Using Digital Repositories to Support Mastery Training and Deliberate Practice in Radiology Training and Medical Education Faculty Development See also examples below: http://www.ajnr.org/ (see Case Collections) https://www.nejm.org/multimedia/images-in-clinical-medicine?query=main_nav_lg (NEJM, see Images in Clinical Medicine) http://casereports.bmj.com/collections/radiology2 http://www.radiologycases.com/index.php/radiologycases https://radiopaedia.org/

1. See, Do, then Teach - To See, Show-Do with
Feedback, Teach with Feedback-Reflection-
Scholarship
Goh Poh Sun
MBBS(Melb), FRCR, FAMS, MHPE(Maastricht), FAMEE
Associate Professor and Senior Consultant
Department of Diagnostic Radiology, National University Hospital, National University Health System
Associate Member, Center for Medical Education, National University of Singapore

2. Background & Objectives
To demonstrate in radiology residency training, and health professions education faculty
development, how a digital repository, within an open access online platform (Blogger),
containing over 10,000 anonymised radiology cases, and 5,000 links to educational
resources, can be used to 1) shorten postgraduate residency training, and support medical
education faculty development; 2) make this process more efficient, using technology; 3)
translate a core curriculum to a standardised set of learning experiences, centred around
curated, peer reviewable, high quality teaching cases, learning paths and training plans; 4)
support deliberate practice and accelerate mastery training; and 5) examine the role of the
medical educator - as filter, curator, facilitator, guide, coach, and educational scholar.

3. "By reviewing research on medical performance and education, the author
describes evidence for these representations and their development within the
expert- performance framework. He uses the research to generate suggestions for
improved training of medical students and professionals. Two strategies— designing
learning environments with libraries of cases and creating opportunities for
individualized teacher-guided training—should enable motivated individuals to
acquire a full set of refined mental representations. Providing the right resources to
support the expert- performance approach will allow such individuals to become
self-regulated learners—that is, members of the medical community who have the
tools to improve their own and their team members’ performances throughout
their entire professional careers.’
from abstract of
Ericsson KA. Acquisition and maintenance of medical expertise: a perspective from
the expert-performance approach with deliberate practice. Acad Med.
2015 Nov;90(11):1471-86. doi:10.1097/ACM.0000000000000939. PubMed PMID:
26375267.
https://www.ncbi.nlm.nih.gov/pubmed/26375267/?ncbi_mmode=std

4. "Understanding basic theory using a few illustrative examples. Mastering a topic by exposure to and
experience with many examples
Typical examples or real-life scenarios can be used to illustrate theory, and help students understand
fundamental principles. Mastering a topic usually requires exposure to and experience with many examples,
both typical and atypical, common to uncommon including subtle manifestations of a phenomenon. The
traditional method of doing this is via a long apprenticeship, or many years of practice with feedback and
experience. A digital collection of educational scenarios and cases can support and potentially shorten this
educational and training process. Particularly if a systematic attempt is made to collect and curate a
comprehensive collection of all possible educational scenarios and case-based examples, across the whole
spectrum of professional practice. Online access to key elements, parts of and whole sections of these
learning cases; used by students with guidance by instructors under a deliberate practice and mastery
training framework, can potentially accelerate the educational process, and deepen learning."
above from
Goh, PS. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct;
5(3), Paper No:19. Epub 2016 Oct 14. http://dx.doi.org/10.15694/mep.2016.000105

5. Methods
For example in Neuroradiology residency training -
https://learningneuroradiology.blogspot.sg/2015/12/cerebral-infarcts-and-its-mimics.html
and https://learningneuroradiology.blogspot.sg/2018/03/radiology-resident-tutorials-january.html
and medical educator faculty development (eLearning) - https://telatcenmed.blogspot.sg/

10. "How could one use this material to dramatically reduce case review time?
Reduce study time?
Reduce residency duration?
Use training time in other ways?"
"How would you use this material to develop confidence and familiarity with less
common conditions?
Given that time is limited."
"How do you stay sharp, not rusty, get better (sharper)."
[Practice. With feedback. With reflection. With increasing difficulty. Systematically.
Regularly. With material that is at hand. At your finger tips.]
-Poh Sun (posted on 7 February 2018 @ 0358am)

