Transcript Education in Emergency Medicine:

Web-based Education in
Emergency Medicine:
Development of an Electronic
Radiology Database, Teaching Module and
Digital Image Database
Ivy Cheng
David Lendrum
Nazanin Meshkat
SWCHSC and UHN
Part I:

Radiology Database and Teaching Module
Part II:

Photographic Image Database
Part I: Radiology Image
Database
Questions (to ask yourself):
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What percentage of the emergency
physician’s time is spent independently
reading radiology images?
How important is accurate interpretation
with respect to patient care?
What tools are available in teaching this
skill? Is there a deficit of resources?
Objectives:
1. Determine the need for a radiology
teaching file
2. Development of comprehensive
database
3. Dissemination for teaching and
evaluation of students, nurses,
paramedics, or residents
4. Evaluation of tool
Objective 1: Needs Survey:
1.
How did you acquire your radiological
interpretation skills?
2.
(Faculty) Do you feel you acquired adequate
radiology interpretation skills by the end of your
residency?
3.
(Residents) Do you have adequate educational
resources for acquisition of interpretative skills of
radiological images?
Needs Survey (con’t)
4.
(Faculty) Do you have adequate resources for
teaching the interpretation of radiological
images?
5.
To what degree would you use a radiology
image database correlated with the RCPS
core curriculum for the purpose of learning or
teaching radiology image interpretation?
Needs Assessment: Results
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E-mail questionnaire sent out to
emergency services list-serv
Dillman method: 3 separate send-outs
82 response out of 161 potential
responses
Response rate: 50.9%
Q1: Radiology Skills Acquisition
Radiology Elective
Residents (21) Faculty (61)
54.1%
19.0%
Book
Website
Before Residency
During Residency
After Residency
Other
61.9%
33.3%
90.5%
95.2%
19.0% (?)
14.3%
73.8%
27.9%
62.3%
82.0%
78.2%
6.6%
Q2. (Faculty) Adequacy of
Knowledge Acquisition?
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Yes=49.2%
No=44.3%
No answer=6.6%
Q3. (Residents) Adequacy of
radiology educational resources?
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Yes=33.3%
No=66.7%
Q4. (Faculty) Adequate
radiology teaching resources?
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Yes=31.1%
No=68.9%
Q5. Potential radiology image
database: frequency of use?
Residents Faculty Combined
All of the time
38.1%
19.7%
24.4%
Some of the
time
Rarely
61.9%
63.9%
63.4%
0%
11.5%
8.5%
Never
0%
3.3%
2.4%
Conclusion
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Acquisition of radiology interpretation skills is
inconsistent across residents and staff
Only 50% of faculty felt they acquired adequate
interpretation skills by the end of their residency
67% of resident respondents voted that there
are inadequate radiology educational resources
69% of faculty respondents voted that there are
inadequate radiology teaching resources.
88% of all respondents would use a radiology
digital database some, or all of the time for
learning, or teaching
Therefore:
Development of a comprehensive radiology
image database
Objective 2: Comprehensive
Database
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Paralleled to the Canadian Core Content
Listing for Emergency Medicine
Core Content is cross-referenced to
chapters in Tintinalli, and Rosen
Web-based
User friendly
Organization (handout):
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Acute disorders by Body System
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Trauma
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Geriatrics
Paediatrics
Geriatrics
Paediatrics
Toxicology
Environmental
Ethical Considerations:
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Patient Privacy: All images must be
cleaned of all identification
Hospital must be made aware of
database’s existence
Acquisition/Retrieval of Images
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Via:
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all Toronto emergency medicine faculty who are
interested in contributing to the database
Radiologists willing to share their databases
Recognition of contribution
User-friendly, web-based system to allow
retrieval of images for teaching/examination
purposes
Password protected
Resident Teaching File
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Images used for exam purposes are to be
transferred to resident teaching file with
answers
Password protected
PGY5 access to full library for study
purposes
Objectives 3 and 4:
Database as an Evaluation Tool:
 Bellringer:
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September 2005
10 images
Short-answer questions
Question 4
3.2.10 C2frac.xr
September 2005: Identification of Radiological Image
Q uest ion
4
C2 #
PGY-1
a
b
c
1
0
1
2.0
67%
PGY-2
a
b
c
0
0.5
0
0.5
17%
PGY-3
a
b
c
0
0
0
0.0
0%
PGY-4
a
b
c
1
1
1
3.0
100%
PGY-5
a
b
c
d
e
Correct I D
Avg. I D rate
0
0
1
0
1.0
25%
7
41%
Appropriateness
Q uality
4
C2#
4
C2#
Clinician
Clinician
a
b
c
d
e
f
g
percent
4
3
2
1
3
4
4
3.0
75%
Poor= 1
Fair= 2
Good= 3
Excellent= 4
a
b
c
d
e
f
g
percent
Yes= 1
N o= 0
1
1
0
0
1
1
1
0.7
71%
Database as an Evaluation Tool:
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Bellringer to be done quarterly
Assessment of residents against PGY level
Assessment of resident during PGY progression
Tool to demonstrate deficits
Determination of appropriate images for exam
purposes
Development of resident teaching file
Current Status:
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Acquisition of more images (incentive)
Website in development:
Teaching module:
www.howtoreadxrays.com by Dr. Nazanin
Meshkat
Future Possibilities:
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Computer-generated quizzes
Expansion of teaching file for other
specialties
Photographic digital images….
Part II: Photographic Image
Database
Special Thanks:
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Dr. Glen Bandiera
Dr. Laurie Morrison
Dr. Vicki Leblanc
Dr. Weiser
Laura Burns
Questions or Suggestions?