Teaching Session for Basic Chest Radiograph Interpretation

Communication module reflection

I created a ten-minute masterclass on interpreting a basic chest radiograph and then provided the teaching session to third year medical students at my local medical school. I decided to use chest radiograph interpretation because it vital skill of a new doctor to be able to identify both normal and certain abnormalities in the acute setting, to guide patient management. I provided a thirty-minute talk to the medical students which was interactive. For this task, I submitted my minute masterclass which I used to introduce the teaching topic.

I chose to teach the medical students basic chest radiograph interpretation because it is a useful skill to develop for when you’re working as a junior doctor on the wards or in the emergency department. There has historically been a lack of radiology teaching to medical students with most doctors only discovering or becoming interested in radiology after undertaking medical or surgical jobs and seeing the workings or the radiology department in terms of diagnostics and intervention. I felt that as a medical student I was underprepared for interpreting plain radiographs. I could only recall being taught about chest radiograph interpretation once throughout my six years of medical study. I remember feeling dread and anxiety having to read a chest radiograph for an unwell patient while waiting for a formal report as a junior doctor. This is something I wanted to help prepare new medical students for during their undergraduate degree.

I was given the opportunity to provide formal radiology teaching to medical students at the medical school linked to the hospital. The plan was to teach chest radiograph interpretation to a small group of approximately 20-30 students in their final year of study. I created a pre-recording and provided a PowerPoint and further teaching session on chest pathology. I familiarised myself with the content and revised the topic prior to the session to ensure I could answer any challenging questions or know where to guide any further questions. I also asked students to fill out a pre-study questionnaire on their level of competence with reporting chest radiographs and a feedback form following the session. I discussed my teaching plan and material with another radiologist in the department to ensure I was covering the relevant points and help ensure it was being pitched at the correct level.

I trained at a different medical school so I wasn’t fully aware of the students’ prior knowledge or teaching on the topic and in radiology in general. I started with a brief discussion to get an understanding of their expectations and prior knowledge. I soon realised they didn’t understand the basics and there I started the teaching from the beginning of the topic.

During the tutorial, I discussed how to approach interpreting a chest radiograph which included a checklist style system to ensure repeatability and help reduce missing abnormalities. After my recording, I then asked the group to work in pairs going through a number of radiographs and discuss the cases. We then went through the cases as a group which allowed us to discuss the answers and any questions. There were many questions and the tutorial didn’t keep to time. I noticed that some of the group were much more outspoken than others and that it was difficult to try and include everybody without forcing people to speak if they weren’t comfortable. After the tutorial, I spoke with another radiologist who had provided a similar teaching session on abdominal radiograph interpretation a few days prior. He said that he went into much more detail but didn’t manage to cover a broad spectrum of topics or give a good overview. I received positive feedback from the students when I provided them with anonymous feedback forms following the teaching session. However, there wasn’t much detail on how I could improve the session in the future which would have been useful.

I had to think about what aspects I would reflect on in detail and document in this report as there had been a lot of teaching and learning on the course and in the process of creating a 10-minute masterclass and in providing the teaching itself to the medical students. I read through multiple reflection theories but started with Jasper’s reflective practice to help me understand the reflective process theory ¹. Reflection is part of the learning process when we learn from experience or doing ². This type of learning fits with my masterclass and preparing a teaching session. Kolb’s learning cycle has four stages, experience, review, conclusion then planning for the next step which is a more straightforward reflective cycle than Gibb’s reflective cycle which adds feelings into the learning cycle.

Shuell defines learning as; “an enduring change in behaviour, or in the capacity to behave in a given fashion, which results from practice or other forms of experience” ³. There are numerous learning definitions and theories which can be applied to a learning experience. We can use a learning theory to help shape our teaching method or to help understanding the learning process the student experiences.

I had to think about how I would develop the masterclass and I realised that based on the fact the students most likely had limited exposure to radiology I would need to start from the basics. Therefore, the initial 10 minutes would be mainly didactic to allow me to teach them the basics. Once the basics had been taught then I could make the session more interactive by showing cases and having discussions in the tutorial. I felt like I was just lecturing and it felt quite negative making the 10-minute presentation because I just remembered lecturers droning on when I was a medical student. This made me determined to make the next part of the presentation much more interactive and discussion / case based.

I had to think about what visual aids I would use, as I have many memories of multi-coloured slides or video clips that were not clearly projected or didn’t work when lecturers presented during my time at medical school. I decided to use a plain normal chest radiograph as the visual aid initially because as a doctor it is vital to first learn what normal looks like before you learn about pathology. I then pointed to the relevant points on the chest radiograph as I gave my presentation so that the students can see the anatomy I was talking about. I also anticipated many questions from students at the masterclass because there is a lot of basic information being taught and it would be almost impossible to remember in one setting without further questioning or independent learning.