11. This article investigates the relation between mind wandering and the spacing effect in
inductive learning. Participants studied works of art by different artists grouped in
blocks, where works by a particular artist were either presented all together successively
(the massed condition), or interleaved with the works of other artists (the spaced
condition). The works of 24 artists were shown, with 12, 15, or 18 works by each artist
being provided as exemplars. Later, different works by the same artists were presented
for a test of the artists' identity. During the course of studying these works, participants
were probed for mind wandering. It was found that people mind wandered more when
the exemplars were presented in a massed rather than in a spaced manner, especially as
the task progressed. There was little mind wandering and little difference between
massed and spaced conditions toward the beginning of study. People were better able
to correctly attribute the new works to the appropriate artist (inductive learning) when
(a) they were in the spaced condition and (b) they had not been mind wandering. This
research suggests that inductive learning may be influenced by mind wandering and that
the impairment in learning with massed practice (compared to spaced practice) may be
attributable, at least in part, to attentional factors-people are "on task" less fully when
the stimuli are massed rather than spaced.
above abstract from
Metcalfe J, Xu J. People mind wander more during massed than spaced inductive
learning. J Exp Psychol Learn Mem Cogn. 2016 Jun;42(6):978-84. doi:
10.1037/xlm0000216. Epub 2015 Nov 30.

12. Inductive learning -- that is, learning a new concept or category by observing
exemplars -- happens constantly, for example, when a baby learns a new word or
a doctor classifies x-rays. What influence does the spacing of exemplars have on
induction? Compared with massing, spacing enhances long-term recall, but we
expected spacing to hamper induction by making the commonalities that define a
concept or category less apparent. We asked participants to study multiple
paintings by different artists, with a given artist's paintings presented
consecutively (massed) or interleaved with other artists' paintings (spaced). We
then tested induction by asking participants to indicate which studied artist
(Experiments 1a and 1b) or whether any studied artist (Experiment 2) painted
each of a series of new paintings. Surprisingly, induction profited from spacing,
even though massing apparently created a sense of fluent learning: Participants
rated massing as more effective than spacing, even after their own test
performance had demonstrated the opposite.
above abstract from
Kornell N, Bjork RA. Learning concepts and categories: is spacing the "enemy of
induction"? Psychol Sci. 2008 Jun;19(6):585-92. doi: 10.1111/j.1467-
9280.2008.02127.x.

13. When students encounter a set of concepts (or terms or principles) that are similar
in some way, they often confuse one with another. For instance, they might
mistake one word for another word with a similar spelling (e.g., allusion instead of
illusion) or choose the wrong strategy for a mathematics problem because it
resembles a different kind of problem. By one proposition explored in this review,
these kinds of errors occur more frequently when all exposures to one of the
concepts are grouped together. For instance, in most middle school science texts,
the questions in each assignment are devoted to the same concept, and this
blocking of exposures ensures that students need not learn to distinguish between
two similar concepts. In an alternative approach described in this review,
exposures to each concept are interleaved with exposures to other concepts, so
that a question on one concept is followed by a question on a different concept. In
a number of experiments that have compared interleaving and blocking,
interleaving produced better scores on final tests of learning. The evidence is
limited, though, and ecologically valid studies are needed. Still, a prudent reading
of the data suggests that at least a portion of the exposures should be interleaved.
above quote from
https://link.springer.com/article/10.1007/s10648-012-9201-3
Rohrer, D. (2012). Interleaving helps students distinguish among similar concepts.
Educational Psychology Review, 24, 355-367

20. "Technology enhanced learning or eLearning allows educators to expand access to educational content, promotes
engagement with students and makes it easier for students to access educational material at a time, place and pace
which suits them. The challenge for educators beginning their eLearning journey is to decide where to start, which
includes the choice of an eLearning tool and platform. This article will share one educator's decision making process,
and experience using blogs as a flexible and versatile integrated eLearning tool and platform. Apart from being a
cost effective/free tool and platform, blogs offer the possibility of creating a hyperlinked indexed content repository,
for both created and curated educational material; as well as a distribution and engagement tool and platform.
Incorporating pedagogically sound activities and educational practices into a blog promote a structured templated
teaching process, which can be reproduced. Moving from undergraduate to postgraduate training, educational blogs
supported by a comprehensive online case-based repository offer the possibility of training beyond competency
towards proficiency and expert level performance through a process of deliberate practice. By documenting
educational content and the student engagement and learning process, as well as feedback and personal reflection
of educational sessions, blogs can also form the basis for a teaching portfolio, and provide evidence and data of
scholarly teaching and educational scholarship. Looking into the future, having a collection of readily accessible
indexed hyperlinked teaching material offers the potential to do on the spot teaching with illustrative material called
up onto smart surfaces, and displayed on holographic interfaces."
Above abstract from
Goh PS. Using a blog as an integrated eLearning tool and platform. Med Teach. 2016 Jun;38(6):628-9.
[2015 Nov 11:1-2. Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/26558420

