Some tips to increase your learning and training effectiveness and efficiency:
Poh-Sun Goh
6. Use textbooks and a wide variety of online resources to improve your diagnostic and interpretative skills. Practice, practice, practice with reflection and feedback, using a range of resources, to increase your exposure to the variety and spectrum of clinical and imaging findings, both normal and abnormal, from typical, to less common and atypical (as you progress to increase your experience and mastery of clinical practice, and improve your knowledge and skills from undergraduate, through postgraduate to continuing professional development and lifelong learning settings).
7. Compare and contrast is one of the simplest and most effective methods to learn to recognise and differentiate between normal and abnormal XRs and scans. Review a series of normal XRs and scans, and then do side by side comparison between examples of normal, normal and abnormal, and examples of abnormal XRs and scans.
https://effectiviology.com/interleaving/ (mixed practice or interleaving superior to blocked practice)
and
Reflect on the well know aphorism "You see what you look for, you look for what you know"
Also reflect on - 1) What your personal and professional goals are?; 2) How good do you want to be, and become?; 3) What benchmarks, and exemplars of performance do you use, or have access to?; 4) How much time and effort do you allocate to this effort, and goal?; 5) Do you (ever) have enough time and energy?
How radiology experts think - and value of online case repositories
by Poh-Sun Goh
1. expertise in radiology is directly correlated with experience
2. case experience should be cumulative
3. case experience should include full spectrum of the presentation of any given diagnosis
4. case experience should include material of increasing complexity
5. increasing complexity involves cases showing typical, then less typical, less easily detectable features, with less associated features, or more confounding associated features, or more than one pathology, and progressively less or contradictory additional information
6. radiology task is simple three step process - see, recognise, diagnose
7. this requires perceptual learning or pattern recognition, categorical learning or the ability to list key features, and diagnostic reasoning or the ability to correlate with the clinical setting
8. experts use rapid wholistic perception linked to experience, which are mental schemas or representations of the key features of a wide range of pathology
9. experts use rapid 200 msec big picture perception to generate the most likely hypothesis, which then drives deliberate search for key features
10. experts rapidly decide on whether radiograph or scan is normal, or has a likely abnormality, and then use visual search and reasoning to confirm diagnosis
11. online case repositories can accelerate the development of expertise, by widening the case experience of radiologists, beyond that of individual day to day direct experience
12. the key is to use case material in a deliberate way
Cognitive apprenticeship
by Poh-Sun Goh
1. Developing into an expert radiologist involves mastering a set of complex task skills.
2. This includes "running the service" - prescribing the optimal imaging technique to address the clinical problem, protocolling the study, modifying the study "in real time" to take into account (unexpected) findings during the radiological examination, and interacting with technical and clinical staff to both optimize the examination, and convey the relevant radiological information that will facilitate clinical management of the patient.
3. The cognitive aspects of making a radiological diagnosis involve the "see, recognize, and diagnose" three step process described above.
4. The role of the trainee resident or fellow in radiology requires a combination of focus, application, sustained effort, and dedication to learn; coupled with a high level of professional responsibility and commitment to learning and practicing the craft of radiology.
5. Ultimately, learning requires active application of effort - learning by doing, with feedback on performance. Passive observation does not lead to true learning or the functional ability to perform in better ways. A combination of reflection, and repeated attempts to apply knowledge and skills is required to "learn" anything. This is an active process. Increasing expertise is acquired by "deliberate practice" http://www.missiontolearn.com/2010/04/deliberate-practice/
6. The role of the instructor in radiology is to "coach", guide and facilitate this learning process in a positive way.
7. An example of a systematic positive coaching paradigm comes from coaching in sports, where the players or learners are reminded that they have total control over three aspects of performance - effort, learning from experience, and response to mistakes - ELM framework http://opinionator.blogs.nytimes.com/2011/10/20/the-power-of-positive-coaching/?src=me&ref=general
8. A useful way of thinking about the trainee - instructor interaction is to reflect on the idea of "cognitive apprenticeship"
"Understanding basic theory using a few illustrative examples. Mastering a topic by exposure to and experience with many examples
Typical examples or real-life scenarios can be used to illustrate theory, and help students understand fundamental principles. Mastering a topic usually requires exposure to and experience with many examples, both typical and atypical, common to uncommon including subtle manifestations of a phenomenon. The traditional method of doing this is via a long apprenticeship, or many years of practice with feedback and experience. A digital collection of educational scenarios and cases can support and potentially shorten this educational and training process. Particularly if a systematic attempt is made to collect and curate a comprehensive collection of all possible educational scenarios and case-based examples, across the whole spectrum of professional practice. Online access to key elements, parts of and whole sections of these learning cases; used by students with guidance by instructors under a deliberate practice and mastery training framework, can potentially accelerate the educational process, and deepen learning."
above from
Goh, P.S. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct; 5(3), Paper No:19. Epub 2016 Oct 14. http://dx.doi.org/10.15694/mep.2016.000105
"By reviewing research on medical performance and education, the author describes evidence for these representations and their development within the expert- performance framework. He uses the research to generate suggestions for improved training of medical students and professionals. Two strategies— designing learning environments with libraries of cases and creating opportunities for individualized teacher-guided training—should enable motivated individuals to acquire a full set of refined mental representations. Providing the right resources to support the expert- performance approach will allow such individuals to become self-regulated learners—that is, members of the medical community who have the tools to improve their own and their team members’ performances throughout their entire professional careers.'
from abstract of
Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from the expert-performance approach with deliberate practice. Acad Med. 2015 Nov;90(11):1471-86. doi:10.1097/ACM.0000000000000939. PubMed PMID: 26375267.
