a survey done with the display workstation. Under regular operating conditions, the PACS outperforms the current film-based operation. The overall PACS module availability is more than 92%, with the display workstation available more than 99% of the time. The overall user acceptance of the system is 3.4 on a four-point ranking scale. This study has demonstrated the full functionality and clinical usefulness of our neuroradiology PACS. On the basis of the results of this study, a large-scale PACS has been designed and implemented in our department.     

Peer learning on a shoe string: success of a distributive model for peer learning in a community radiology practice

PurposeTo describe our 3-year experience operating a peer learning program with minimal resources, calculate the cost of the program, and compare participants' attitudes toward peer learning to the historical peer review system.Materials and methodsThe peer learning conference is held monthly for 1 h via a web-based video conferencing platform. Case identification, curation, and conference presentation are performed by individual radiologists. Using national estimates for unit costs of radiologist time and other inputs, we calculated the marginal cost of the peer learning program to the medical group. After 21 months of holding the conference, we conducted an anonymous survey to assess the impact of the conference and how it may be improved.ResultsA peer learning conference was established for a 24- person community-based practice, which is part of a large multi-disciplinary medical group. Cases discussed included diagnostic errors, technologist errors, good calls, and challenging cases. Total annual cost of the program is $3288. Survey respondents had overall positive views of the conference and strongly preferred peer learning to the existing peer review system in place, with 80% of respondents rating peer learning more favorably than peer review on education value, supportive environment, and punitive process, and 70% more positively on culture of blaming.ConclusionWe established a peer learning program with minimal resources. Radiologists in the group strongly prefer the peer learning conference over the existing peer review program in place. A peer learning program can be successfully started and sustained with limited resources.     

Partnerships for clinical learning: A collaborative initiative to support medical imaging technology students and their supervisors

IntroductionThe involvement of practitioners in the teaching and supervision of medical imaging technology students is central to students' learning. This article presents an overview of a learning partnership initiative, reinforced by an online platform to support students' learning and their medical imaging technologist supervisors' (MITs) teaching within a clinical learning environment in a New Zealand context.MethodologyData were generated through a series of fourteen collaborative action research focus group meetings with MITs and student MITs.ResultsThe findings revealed that a robust relationship between a student and their MIT partner gave students an ‘anchor’ for learning and a sense of belonging. The online platform supported the relationship and provided an effective means for communication between students and their MIT partners. The relationship was not one-directional as it also supported the enhancement of MITs' practice.ConclusionsThe recommendations from the study suggest learning partnerships between MITs and student MITs will be valuable in supporting teaching and learning respectively. MITs need to be better supported in their teaching role to enable them to make a greater investment in students' learning. A redistribution of funding for clinical education needs to be considered to support the MITs' central role in teaching medical imaging students.     

PowerPoint97在多媒体医学教学中的应用

目的 :寻求一种操作简便、功能性强、供制作多媒体医学教学课件使用的操作平台。方法 :通过PowerPoint97将通常课堂教学使用的投影片、幻灯片、挂图、录像带、解说词及影片资料制成多媒体医学教学课件。结果 :该课件可方便地进行不同格式的文本、图片、声音和影像的制作、编辑和播放 ,初步实现了互动式多媒体教学 ;借助国际互联网进行远程多媒体教学以及自动完成更新有关教学内容的研究进展、发展动态等最新信息的多种功能。结论 :PowerPoint97是一种简便易学的多媒体操作平台 ,基本能满足医学教学课件的制作要求 ,适合医学教学工作者 ,特别是一些初学者制作课件的需要。     

The specialty program as a training tool: an individual training plan for each resident

The official training program for the specialty "Diagnostic Imaging" establishes minimum learning objectives that must be fulfilled. Each accredited teaching unit is responsible for designing and carrying out a curriculum to ensure that these objectives are met, and this approach permits a degree of flexibility. Various aspects must be considered in the individual training plans for each resident: the rotation scheme according to the way the department is organized, plans for recovering missed material or reinforcing weak points, optional rotations, increasing degrees of responsibility as skills are acquired during training, and accommodating special needs of handicapped persons. Nevertheless, the individual plan must be fitted to the established curriculum and guarantee that the content of the official program is covered and that the objectives stipulated therein are met. Furthermore, the methods of teaching must be adapted to the individual characteristics of the residents, and this is the most important aspect of the individualization of training. To this end, it is fundamental for residents to take on an active role in their training, guided by their tutor and with the participation of all the radiologists in the department including the other residents, all of whom should act as teachers.     

