Eye Movements of Radiologists Reflect Expertise in CT Study Interpretation: A Potential Tool to Measure Resident Development.

Purpose To establish potential markers of visual expertise in eye movement (EM) patterns of early residents, advanced residents, and specialists who interpret abdominal computed tomography (CT) studies. Materials and Methods The institutional review board approved use of anonymized CT studies as research materials and to obtain anonymized eye-tracking data from volunteers. Participants gave written informed consent. Early residents (n = 15), advanced residents (n = 14), and specialists (n = 12) viewed 26 abdominal CT studies as a sequence of images at either 3 or 5 frames per second while EMs were recorded. Data were analyzed by using linear mixed-effects models. Results Early residents' detection rate decreased with working hours (odds ratio, 0.81; 95% confidence interval [CI]: 0.73, 0.91; P = .001). They detected less of the low visual contrast (but not of the high visual contrast) lesions (45% [13 of 29]) than did specialists (62% [18 of 29]) (odds ratio, 0.39; 95% CI: 0.25, 0.61; P < .001) or advanced residents (56% [16 of 29]) (odds ratio, 0.55; 95% CI: 0.33, 0.93; P = .024). Specialists and advanced residents had longer fixation durations at 5 than at 3 frames per second (specialists: ß = .01; 95% CI: .004, .026; P = .008; advanced residents: ß = .04; 95% CI: .03, .05; P < .001). In the presence of lesions, saccade lengths of specialists shortened more than those of advanced (ß = .02; 95% CI: .007, .04; P = .003) and of early residents (ß = .02; 95% CI: .008, 0.04; P = .003). Irrespective of expertise, high detection rate correlated with greater reduction of saccade length in the presence of lesions (ß = -.10; 95% CI: -.16, -.04; P = .002) and greater increase at higher presentation speed (ß = .11; 95% CI: .04, .17; P = .001). Conclusion Expertise in CT reading is characterized by greater adaptivity in EM patterns in response to the demands of the task and environment. © RSNA, 2016 Online supplemental material is available for this article.

Joint online distance learning to complement postgraduate pathology training in preparation for national board examinations.

AIMS: To meet the flexible learning needs of pathology residents preparing for national board examinations, a joint distance learning approach was developed using both asynchronous and synchronous activities with whole slide images, drawing on empirical educational research on online distance learning. METHODS: In a case study of an implementation of the designed joint distance learning approach with a geographically dispersed group of pathology residents in Finland, the participants' perceptions were measured with a 12-item questionnaire covering the value of the learning opportunity, the quality of the sociocognitive processes and their emotional engagement and social cohesion. Communication during the online session was also recorded and analysed to provide objectivity to the self-report data. RESULTS: The effectiveness of joint online learning for knowledge acquisition and preparation for national board examinations was highly rated. However, despite strong emotional engagement during synchronous activities, participants reported minimal interpersonal interaction, which was also reflected in the recordings of the online session. CONCLUSION: Using a technology integration framework and guided by the principles of self-determination theory, joint distance learning is emerging as a beneficial addition to postgraduate pathology programmes in preparation for national examinations. However, to realise the full potential of interpersonal interaction, participants should be prepared for an appropriate mindset.

The developmental trajectory of perceived self-regulation, personal interest, and general achievement throughout high school: a longitudinal study.

BACKGROUND: Our interest in perceived self-regulation of learning arose in the context of educational reform. After decades of stability, the Finnish high school system underwent reform in the 1990s, with a significant emphasis being placed on promoting student self-regulation of learning. AIMS: The purposes of the study were (1) to evaluate changes in the mean level of perceived self-regulation throughout high school and (2) to evaluate the nature of the developmental relations between achievement, perceived self-regulation, and personal interest. SAMPLE: The participants consisted of 245 systematically sampled high school students from a mid-sized Finnish city. METHODS: T tests for paired samples were employed to assess changes in the level of personal interest and perceived self-regulation. Analysis of the developmental relations was carried out within a structural equations modelling framework. RESULTS: The main result was that perceived self-regulation at the beginning of high school predicted not only scholastic achievement at the end of high school over and above prior achievement, but also subsequent personal interest. Additionally, following an international trend, the level of perceived self-regulation decreased from the first to third year of study. CONCLUSIONS: The study has important theoretical and practical implications. First, the results suggest that perceived self-regulation and personal interest are only partially explained by achievement. Second, it appears that perceived self-regulation drives personal interest, not the other way around. Finally, ways for teachers and schools to sustain perceived self-regulation throughout the high school years are discussed.

