A think-aloud study to inform the design of radiograph interpretation practice
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A think‑aloud study to inform the design of radiograph interpretation practice Jong‑Sung Yoon1 · Kathy Boutis2 · Martin R. Pecaric3 · Nancy R. Fefferman4 · K. Anders Ericsson5 · Martin V. Pusic6,7 Received: 8 November 2018 / Accepted: 17 February 2020 © The Author(s) 2020
Abstract Models for diagnostic reasoning in radiology have been based on the observed behaviors of experienced radiologists but have not directly focused on the thought processes of novices as they improve their accuracy of image interpretation. By collecting think-aloud verbal reports, the current study was designed to investigate differences in specific thought processes between medical students (novices) as they learn and radiologists (experts), so that we can better design future instructional environments. Seven medical students and four physicians with radiology training were asked to interpret and diagnose pediatric elbow radiographs where fracture is suspected. After reporting their diagnosis of a case, they were given immediate feedback. Participants were asked to verbalize their thoughts while completing the diagnosis and while they reflected on the provided feedback. The protocol analysis of their verbalizations showed that participants used some combination of four processes to interpret the case: gestalt interpretation, purposeful search, rule application, and reasoning from a prior case. All types of processes except reasoning from a prior case were applied significantly more frequently by experts. Further, gestalt interpretation was used with higher frequency in abnormal cases while purposeful search was used more often for normal cases. Our assessment of processes could help guide the design of instructional environments with well-curated image banks and analytics to facilitate the novice’s journey to expertise in image interpretation. Keywords Education (medical) · Radiology · Instructional design · Cognition · Emergency medicine * Martin V. Pusic [email protected] 1
Department of Psychology, University of South Dakota, Vermillion, SD, USA
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Dept. of Pediatrics, The Hospital for Sick Children, and University of Toronto, Toronto, Canada
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Contrail Consulting Services, Toronto, Canada
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Department of Radiology, New York University School of Medicine, New York, USA
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Department of Psychology, Florida State University, Tallahassee, FL, USA
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Department of Emergency Medicine, New York University School of Medicine, New York, USA
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Division of Learning Analytics, Institute for Innovation in Medical Education, 550 First Avenue, MSB G109, New York, NY 10016, USA
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J.-S. Yoon et al.
Introduction Diagnostic images play an important role in everyday medical practice. Radiographs, in particular, are one of the most commonly ordered image-based tests (Boutis et al. 2019). Since interpretation errors are a potential threat to patient safety (Graber et al. 2012) considerable resources are invested in training clinicians to high levels of performance. However, development of expertise
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