Adaptive tutorials versus web-based resources in radiology: a mixed methods analysis in junior doctors of efficacy and engagement

Abstract

Background: Radiology education is limited in undergraduate Medicine programs. Junior doctors might not have the necessary background to effectively order and interpret diagnostic imaging investigations. Furthermore, junior doctors are often time-poor, balancing clinical commitments with ongoing learning, leadership and teaching responsibilities. Previous studies have demonstrated the efficacy of radiology-themed online adaptive tutorials for senior medical students. Such adaptive tutorials might therefore be an efficient and effective form of radiology education for junior doctors.

Methods: A randomised controlled crossover trial was performed to evaluate the impact of adaptive tutorials on learning the indications for, and interpretation of, basic imaging studies, compared with peer-reviewed web-based resources. Ninety-one volunteer junior doctors, comprising 53 postgraduate year 1 (PGY 1) and 38 postgraduate year 2 (PGY 2), were randomly allocated into two groups. In the first phase of the trial, focusing on head CT, one group accessed adaptive tutorials while the other received web-based resources. In the second phase of the trial, focusing on chest CT, the groups crossed over. Following each phase of the trial, participants completed exam-style online assessments. At the conclusion of the study, participants also completed an online questionnaire regarding perceived engagement and efficacy of each type of educational resource.

Results: Junior doctors completed the adaptive tutorials significantly faster than the relevant web-based resources for both head CT and chest CT (p = 0.03 and < 0.01 respectively). Mean quiz scores were higher in the groups receiving adaptive tutorials on head CT and chest CT (86.4% vs 83.5 and 77.7% vs 75% respectively). However, in contrast to previous studies in senior medical students, these differences were not statistically significant. Participants reported higher engagement and perceived value of adaptive tutorials, compared with web-based resources.

Conclusions: Adaptive tutorials are more time-efficient than existing web-based resources for learning radiology by junior doctors, while both types of resources were equally effective for learning in this cohort. Junior doctors found the adaptive tutorials more engaging and were more likely to recommend these resources to their colleagues.

Keywords: Adaptive tutorials; Diagnostic imaging; Junior doctors; Medical education; Radiology.

Fig. 1

Representative examples of drag and drop interaction in adaptive tutorials on CT scans of the head (a) and chest (b), with feedback following submission of answers

Fig. 2

Baseline imaging quiz scores for both groups (a), quiz scores for the head CT quiz for phase 1 of the study (b) and the chest CT quiz for phase 2 of the study (c). (Mean with 95% CI and range)

Fig. 3

a: Exit questionnaire analysis of the perceived utility of adaptive tutorials compared with web-based resources (median score with an interquartile range; *p ≤ 0.05, Mann Whitney). Likert scale – 1 strongly disagree to 6 strongly agree. b: Perceived improvement in understanding and overall perceived value of adaptive tutorials compared with web-based resources (Median score with an interquartile range; *p ≤ 0.0001, Wilcoxon Ranked Sign test). Likert scale – 0 least understanding to 10 most understanding. Likert scale – 0 not useful to 10 extremely useful

Fig. 4

Major qualitative themes derived from open-ended feedback regarding adaptive tutorials (a) and web-based resources (b)