Formative evaluation of standardized training for CT colonographic image interpretation by novice readers.

PURPOSE: To introduce an educational intervention-specifically, a specialized training course-and perform a formative evaluation of the effect of the intervention on novice reader interpretation of computed tomography (CT) colonographic data. MATERIALS AND METHODS: The study was institutional review board approved. Ten normal and 50 abnormal cases, those of 60 patients with 93 polyps-61 polyps 6-9 mm in diameter and 32 polyps 10 mm or larger-were selected from a previously published trial. Seven novice readers underwent initial training that consisted of a 1-day course, reading assignments, a self-study computer module (with 61 limited data sets), observation of an expert interpreting three cases, and full interpretation of 10 cases with unblinding after each case. After training, the observers independently interpreted 60 cases by means of primary two-dimensional reading with unblinding after each case. For each case, the reading time and the location and maximal diameter of the polyp(s) were recorded. A t test was used to evaluate the observers' improvements, and empirical receiver operating characteristic (ROC) curves were constructed. RESULTS: By-patient sensitivities and specificities were determined for each observer. The lowest by-patient sensitivity at the 6 mm or larger polyp threshold was 86%, with 90% specificity. Four observers had 100% by-patient sensitivity at the 10 mm or larger polyp threshold, with 82%-97% specificity. For polyps 10 mm or larger, mean sensitivity and specificity were 98% and 92%, respectively. For the last 20 cases, the average interpretation time per case was 25 minutes. The range of areas under the ROC curve across observers was low: 0.86-0.95. CONCLUSION: In the described polyp-enriched cohort, novice CT colonographic data readers achieved high sensitivity and good specificity at formative evaluation of a comprehensive training program. Use of a similar comprehensive training method might reduce interreader variability in interpretation accuracy and be useful for reader certification.

The promise of new ideas and new technology for improving teaching and learning.

There have been enormous advances in our understanding of human learning in the past three decades. There have also been important advances in our understanding of the nature of knowledge and new knowledge creation. These advances, when combined with the explosive development of the Internet and other technologies, permit advances in educational practices at least as important as the invention of the printing press in 1460. We have built on the cognitive learning theory of David Ausubel and various sources of new ideas on epistemology. Our research program has focused on understanding meaningful learning and on developing better methods to achieve such learning and to assess progress in meaningful learning. The concept map tool developed in our program has proved to be highly effective both in promoting meaningful learning and in assessing learning outcomes. Concept mapping strategies are also proving powerful for eliciting, capturing, and archiving knowledge of experts and organizations. New technology for creating concept maps developed at the University of West Florida permits easier and better concept map construction, thus facilitating learning, knowledge capture, and local or distance creation and sharing of structured knowledge, especially when utilized with the Internet. A huge gap exists between what we now know to improve learning and use of knowledge and the practices currently in place in most schools and corporations. There are promising projects in progress that may help to achieve accelerated advances. These include projects in schools at all educational levels, including projects in Colombia, Costa Rica, Italy, Spain, and the United States, and collaborative projects with corporate organizations and distance learning projects. Results to date have been encouraging and suggest that we may be moving from the lag phase of educational innovation to a phase of exponential growth.