The development of paediatric neuroradiology

Summary The development of paediatric neuroradiology is a specific persuasion within neuroradiology and has increased in scope and significance throughout the last ten years. The emergence of computed tomography has altered the indications for types of neuroradiological procedures in infants and children. The sophistication, accuracy, and safety of standard neuroradiological procedures have been increased by the accuracy and safety of computed tomography, particularly in the premature infant. There is a growing need for education and instruction in paediatric neuroradiological techniques and paediatric neuroradiological diseases within the neuroradiological fraternity as a whole.     

Differences in Neuroradiology Training Programs around the World

BACKGROUND AND PURPOSE:No previous study compares neuroradiology training programs and teaching schedules across the globe, to our knowledge. This study was conducted to better understand international program requisites.MATERIALS AND METHODS:Data from 43 countries were collected by an e-mail-based questionnaire (response rate, 84.0%). Radiologists across the world were surveyed regarding the neuroradiology training schemes in their institutions. Answers were verified by officers of the national neuroradiology societies.RESULTS:While many countries do not provide fellowship training in neuroradiology (n = 16), others have formal postresidency curricula (n = 27). Many programs have few fellows and didactic sessions, but the 1- or 2-year duration of fellowship training is relatively consistent (n = 23/27, 85%).CONCLUSIONS:There is a wide variety of fellowship offerings, lessons provided, and ratios of teachers to learners in neuroradiology training programs globally.

The United States considers itself a leader in medical education and training among nations.¹ Generally speaking, American medical school, residency, and fellowship programs are considered globally as being well-structured, highly competitive, and outstanding in the quality of education and instruction. As of the 2013–2014 academic year, 185 radiology residency programs and 85 neuroradiology (NR) fellowship programs in the United States are voluntarily supervised by the Accreditation Council for Graduate Medical Education (ACGME). This private, nonprofit organization sets educational standards and periodically reviews their implementation within the respective graduate medical education programs.² In addition, completion of programs accredited by the ACGME is a prerequisite to becoming board-certified in diagnostic radiology and subspecialty certified in neuroradiology. Examinations are offered by the American Board of Radiology annually through the American Board of Medical Specialties. It oversees specialty and subspecialty certification in radiology and 23 other medical specialties in the United States.The educational path for an aspiring American neuroradiologist typically begins by matching in a first-postgraduate-year prerequisite clinical year (internship year) and an ACGME-accredited postgraduate year 2- to 5-year diagnostic radiology residency program.³ The first 3 years of residency focus on diagnostic radiology (postgraduate years 2–4) and include 9 core rotations in abdominal radiology, breast imaging, cardiothoracic radiology, musculoskeletal radiology, neuroradiology, nuclear radiology, pediatric radiology, sonography, and vascular and interventional radiology. In postgraduate year 5, residents may participate in subspecialty rotations of their choice.⁴ The trainees'' diagnostic experience in the different imaging modalities is assessed through a case/procedure log system, which is annually reviewed by the faculty of the program and the ACGME.⁵After finishing residency, graduating radiologists have the opportunity to start additional fellowship training within their discipline of choice if they desire subspecialty expertise.⁶ Contributing factors that promote the implementation of fellowship programs in radiology are the rapid development of new imaging techniques, the need for appropriate interpretation skills and expertise to compete in the job market, and the trend toward endovascular and percutaneous therapies.¹The first NR fellowship positions were offered in Stockholm and London in the 1950s and approximately 10 years later in New York (1960).⁷ Regarding neuroradiology, 2 fellowships are offered in the United States currently: diagnostic neuroradiology (DNR) and interventional neuroradiology (INR), with the latter, by ACGME regulations, requiring a previous DNR year. However, very few of the offered neurointerventional programs are currently ACGME-accredited, so this requirement is often not completed.Because there is a trend toward greater subspecialization in radiology globally, we conducted a survey to investigate differences in radiology training programs across the world with regard to the general curriculum, focusing on neuroradiology fellowships in particular. Therefore, departments in countries on all continents were asked to complete a standardized questionnaire about their training programs. Hence, differences in international educational structures could be revealed.     

基于Web的经济型PACS的构建与实现

目的:构建一套符合中小型医院实际的基于Web的经济型医学影像存档与传输系统(PACS)。方法:在院内局域网基础上,采用配备海量硬盘的普通PC机,架设Web及FTP服务器,应用ASP加Access数据库技术,撰写网页,实现影像报告的书写、打印,同时将影像数据导入服务器,实现院内共享及远程会诊。结果:以极为经济的方式实现了PACS的基本功能。结论:构建基于Web的经济型PACS在基层医院切实可行。