Kok Ellen M, van Geel Koos, van Merriënboer Jeroen J G, Robben Simon G F
Department of Educational Development and Research, School of Health Professions Education, Maastricht University Maastricht, Netherlands.
Department of Radiology, Maastricht University Medical Centre Maastricht, Netherlands.
Front Psychol. 2017 Mar 3;8:309. doi: 10.3389/fpsyg.2017.00309. eCollection 2017.
Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.
医学影像解读方面的教育工作者很难找到关于应如何设计教学的科学依据。我们回顾并评论了81篇研究医学影像解读教学设计的论文。我们区分了评估完整离线课程和课程体系的研究、评估电子学习模块的研究以及评估特定教育干预措施的研究。所有研究中有23%评估了完整课程或课程体系的实施情况，44%的研究评估了电子学习模块的实施情况。我们认为这些研究取得了令人鼓舞的成果，但为教育工作者提供的信息很少：不同条件之间存在太多差异，无法明确将学习效果归因于特定的教学技巧。此外，概念没有统一的定义，方法上的弱点进一步限制了这些研究所提供证据的有用性。32%的研究评估了一种特定的干预技术。我们讨论了为这些研究提供指导的三个理论框架：诊断推理、认知图式和学习策略。关于诊断推理的研究建议教导学生从非分析性推理开始，随后应用分析性推理，但对于如何训练非分析性推理知之甚少。关于认知图式的研究调查了有助于形成适当认知图式的活动。最后，关于学习策略的研究支持了实践测试的有效性，但更多的学习策略可能适用于医学影像解读的学习。我们的评论强调了评估特定教学技巧的价值，但需要更多证据才能为医学影像解读方面的教育工作者提供最佳指导。
