Training the best radiologist is the tutor’s aim. Considering both residents features -whose intention is becoming to radiologist- and the trainer profile, the method simultaneously combines the most suitable tools, in order to reach the aim.
The method knowledge and the available tools facilitate the tutor planning and his cooperation in the whole resident learning process.
Can you be an ear radiologist? Is it possible to practice the profession of radiologist only with the knowledge learned by ear and with the skills and attitudes acquired by imitation of the teachers and tutors? Of course not. So the next task of the tutor is to instill in the resident the need for personal study as the first tool for acquiring knowledge.
In order to support the personal study, it is useful to plan by theme the study and the carrying out of oral or written exams that stimulate the resident. Whenever possible, the themes will be consistent with the area of rotation of the resident.
Other tools to support the study are undoubtedly the sessions: monographic, update, morbi-mortality and bibliographies, among others, which will be elaborated by the resident as a function of their progression. A good way to finish a rotation is to prepare one or two sessions on a topic of interest, which will serve, on the one hand, to establish knowledge and, on the other, to evaluate the resident (communication skills, oral presentations , Ability in the search and selection of bibliography).
As for monographs and update sessions given by teachers attached or guardians should not be an example of expository teaching method ( Table 3 ), which is boring and uninspiring for both the resident and teacher. They can raise interactively, if known before the contents, so as to allow the resident the previous study of the subject and its subsequent participation, which can give an unexpected twist to the exhibition.
Theoretical classes can be enlivened by the use of audiovisual elements, such as slide shows, which may include images or videos. Currently, whiteboards are being used with great success by students, allowing more dynamic exhibitions, with participation of students in May .
The exhibitions can be converted to electronic format and used in computer-aided teaching, both in linear programs (programmed teaching) and branched programs of the type of tutorials, such as the following, which can be found on the Internet:
http://www.med-ed.virgina.edu/courses/rad : introductory course in radiology, which organizes the content on the main page.
http://uwmsk.org/moodle : courses classified by status.
https://www.cchs.net/pediatricradiology : pediatric radiology courses organized by organ systems with pre-course and repeat questions later questions.
Such tools can be used on-line or off-line and allows students to control their rate of progress 2.6 .
Conferences online with or without audio, which can be found on the Internet, are a key teaching tool that can be found as part of virtual conferences, such as those found in the scientific agencies led by the American College of Radiology in July , which Consists of a virtual campus, courses for the acquisition of basic skills such as effective presentations and bibliographic searches, a search engine for lectures with audio classified by organs and systems, or portals such as LearningRadiology.com containing cases of the day and presentations without organized audio system organ 8 .
Examples of resources off-line invaluable for learning radiology are the album radiological signs designed by Drs. Navarro and Sendra, of the University of Malaga in September , the atlas of anatomy by Dr. Sempere sectional image Durá University Rovira i Virgili 10 , or the functional anatomy atlas designed by Dr. Valdivia, Faculty of Sciences of Physical Activity and Sport, Granada 11 .
These resources can be used to perform practical examinations on radiological anatomy (depending on the year of residence, can be chosen from simple radiology to resonance) or to evaluate knowledge about classic or pathognomonic radiological signs.
Audio presentations can be archived in the service (only a microphone is needed for presentations in the most usual programs), which will serve as proof of their performance and, on the other hand, for further study by teachers or residents 6 .
Videoconferencing is another educational tool that removes the barriers of space, allowing interaction between teacher and resident, such as organized by several European and American universities for teaching practice evidence – based 12 .
Attending training courses, scientific meetings and conferences stimulates learning. The training courses allow to acquire knowledge about a specific area of the specialty, resulting in greater usefulness to the residents of lower year.
The congresses update knowledge, foster relationships between residents and adjuncts of different centers, give a view of what is done in other centers, stimulating the acquisition of new practical skills, which is why it is recommended for senior residents.
It is advisable for the resident to prepare a summary session of the course, which will serve on one side to update the rest of the components of the service and on the other to settle the knowledge acquired.
The active participation in scientific meetings and congresses allows to train and to evaluate the abilities acquired by the resident in the accomplishment of scientific works, collection of cases and exhibition of these.
Skills and values
At the same time that the resident acquires knowledge, he supervises supervised care according to the degree of responsibility, which allows him to acquire the necessary skills for future professional performance.
In the daily work we use the demonstrative educational method ( Table 3 ). The teacher, in a first phase, teaches how to perform a procedure and the resident in a second phase imitates the teacher. This method is especially useful for the development of certain manual skills and encourages resident participation, making the active learning 4 . With the demonstration method, values such as the humanistic aspects of medical care and effective communication with patients, relatives and the rest of the hospital professionals are transmitted, important aspects in the training, given the imbalance that has occurred in our society between technology and art of communication 13 .
