Learning How to Order Imaging Tests and Make Subsequent Clinical Decisions: a Randomized Study of the Effectiveness of a Virtual Learning Environment for Medical Students

Abstract

Rationale and objectives: Two critical skills that medical students must acquire during undergraduate education are the ability to order imaging tests and make clinical decisions based on their results. We implemented an e-learning course in Moodle specifically designed to teach these skills to medical students. The aim of this study was to assess the effectiveness of our course.

Material and methods: We randomized 26 undergraduate medical students to an experimental group that had access to the virtual learning environment and a control group that did not. Three weeks after the course, we evaluated its effectiveness through a blinded objective structured clinical examination. To avoid any bias in favor of the experimental group, the assessment considered scores on two pre-specified subscales: one related to the contents of the course and the other to new clinical scenarios.

Results: Students that completed the e-course performed better overall than controls (mean score ± standard deviation 59.3 ± 6.2 vs 41.8 ± 10.2, p = 0.0020). This better performance was observed in both types of skills assessed (ordering imaging tests, and making diagnostic and therapeutic decisions based on test results). More importantly, this better performance of the experimental group was observed consistently both with items related to the course content (1.7 times higher, p = 0.0034) and new scenarios (1.3 times higher, p = 0.0098).

Conclusions: Through an ad - hoc e-course, undergraduate medical students learned effectively how to order imaging tests and make optimal subsequent decisions. Moreover, they were able to apply these skills to new clinical scenarios.

Keywords: Clinical decision-making; Medical education; Online education; Randomized controlled trial.

Fig. 1

Flow chart representing all the contents of the e-course organized into consecutive modules. In each one, a topic is approached through slideshows with voiceover and practical exercises that correspond to one or several learning objectives. As shown, the objectives can be addressed in different modules (and/or through different activities). On the other hand, the route through the slideshows and exercises follows a set order to ensure the acquisition of certain knowledge and skills before moving on to the next ones

Fig. 2

Sample slides. a Synergy between the clinician ordering the test and the radiologist begins with the formulation of a diagnostic question based on clinical data; the same data influence the performance of the imaging test and its interpretation by the radiologist in response to the question of the clinician. b Detail outline of the mental process from clinical suspicion to the radiological features explored by the radiologist, which require different image acquisition techniques in computed tomography

Fig. 3

Sample slides explaining how the ordering physician and the radiologist can collaborate to optimize the imaging tests. a The clinical situation and other characteristics of a patient influence the performance of an ultrasound examination. b In most patients with abdominal emergencies, it is sufficient for the computed tomography to be performed in the portal phase, but some scenarios require the acquisition of other phases and it is necessary to know this beforehand

Fig. 4

Diagram showing the feedback features of the virtual course (on the left) and their relationship with phases of the metacognitive cycle (on the right): planning, goal setting, monitoring, evaluation, and adaptation

Fig. 5

Results of the effectiveness assessment by type of skill tested. The three sets of results show from left to right students’ overall performance, their performance ordering imaging tests, and their performance making subsequent decisions

Fig. 6

Results of the effectiveness assessment by the familiarity of the content tested. On the left, students’ performance on items related to the content of the e-learning course (abdominal emergencies). On the right, their performance on items not related to abdominal emergencies (new content)