Traditional hands-on radiology education that continues to be used today only displays key images in typical imaging layers rather than the whole images. While this teaching method may be useful for helping students handle typical imaging features, it may be insufficient for understanding the anatomy. Hence, students may struggle to provide accurate imaging descriptions and interpretation when they are expected to perform independently in real clinical practice. Although a variety of radiology education models such as problem-based learning[11] and the use of dynamic images[12] can improve part of this problem, the most ideal learning model can be provided through simulating similar clinical environment for the students. Thus, we have introduced the experiential education model into our radiology teaching.
The theory of experiential education was first proposed by John Dewey in 1938. He initiated the topic of experiential education in his work entitled Experience and Education. Unlike hands-on education, this educational philosophy emphasizes the process of learning through experience[13]. Based on this educational concept, students should be responsible for their own learning. As such, students are able to acquire relative knowledge in the real world by discovering both questions and proactive solutions. This kind of learning method has the potential to motivate students’ autonomy while also elevating their interest in knowledge[13]. Outdoor education, cooperative and environmental learning represent some of the common practice models used in experiential education. In a sense, the intern and resident rotations serves as experiential education model for post graduate learning. This educational concept is increasing in popularity at all levels of education [14, 15].
During this study, we modified an experiential education course by applying the PACS and DICOM viewer software to simulate a working environment mirroring our typical clinical work. The study results indicated the experiential education approach allows better clinical guidance necessary in assisting students to form a holistic point of view in both anatomy and pathology. Most importantly, this teaching method allows better guidance for students to develop critical thinking using a systematic approach to formulate imaging interpretation and differential diagnosis. This may be partly thanks to the abundant data information of the experiential education mode.
Apart from objective improvement in imaging descriptions and interpretations, subjective improvements in self-confidence were observed from self-assessment questionnaires. Such skills included determining the order of interpreting different imaging sequences, choosing the proper window width and level, as well as the choice of the reconstruction method. This might be due to the intervention of the trainer during the activity. Moreover, following the experiential courses, the experiential approach allows better interactions which encouraged better interest in radiology which is vital for the future development of radiology.
Our study shows better efficacy in conveying anatomical knowledge when experiential education model was used during radiology education. Anatomy is the basis for radiology education. In theory, reading CT and MR images is a good way to study anatomy because the contiguous scanning helps students to form three-dimensional concepts of relative locations of the structuresvisualized by students. This finding was consistent with other studies [19].
Much effort is needed to bring experiential education models into practice. The PACS and a proper DICOM viewer represent the basic software requirements for experiential education. To protect patients’ privacy, we chose to copy the DICOM data from the PACS rather than to link to the original PACS. Similar to the Medicine faculty in University of Colorado, the development of a simulation PACS for undergraduate medical education was an ideal method for forming a simulation software environment for students[3]. In addition, teacher guidance is an especially critical element in this education model. At least 3 teaching assistants with standardized radiology training experience are needed in one class, as team-based discussion is a component in our experiential courses. Students need the teaching assistants to guide imaging interpretation. Therefore, teaching assistants with specific clinical experience a radiology department is vital. During our study, we recruited junior radiology registrars as the teaching assistants. Nevertheless, a shortage of teachers and assistants may hinder the use of this teaching model on a wider scale, which may be one of the limitations when bringing experiential education approach to practice.
There are several limitations to the study. Firstly, due to the limited number of supervisors, the sample size was similarly limited. Secondly, this was a single centre study. Thirdly, due to the limitation of actual operation, only 47 of 61 students completed the questionnaire in the control group, which might lead to selective bias. Fourthly, although we have utilized objective evaluation measurements, this study also exposed the weakness of our evaluation system within radiology education. The study measures consisted of paper-and-pencil tests, with most questions consisting of objective items that test memory such as multiple choice questions and short answer questions. Furthermore, the subjective items that are used to test application ability are limited. Consequently, only a small part of the final exam reflected the difference between the experiential education group and the control group. Other test forms such as bedside examinations and multi-station examinations should be used in the future for better assessment [20, 21].
As stated in the students’ recommendations, this model of experimental teaching can be improved. For example, at Dartmouth-Hitchcock Medical Center, students are required to attend a radiology triage programme to work with on-call radiology residents [22]. Such students have reported this to be a valuable clinical learning experience, as well as a good way to relieve the workflow of residents. In our questionnaire, some students also requested to take the internship in the radiology department. This kind of programme can be brought into practice as an important aspect of experiential education. Additional forms of education, such as integrative teaching, may also be applied in future radiology education courses[23].