This method is used in the teaching practice of numerous skills, both information and techniques: bibliographic searches, use of audiovisual media, use of biopsy needles, drainage systems, handling of complicated devices, reading of plaques etc. In Table 4 you can see an example of practical designed. To be considered a real practice, three quarters of the time spent on it should correspond to uptime resident 4 .
For the acquisition of technical skills, which pose a risk to the patient, new training tools, such as simulators, are being evaluated and designed, which allow the acquisition of skills necessary for daily practice without putting patients at risk. Some examples of simulators:
Models to train visceral artery catheterization before performing angiography in patients 14 .
Simulator that evaluates the performance of residents to adverse reactions to contrast 15 .
Simulator integrated into the PACS, to help residents cope with the guards 16 .
A step further is creating virtual hospitals, which may be useful for the acquisition of skills covered by cross – training plans 17 . As an example, the virtual hospital Adolfo Varona, created in the Hospital of Basurto (Bilbao).
The interrogative method ( Table 3 ) is primarily used for learning in the performance of the work of resident care. The teacher or tutor contributes questions to reach a diagnostic approach. When the resident asks about something he should know, it is advisable for the resident himself to seek the answer and expose it.
It is also used in cases reading sessions, fundamental tool in the training of the resident, which pursue questions arise radiological logical reasoning 2 . Classically, an x-ray was hung on a negatoscope and the responsible radiologist was finger-tapping one of the residents, who began with reading, differential diagnosis and diagnostic approach, submitting to the questions raised by everyone present. Subsequently, visual media were added, such as the overhead projector, Beamer Test fürs Heimkino, the slide projector and computer projectors.
Some collections of cases on the Internet use the interrogative method to facilitate reading, for example:
http://ww.auntminnie.com , RSNA, use the interrogative method for diagnosis.
http://casepoint.acr.org , ACR, use the interrogative method for reading and diagnosis of cases.
http://essentials-of-pediatric-radiology.com/case-studies/ , Essentials of Pediatric Radiology: it has been ordered by pathologies, using interrogative method.
Some of these collections contain an evaluation system that allows to evaluate the knowledge on each case.
Dr. Fernández Ollera, a tutor at the Virgen Macarena University Hospital in Seville, has created a blog or blog for the teaching of radiology residents, which contains a collection of resolved cases and non-audio presentations, prepared by residents, classified by dates and topics 18 . More rudimentary is the formula that we use in our service to encourage the participation of all residents of the hospital: “cases to plank”. These are cases taken from daily work that pursue the acquisition of basic knowledge. They contain a minimal clinical information and radiological images and the resident is asked to enumerate the radiological findings, to make a differential diagnosis and a diagnostic approach. These cases are emailed to all hospital residents with a one-week notice. Residents are asked to mail their opinions and participate in the reading by one of them, supervised by the specialists. During the reading session, questions arise that should be answered by residents at the next session. At the end of the reading, the presentation of the session is sent by email, as well as the questions raised that must be resolved. With this system we are getting more residents to participate than with the mere invitation to the sessions of the service.
Level of responsibility
As the resident is settled and expand their knowledge, skills and values, it is often used educational method discovery ( Table 3 ), in which the teacher or tutor provides resources and means to motivate, encourage and lead to residents The resolution of problems or coping with specific situations. Residents take a more active role, which is more creative, increases self – esteem and self – efficacy, and facilitates the lasting acquisition of knowledge, skills, changing attitudes, beliefs and values 4 .
We see examples of this method in the case study, developing case files, the radiopatológicas correlations, research, communications or articles and problem – based learning, which can be protected or not 19 .
Problem-based learning uses appropriate problems to increase knowledge and understanding. In this method, students use the “triggering elements” of the problem case or scenario to define their own learning objectives. They then study independently, before returning to the group to discuss and refine their knowledge.
For example, there may be problems regarding the choice of the most appropriate radiological test depending on the clinical data provided, taking into account variables such as the age of the patient and the means available. Another example may be to list symptoms of an allergic reaction to contrast and the resident to diagnose the degree of reaction and appropriate treatment. Choosing the pathway for a drainage, choosing between FNA and BAG, or selecting the appropriate material for performing an angiographic test are other examples.
Group learning facilitates the acquisition not only of knowledge but also of skills and attitudes such as: communicative skills, teamwork, problem solving, independent responsibility in learning, dissemination of information and respect for others.
One of the tasks of the tutor is to look for innovative teaching strategies that are adapted to the needs of the resident, focused on the learner, and one of them is the use of tools based on information and communication technologies, coordinating their efforts through collaborative networks, whose purpose is to autonomous learning approach, which allows the resident utilize the resources that new technologies offer 20 .
We must not forget that the new educational techniques are not an end in itself, but a means that allows us to reach the established goal. The media can influence the message and even make the stronger and clearer message, but can never replace the message.