I had not met the students prior to the teaching session and therefore was unaware of their prior knowledge and exposure to different teaching methods or styles. I initially tried to help develop a relationship with the students so they could ask questions freely and not feel judged negatively in the class. Carl Roger’s person centred approach has a focus on developing a relationship with unconditional positive regard ⁴.  I tried to empathise with the students, having been a medical student myself a few years previously, I could remember what it was like. I remembered the difference between having a tutor that engaged us without making us feel useless or scared to speak up or picking on students and then humiliating you for any mistake made in the learning process. Empathy is a key factor for Carl Roger’s. Another theory is Maslow’s Hierarchy of needs, which sets out that people have several individual needs which are a motivating drive ⁵. The basic needs include things like food, warmth, security and water and if these basic needs are not met then the more complex needs cannot be fulfilled ⁶. Emotional and physical safety in the class are basic needs and are vital in Roger’s concept of building a relationship. To help with this I had a clear introduction where I introduced myself the topic and the learning objectives and allowed time to get to know the students at the beginning of the teaching.

Dennick states that’s students lack motivation if their physical and psychological needs are not fulfilled ⁷.  Dennick also states that “learning is facilitated by a relationship”. This can include addressing students by their name and respectfully involving quieter students to help reduce anxiety ⁷. I attempted to do this by asking a person from each row if they had any comments and if not then going around the class in a non-confrontational approach. This allowed the quieter students to participate and get involved.

The group were quite tired in the morning teaching session that started at 8am and I assume that is because some of them may have been lacking adequate sleep, which forms part of Maslow’s basic needs ⁶. I noticed that the group were more alert after the first 20 minutes and when we moved onto the more clinically relevant cases. I would like to learn more detail regarding Maslow and Rogers as I feel that this would help me be a better teacher.

My previous teaching experience involved medical students, foundation doctors or radiology trainees within the department. Adult learning is known as andragogy, while child leaning is pedagogy per Knowles ⁸. Pedaogy is teacher centred and is more common in teaching children, while andragogy is learner focused. Theories are increasingly recognising the two styles are on the spectrum of learning, as the learning gains more knowledge and experience then the teaching style often shifts to being learner centred ⁹. My masterclass on reflection was much more teacher centred and in future I would try to make it more learner focused. This is specially so because I am teaching adult students which are generally considered to be motivated and are more self-directed in their own learning. In Malsows theory to reach self-actualisation there is often a strong motivation to gain and improve knowledge in learning. Student participation and a good learning environment are vital in Roger’s theory of learning.

I could have further assessed the students prior knowledge using KWL strategy whereby I could have found out what the students knew, what they want to learn and then find out what they did learn after the teaching session. This could be tested using an informal exam before and after the teaching session ⁹. I remember having this during medical school with interactive remote login to applications on the PowerPoint during certain sessions in pharmacology. Having feedback from what the students learnt could help shape and improve my teaching for future sessions and focus on which parts I taught well or didn’t ¹⁰.

I also reflected on the teaching I had received on transactional analysis during the MSc modules and I thought about my interaction with the students during my masterclass. I felt that it was an adult to adult interaction which can be good developing a healthy relationship that encouraged the students to identify their own learning needs and I provided further reading and cases for them to practice after the teaching session. Initially in the session when the students were more tired I perhaps taught in a more parent to child transaction where I wasn’t gaining much feedback back and I wanted to get across the basics.

I feel there are many points of the masterclass that could be improved, including the delivery and making the content more interactive. I found that the actual delivered teaching sessions went quite well with positive feedback received but this could be because students have traditionally received very little radiology teaching as medical students, so perhaps they valued any teaching provided. If I were to provide the teaching again I would like to use a more interactive quiz where students could record their answers on their smart phones for answering questions in class as that could engage the students more.

References:

1. Jasper M. Beginning reflective practice. Nelson Thomes; 2003.
2. Kolb DA. Experiemental learning: Experience as the source of learning and development. FT prss; 2014.
3. Shuell T. Cognitive conceptions of learning. Review of Educational Research, 56, 411-436. 1986.
4. Rogers C. On becoming a Person, A theapist’s view of psychotherapy. Harvard. 1961.
5. Maslow A. Motivation and personality. New York: Harper and Row. 1954.
6. McLeod S. Maslow’s Hierarchy of Needs. www.simplypsychology.org/maslow.html.
7. Dennick R. Twelve tips for incorporating educational theory into teaching practices. Medical Teacher. 34; 618-624. 2012.
8. Knowles M. The modern practice of adult education: andragogy versus pedagogy. New York: association press. 1970.
9. Collins J. Education Techniques for lifelong learning. Principal of adult learning. Radiographics; 24:1483-1489. 2004.
10. Taylor D et al. Adult Learning Theories: Implications for learning and teaching in medical education: AMEE Guide No.83. Medical Teacher 35: e1561-e1572. 2013.