Tumor imaging instruction and assessment at chiropractic colleges in North America: a pilot study with implications for National Board of Chiropractic Examiners content.

OBJECTIVE: This pilot study tested a survey instrument pertaining to the instruction and assessment of tumor imaging in chiropractic training programs. The secondary purpose was to gather data regarding credentials of lead instructors, textbook and resource use, and tumors taught and assessed. METHODS: An electronic survey was distributed to lead tumor imaging instructors at all chiropractic colleges in the United States and Canada. A focus group of tumor imaging instructors was conducted to clarify ambiguous data. RESULTS: Diplomate status with the American Chiropractic Board of Radiology was held by 87.5% of the instructor respondents. There were similarities in course content and assessment across institutions. A total of 26 tumors were considered clinically significant by more than 65% of instructors, 9 tumors were identified as not clinically significant by more than 65%, and 4 tumors were considered clinically significant by 35% to 65% of instructors. There was correlation between those instructors who evaluated on various tumors and those who feel it is important to evaluate such tumors (rS = 0.94, p < .001). The focus group addressed the 4 equivocal tumors and recommended 3 be added to the list of clinically insignificant tumors. CONCLUSION: The survey instrument is ready to be used to conduct a study of all clinical areas of the chiropractic curriculum. A total of 12 tumors were recommended for removal from National Board of Chiropractic Examiners tests. The authors recommend that the Academics Committee of the American Chiropractic Board of Radiology share information regarding learning libraries to allow for a richer learning experience across all campuses.

Grading Osteoarthritic Changes of the Zygapophyseal Joints from Radiographs: A Reliability Study.

OBJECTIVE: This study tested the reliability of a 5-point ordinal scale used to grade the severity of degenerative changes of zygapophyseal (Z) joints on standard radiographs. METHODS: Modifications were made to a Kellgren grading system to improve agreement for grading the severity of osteoarthritic changes in lumbar Z joints. These included adding 1 grade of no degeneration, multiple radiographic views, and structured examiner training. Thirty packets of radiographic files were obtained, which included representation of all 5 grades including no degeneration (0) and Kellgren's 4-point (1-4) joint degeneration classification criteria. Radiographs were digitized to create a radiographic atlas that was given to examiners for individual study and blinded evaluation sessions. Intrarater and interrater agreement was determined by weighted κ (κw) from the examination of 79 Z joints (25 packets). RESULTS: Using the modified scale and after training, examiners demonstrated a moderate-to-substantial level of interrater agreement (κw = 0.57, 0.60, and 0.68). Intrarater agreement was moderate (κw = 0.42 and 0.54). CONCLUSIONS: The modified Kellgren 5-point grading system provides acceptable intrarater and interrater reliability when examiners are adequately trained. This grading system may be a useful method for future investigations assessing radiographic osteoarthritis of the Z joints.

Radiology Undergraduate and Resident Curricula: A Narrative Review of the Literature.

OBJECTIVE: The purpose of this study was to examine the literature regarding radiology curricula for both undergraduates and residents. METHODS: A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references. RESULTS: Of the 4716 unique abstracts reviewed by the author, 142 were found to be relevant to the purpose of this study. Undergraduate radiology education, radiology curriculum, and radiology pedagogy vary widely between disciplines and between colleges within disciplines. Formal radiology education is not taught at all medical programs and little radiology training is incorporated into non-radiology residencies. This results in some medical graduates not being taught how to interpret basic radiology images and not learning contraindications and indications for ordering diagnostic imaging tests. There are no definitive studies examining how to incorporate radiology into the curriculum, how to teach radiology to either undergraduates or residents, or how to assess this clinical competency. CONCLUSIONS: This review shows that radiology education is perceived to be important in undergraduate and residency programs. However, some programs do not include radiology training, thus graduates from those programs do not learn radiology essentials.

Student Evaluations, Outcomes, and National Licensure Examinations in Radiology Education: A Narrative Review of the Literature.

OBJECTIVE: The purpose of this study was to examine literature on radiological student evaluation and outcome assessments including national board examinations. METHODS: A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references. RESULTS: Of the 4716 unique abstracts reviewed by the author, 54 were found to be relevant to the purpose of this study. Student grade point average correlates with board scores in the nursing, chiropractic, and medical professions. Scores on the chiropractic college admission test and undergraduate grade point average correlate with success in professional college. There is a correlation between board scores and college attended. Board preparation programs do not appear to affect board examination scores. CONCLUSION: Although evaluations can be effective teaching tools, they are not used by many radiology programs. Some programs have inadequate evaluations and do not allow students to review their evaluations. There are no definitive links between mastery of radiology and specific evaluations, outcomes, or pre-professional/clinical grades. Studies suggest that board examination scores reflect long-term mastery of knowledge rather than short-term memorization of facts.

Pedagogical Approaches to Diagnostic Imaging Education: A Narrative Review of the Literature.

OBJECTIVE: The purpose of this study was to examine literature on how radiology is taught and learned by both radiology residents and undergraduates in the health professions. METHODS: A review of the literature was performed using relevant key words. Articles were retrieved through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references. RESULTS: Of the 4716 unique abstracts reviewed by the author, 91 were found to be relevant to the purpose of this study. The literature retrieved reported pedagogical approaches to teaching radiology including the following: problem solving, technology as teacher, independent learning tools, visiting lectureships, case based teaching, and conferences. There was some exploration of the relative effectiveness of educational formats. Suggestions for future research identify 7 areas of relative consistency. CONCLUSION: Radiology is a clinical skill that requires integration science, clinical information, clinical experiences, and information recorded on diagnostic imaging studies. The research in this area focuses on problem solving, the use of algorithm/scripts, introducing uncertainty in clinical scenarios, incorporating technology in learning environments, active learning techniques, and methods of independent learning. Although the literature in this area is still in its infancy, the research examining the relative effectiveness of these various educational formats is often contradictory, suggesting that this is a complex area of study with numerous factors influencing student learning.

Radiologists as Educators: A Narrative Review of the Literature.

OBJECTIVE: The purpose of this study was to examine literature on how radiologists are trained to be effective educators for both residents and undergraduates in the health professions. METHODS: A review of the literature was performed using relevant key words. Articles were retrieved through from 1990 through December 2012 using PubMed, ScienceDirect, ERIC, Proquest, and ICL databases along with a manual review of references. RESULTS: Of the 4716 unique abstracts reviewed by the author, 51 were found to be relevant to the purpose of this study. Faculty teaching skills seem to be solidified during residency. This may be due to a failure to include scholarship of teaching and learning in education and faculty development. Preliminary research shows that creating opportunity for faculty development is beneficial with much of this literature focused on explaining educational concepts to radiologists. CONCLUSION: The literature examining faculty training in the area of radiology education is sparse. Several articles address the need for more academic radiologists and the need for better training of academic radiologists. The few articles aimed at providing insight to radiologists in this area introduce basic educational concepts such as lecture creation, examination writing, and learning styles or simply delineating what makes an effective educator.