Do prior knowledge, personality and visual perceptual ability predict student performance in microscopic pathology?

OBJECTIVES There has been long-standing controversy regarding aptitude testing and selection for medical education. Visual perception is considered particularly important for detecting signs of disease as part of diagnostic procedures in, for example, microscopic pathology, radiology and dermatology and as a component of perceptual motor skills in medical procedures such as surgery. In 1968 the Perceptual Ability Test (PAT) was introduced in dental education. The aim of the present pilot study was to explore possible predictors of performance in diagnostic classification based on microscopic observation in the context of an undergraduate pathology course. METHODS A pre- and post-test of diagnostic classification performance, test of visual perceptual skill (Test of Visual Perceptual Skills, 3rd edition [TVPS-3]) and a self-report instrument of personality (Big Five Personality Inventory) were administered. In addition, data on academic performance (performance in histology and cell biology, a compulsory course taken the previous year, in addition to performance on the microscopy examination and final examination) were collected. RESULTS The results indicated that one personality factor (Conscientiousness) and one element of visual perceptual ability (spatial relationship awareness) predicted performance on the pre-test. The only factor to predict performance on the post-test was performance on the pre-test. Similarly, the microscopy examination score was predicted by the pre-test score, in addition to the histology and cell biology grade. The course examination score was predicted by two personality factors (Conscientiousness and lack of Openness) and the histology and cell biology grade. CONCLUSIONS Visual spatial ability may be related to performance in the initial phase of training in microscopic pathology. However, from a practical point of view, medical students are able to learn basic microscopic pathology using worked-out examples, independently of measures of personality or visual perceptual ability. This finding should reassure students about their abilities to improve with training independently of their scores on tests on basic abilities and personality.

'Ain't nothin' like the real thing'. Motivation and study processes on a work-based project course in information systems design.

BACKGROUND: Advocates of the project method claim that project-based learning inspires student learning. However, it has been claimed that project-based learning environments demand quite a bit of self-regulation on the part of the learner. AIMS: Consequently, it was tested whether students scoring low in self-regulation of learning experienced 'friction', an incompatibility between student self-regulation and the demands posed by the learning environment. This would be manifest in cognitive processing and motivation. SAMPLES: The target group consisted of 58 mainly third-year Finnish university students taking a mandatory project course in information systems design. During the project course, student teams completed a commissioned assignment. The study also included a matched nonequivalent comparison group composed of computer science students attending study programmes without a project-based component. METHODS: Data were gathered by means of a questionnaire administered at the beginning and end of the project course and it was analysed by between-groups repeated measures ANOVA. In addition, the students on the course were interviewed. RESULTS: Results suggest that the work-based project model in question may indeed have a substantial motivational impact, interestingly benefitting especially those students who scored low in self-regulation. CONCLUSIONS: It is argued that we tend to view learning environments too simplistically. In particular, a basic distinction should be made between individual and collaborative learning contexts, since peer scaffolding, group grading and choice of group roles may explain why students scoring low in self-regulation of learning did not encounter friction as expected.

More technology, better learning resources, better learning? Lessons from adopting virtual microscopy in undergraduate medical education.

The adoption of virtual microscopy at the University of Turku, Finland, created a unique real-world laboratory for exploring ways of reforming the learning environment. The purpose of this study was to evaluate the students' reactions and the impact of a set of measures designed to boost an experimental group's understanding of abnormal histology through an emphasis on knowledge of normal cells and tissues. The set of measures included (1) digital resources to review normal structures and an entrance examination for enforcement, (2) digital course slides highlighting normal and abnormal tissues, and (3) self-diagnostic quizzes. The performance of historical controls was used as a baseline, as previous students had never been exposed to the above-mentioned measures. The students' understanding of normal histology was assessed in the beginning of the module to determine the impact of the first set of measures, whereas that of abnormal histology was assessed at the end of the module to determine the impact of the whole set of measures. The students' reactions to the instructional measures were assessed by course evaluation data. Additionally, four students were interviewed. Results confirmed that the experimental group significantly outperformed the historical controls in understanding normal histology. The students held favorable opinions on the idea of emphasizing normal structures. However, with regards to abnormal histology, the historical controls outperformed the experimental group. In conclusion, allowing students access to high-quality digitized materials and boosting prerequisite skills are clearly not sufficient to boost final competence. Instead, the solution may lie in making students externally accountable for their learning throughout their training.

