Friday, 5 October 2012

Master Thesis - Master of Health Professions Education (MHPE), 2012

Master Thesis Title: Use of case pairs can potentially improve the efficiency and effectiveness of radiology residency


In this Master Thesis, the topic to be investigated is a method to improve the efficiency and effectiveness of residency training in radiology in order to potentially shorten residency training while maintaining effectiveness, in order to increase the numbers of trained radiologists. 

The research question to be investigated is whether compare and contrast case review with pairs of cases is more time efficient and effective compared with traditional sequential case review with single cases in radiology problem solving.

The research question was investigated by the use of a quantitative experimental design – an independent groups (or between groups) design. 10 residents participated with a within subjects design allowing the 10 residents to take part in both the control and experimental conditions with crossover between the groups. Resident performance with 30 CXRs and 30 CT head scans was compared between the experimental and control group, in a pretest, practice and posttest phase each with 10 different cases, with all 30 cases examples from a single key clinical diagnostic category for each type of examination. 

There was a consistent trend in time efficiency for the experimental group compared with the control group, with a medium effect size comparing pretest times (d = 0.48), and a relatively smaller effect size comparing times taken for the posttest phase (d = 0.33). A strong effect size, with statistically significant difference in performance was also found in the pretest phase of the study favoring the experimental group (d = 1.06).  The control group comparing pretest with posttest also demonstrated a learning gain. Though a learning effect was not demonstrated for the experimental group, this group was found to have reached a high (good pass) level of performance in the pretest, with no significant change in performance for the posttest.

The results of this Master Thesis project provide some support for the experimental hypothesis, that compare and contrast case review of pairs of cases, is more time efficient than, and at least as effective as sequential single case review, in interpreting radiology cases, and potentially in learning radiology for residency training. There is also some support for the effect of deliberate practice.

The control group showing learning gain between the pretest and posttest phases is consistent with the expected effect of traditional radiology residency training, with one case at a time case presentation and review. The experimental group showing not only more efficient, but also more effective problem solving, with moderate and strong effect respectively, in the pretest phase, raises the interesting possibility that a much fewer number of cases might be required for training for any one diagnostic category if paired presentation and review is systematically used.

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