21. "In terms of evaluation of learners, assessment should be in-process, not at the
conclusion of a course in the form of an exam or a test. Let’s say we develop
semantically-defined learning materials and ways to automatically compare
learner-produced artifacts (in discussions, texts, papers) to the knowledge
structure of a field. Our knowledge profile could then reflect how we compare to
the knowledge architecture of a domain — i.e. “you are 64% on your way to being
a psychologist” or “you are 38% on your way to being a statistician.”
above quote from George Siemens in interview below
https://www.oreilly.com/ideas/education-data-analytics-learning

22. "Learning analytics (LA) can be combined with data from Assessment
(both formative and summative), faculty and peer/student observations
and feedback, to inform both (e)Teaching (for faculty), and (e)Learning
(for students). LA can provide insight and visualisation of the learning
journey undertaken by students and trainees, from attendance, through
engagement, (active) interaction with the learning content and training
process, as well as collaborative learning with fellow students and
trainees, toward step-wise and progressive achievement of learning
milestones, learning objectives and outcomes.”
above first presented at 15th APMEC 2018 conference symposium below
https://datainformedelearning.blogspot.sg/2017/11/using-data-analytics-
to-inform.html
and
https://datainformedelearning.blogspot.sg/

27. Background & Objectives
To demonstrate in radiology residency training, and health professions education faculty
development, how a digital repository, within an open access online platform (Blogger),
containing over 10,000 anonymised radiology cases, and 5,000 links to educational
resources, can be used to 1) shorten postgraduate residency training, and support medical
education faculty development; 2) make this process more efficient, using technology; 3)
translate a core curriculum to a standardised set of learning experiences, centred around
curated, peer reviewable, high quality teaching cases, learning paths and training plans; 4)
support deliberate practice and accelerate mastery training; and 5) examine the role of the
medical educator - as filter, curator, facilitator, guide, coach, and educational scholar.

28. Results
The breadth and range of digital content, and training paths,
together with a discussion of their value and impact will be
demonstrated from a collection of training blogs -digital
repositories on this link - https://goo.gl/rYMkH1

29. Conclusion
Content and training paths from digital repositories, made
available via blogs (as an integrated eLearning tool and
platform) can support our efforts as clinician educators, and in
health professions education faculty development.

30. References
https://medicaleducationelearning.blogspot.com/2017/09/meded-peer-reviewed-publications.html
Goh PS. Using a blog as an integrated eLearning tool and platform. Med Teach. 2016 Jun;38(6):628-9.
doi:10.3109/0142159X.2015.1105947
Goh, P.S., Sandars, J. An innovative approach to digitally flip the classroom by using an online "graffiti wall"
with a blog. Med Teach. 2016 Aug;38(8):858. Epub 2016 Jul 14.
http://www.ncbi.nlm.nih.gov/pubmed/27414992
Goh, P.S. A series of reflections on eLearning, traditional and blended learning. MedEdPublish. 2016 Oct;
5(3), Paper No:19. Epub 2016 Oct 14.
http://dx.doi.org/10.15694/mep.2016.000105
Goh, P.S., Sandars, J. Insights from the culinary arts for medical educators. MedEdPublish. 2017 Jan; 6(1),
Paper No:10. Epub 2017 Jan 18.
http://dx.doi.org/10.15694/mep.2017.000010
Goh, P.S. Learning Analytics in Medical Education. MedEdPublish. 2017 Apr; 6(2), Paper No:5. Epub 2017
Apr 4. https://doi.org/10.15694/mep.2017.000067
Goh, P.S. eLearning in Medical Education - Costs and Value Add. The Asia Pacific Scholar (TAPS). Published
online: 2 May, TAPS 2018, 3(2), 58-60. DOI: https://doi.org/10.29060/TAPS.2018-3-2/PV1073