The effect of expertise on eye movement behaviour in medical image perception.

The present eye-movement study assessed the effect of expertise on eye-movement behaviour during image perception in the medical domain. To this end, radiologists, computed-tomography radiographers and psychology students were exposed to nine volumes of multi-slice, stack-view, axial computed-tomography images from the upper to the lower part of the abdomen with or without abnormality. The images were presented in succession at low, medium or high speed, while the participants had to detect enlarged lymph nodes or other visually more salient abnormalities. The radiologists outperformed both other groups in the detection of enlarged lymph nodes and their eye-movement behaviour also differed from the other groups. Their general strategy was to use saccades of shorter amplitude than the two other participant groups. In the presence of enlarged lymph nodes, they increased the number of fixations on the relevant areas and reverted to even shorter saccades. In volumes containing enlarged lymph nodes, radiologists' fixation durations were longer in comparison to their fixation durations in volumes without enlarged lymph nodes. More salient abnormalities were detected equally well by radiologists and radiographers, with both groups outperforming psychology students. However, to accomplish this, radiologists actually needed fewer fixations on the relevant areas than the radiographers. On the basis of these results, we argue that expert behaviour is manifested in distinct eye-movement patterns of proactivity, reactivity and suppression, depending on the nature of the task and the presence of abnormalities at any given moment.

Histological knowledge as a predictor of medical students' performance in diagnostic pathology.

Over the years, the role and extent of the basic sciences in medical curricula have been challenged by research on clinical expertise, clinical teachers, and medical students, as well as by the development and diversification of the medical curricula themselves. The aim of this study was to examine how prior knowledge of basic histology and histopathology among students predicts early learning of diagnostic pathology. Participants (N=118, representing 91% of the full student cohort) were medical students at the University of Turku, Finland. Data were collected during two preclinical courses that students attended in their first and second years of medical school. The measurements included tests on biomedical and clinical knowledge and a performance test in diagnostic pathology. Second-year performance on the diagnostic pathology examinations was predicted by the students' prior knowledge of histology, but not by the students' prior knowledge of histopathology. Although earlier research has demonstrated similar results in studies with shorter longitudinal designs, the present study demonstrates that the effect remains even if there is a considerably long time delay (a year) between the measurements, thus confirming the long-term value of basic science studies in the preclinical phase.

Traditional microscopy instruction versus process-oriented virtual microscopy instruction: a naturalistic experiment with control group.

BACKGROUND: Virtual microscopy is being introduced in medical education as an approach for learning how to interpret information in microscopic specimens. It is, however, far from evident how to incorporate its use into existing teaching practice. The aim of the study was to explore the consequences of introducing virtual microscopy tasks into an undergraduate pathology course in an attempt to render the instruction more process-oriented. The research questions were: 1) How is virtual microscopy perceived by students? 2) Does work on virtual microscopy tasks contribute to improvement in performance in microscopic pathology in comparison with attending assistant-led demonstrations only? METHOD: During a one-week period, an experimental group completed three sets of virtual microscopy homework assignments in addition to attending demonstrations. A control group attended the demonstrations only. Performance in microscopic pathology was measured by a pre-test and a post-test. Student perceptions of regular instruction and virtual microscopy were collected one month later by administering the Inventory of Intrinsic Motivation and open-ended questions. RESULTS: The students voiced an appreciation for virtual microscopy for the purposes of the course and for self-study. As for learning gains, the results indicated that learning was speeded up in a subgroup of students consisting of conscientious high achievers. CONCLUSIONS: The enriched instruction model may be suited as such for elective courses following the basic course. However, the instructional model needs further development to be suited for basic courses.