Traditional hands-on radiology education that continues to be used today only displays 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 learning anatomy[14]. Hence, students may remain unable to provide quality image readings when they were expected to perform independently during clinical practice[15]. Although a variety of radiology education models such as problem-based learning[16] and the use of dynamic images can solve part of this problem, we believe the original working environment represents the most ideal learning method. Thus, we have introduced the experiential education method 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[17]. 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 of knowledge[17]. Outdoor education, cooperative and environmental learning each represents different practice models of experimental education. In a sense, the intern and resident rotation is also a kind of experiential education. This educational concept is increasing in popularity at all levels of education [18, 19].
During this study, we created 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 and systematic approach to formulate imaging interpretation and differential diagnosis, which may be partly thanks to the free inquisitive space of the experiential education mode.
Apart from objective improvement in imaging descriptions and interpretations, subjective improvements in self-confidence were also seen from the student feedback obtained during self-assessment questionnaires. Such skills included determining the order in which to read an imaging sequence, choosing the proper window width and level, as well as the choice of the reconstruction method. That might the result affected by the intervention of the trainer during the activity as well as the open discussion training. 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[20].
Our study shows the efficacy of experiential education mode in the study of imaging anatomy. 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 organs[21, 22]. It was globally concluded that imaging anatomy enhanced the quality and efficiency in human anatomy education[23]. However, it is hard to recognize the whole anatomical structure from a single cross-sectional image, which tends to increase student confusion[22]. Our study results provide evidence that reading a contiguous scan improves students’ comprehensive understanding of anatomy. Additionally, by utilizing multiple reconstruction methods, three dimensional images are more comprehensively visualized by students, which is a finding that has also been proven by other studies[24].
Much effort is needed to bring experiential education 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. In this way, the development of a simulation PACS for undergraduate medical education similar to that of the University of Colorado School of Medicine is an ideal method for forming a simulation software environment[6].In addition, teacher guidance is an especially critical element in education. 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 both guide image reading as well as to answer questions. Therefore, teaching assistants need specific experience working in a radiology department. Thus, we chose the junior radiology specialists as teaching assistant. Nevertheless, a shortage of teachers hinders the use of this teaching model on a wider scale, which serves as a limitation of the experiential education approach.
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. Though the probability is very small, it still has a chance to lead to the bias of the result. Fourthly, though we have control the faculty and the teaching standard between the two groups, the bias caused by human factor still can not be fully avoided in practice. Fifthly, although we 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 of application ability[25, 26].
As stated in the students’ recommendations, this model of experimental teaching can still 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[27]. 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[28].