What is the message from the "yellow curve" below?
"How could one use this material to dramatically reduce case review time?
Reduce study time?
Reduce residency duration?
Use training time in other ways?"
"How would you use this material to develop confidence and familiarity with less common conditions?
Given that time is limited."
"How do you stay sharp, not rusty, get better (sharper)."
[Practice. With feedback. With reflection. With increasing difficulty. Systematically. Regularly. With material that is at hand. At your finger tips.]
-Poh Sun (posted on 7 February 2018 @ 0358am)
This article investigates the relation between mind wandering and the spacing effect in inductive learning. Participants studied works of art by different artists grouped in blocks, where works by a particular artist were either presented all together successively (the massed condition), or interleaved with the works of other artists (the spaced condition). The works of 24 artists were shown, with 12, 15, or 18 works by each artist being provided as exemplars. Later, different works by the same artists were presented for a test of the artists' identity. During the course of studying these works, participants were probed for mind wandering. It was found that people mind wandered more when the exemplars were presented in a massed rather than in a spaced manner, especially as the task progressed. There was little mind wandering and little difference between massed and spaced conditions toward the beginning of study. People were better able to correctly attribute the new works to the appropriate artist (inductive learning) when (a) they were in the spaced condition and (b) they had not been mind wandering. This research suggests that inductive learning may be influenced by mind wandering and that the impairment in learning with massed practice (compared to spaced practice) may be attributable, at least in part, to attentional factors-people are "on task" less fully when the stimuli are massed rather than spaced.
above abstract from
above abstract from
Inductive learning -- that is, learning a new concept or category by observing exemplars -- happens constantly, for example, when a baby learns a new word or a doctor classifies x-rays. What influence does the spacing of exemplars have on induction? Compared with massing, spacing enhances long-term recall, but we expected spacing to hamper induction by making the commonalities that define a concept or category less apparent. We asked participants to study multiple paintings by different artists, with a given artist's paintings presented consecutively (massed) or interleaved with other artists' paintings (spaced). We then tested induction by asking participants to indicate which studied artist (Experiments 1a and 1b) or whether any studied artist (Experiment 2) painted each of a series of new paintings. Surprisingly, induction profited from spacing, even though massing apparently created a sense of fluent learning: Participants rated massing as more effective than spacing, even after their own test performance had demonstrated the opposite.
above abstract from
When students encounter a set of concepts (or terms or principles) that are similar in some way, they often confuse one with another. For instance, they might mistake one word for another word with a similar spelling (e.g., allusion instead of illusion) or choose the wrong strategy for a mathematics problem because it resembles a different kind of problem. By one proposition explored in this review, these kinds of errors occur more frequently when all exposures to one of the concepts are grouped together. For instance, in most middle school science texts, the questions in each assignment are devoted to the same concept, and this blocking of exposures ensures that students need not learn to distinguish between two similar concepts. In an alternative approach described in this review, exposures to each concept are interleaved with exposures to other concepts, so that a question on one concept is followed by a question on a different concept. In a number of experiments that have compared interleaving and blocking, interleaving produced better scores on final tests of learning. The evidence is limited, though, and ecologically valid studies are needed. Still, a prudent reading of the data suggests that at least a portion of the exposures should be interleaved.
above quote from
Rohrer, D. (2012). Interleaving helps students distinguish among similar concepts. Educational Psychology Review, 24, 355-367
Learn To Study Using…Interleaving (The Learning Scientists)
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Open Access Radiology Training Resources
https://radiogyan.com/foamrad-resources/
https://radiologyresidentcorelectures.com/
https://www.asnr.org/neurocurriculum-live/
https://www.asnr.org/case-of-the-week/
https://twitter.com/PhilipRChapman1
https://www.neuroradiologyu.com/
Previous Resident Tutorials
https://medicaleducationelearning.blogspot.com/2023/03/radiology-resident-tutorial-monday-13.html
https://medicaleducationelearning.blogspot.com/2022/10/radiology-resident-tutorial-applied.html
https://medicaleducationelearning.blogspot.com/2022/07/radiology-resident-tutorial-your-past.html
https://medicaleducationelearning.blogspot.com/2021/11/pre-2b-frcr-tutorial-radiology-of-skull.html
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Some Recent Literature on Residency Training and Education
Derakhshani A, Ding J, Vijayasarathi A. On-call radiology 2020: Where trainees look for help in a high stakes and time sensitive environment. Clin Imaging. 2021 Sep;77:219-223. doi: 10.1016/j.clinimag.2021.05.003. Epub 2021 May 6. PMID: 33992883. https://pubmed.ncbi.nlm.nih.gov/33992883/
Larocque, N., Shenoy-Bhangle, A., Brook, A., Eisenberg, R., Chang, Y. M., & Mehta, P. (2021). Resident Experiences With Virtual Radiology Learning During the COVID-19 Pandemic. Academic radiology, 28(5), 704–710. https://doi.org/10.1016/j.acra.2021.02.006
Shu, L., Bahri, F., Mostaghni, N., Yu, G., & Javan, R. (2021). The Time Has Come: a Paradigm Shift in Diagnostic Radiology Education via Simulation Training. Journal of digital imaging, 34(1), 212–227. https://doi.org/10.1007/s10278-020-00405-2
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