Electronic Platform-based Education for Radiology Residents: Results of a Two-Year Survey

Electronic Platform-based Education for Radiology Residents: Results of a Two-Year Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Electronic Platform-based Education for Radiology Residents: Results of a Two-Year Survey Emilio Quaia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1978691/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Mar, 2023 Read the published version in BMC Medical Education → Version 1 posted 10 You are reading this latest preprint version Abstract Background Electronic platform-based resident education is increasing. The aim of this study was to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology residents which can predict a successful final year multiple choice test. Methods A two year survey was conducted based on the records of an electronic platform-based educational material for radiology residents. Radiology resident education was based on the educational content of two educational electronic platform databases. A pool of questions were addressed by each resident after reading the content of each electronic section related to a specific topic. A per-resident analysis was performed between the number of per-topic addressed questions and number of electronic platform content access, in terms of login access number, during the academic year (predictor variables) and final percentage of correct answers on final year electronic test (outcome variable). Statistical significance (p < 0.05) was determined using correlation analysis. Results Total login times (OR, 3; 95% CI, 2.2 -4), login frequency per month (OR, 4; 95% CI, 3.1–5.3), the number of per-topic addressed questions (OR, 3; 95% CI, 2.2 -4), and the number of topic-verified correct answers to multiple choice test (OR, 30.5; 95% CI, 12.8–80.9) all showed a statistically significant correlation with final percentage of correct answers on final year electronic test. Conclusion The number of correct answers to multiple choice test was related to the number and frequency of login access number, the number of per-topic addressed questions and the number of topic-verified correct answers to multiple choice test. The electronic-based educational material contributes significantly to a successful radiology residency program. education radiology resident electronic Figures Figure 1 Background The primary goal of a residency program is to graduate prepared and professional radiologists who are able to add value to the health care team and radiology departments must invest time and money to provide innovative educational opportunities [ 1 ]. Radiology residency education must evolve to meet the growing demands of radiology training. Traditionally, residents have been learning radiology through didactic frontal lectures and observational experience on extensive reading sessions. Radiology resident education in the era of COVID-19 was modified according to restrictions placed by health authorities, medical schools, and universities [ 2 ]. Consequently, traditional in-person teaching lectures, meetings, and conferences have been widely replaced by virtual live or recorded conferences [ 3 ]. Few published data are available investigating the radiology resident improvement in knoweldge based on unconventional educational supports including electronic platform-based education. We herby report the results of a two-year survey on radiology residents education based on electronic platform-based educational material organized in different sections related to different educational topics of diagnostic radiology. This study investigated residents’ self-regulated learning ability as well as their online behavioral patterns such as their login time and frequency. The aim of the present study was to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology resident which can predict a successful final year multiple choice test. Materials And Methods Data on radiology resident survey data, based on RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam), are not publicly available. Data analysis was performed in accordance with relevant guidelines and regulations with resident name anonymization. Consequently resident data (names, age), were not included in data analysis and the need for ethics approval was waived by ethics committee of Hospital of Padova. In Italy, the radiology residency program lasts four years with an increasing clinical responsibility of the resident through each year of curriculum. Beside frontal lectures, which correspond roughly to 10% of each resident time, all radiology residents undergo professional activity in diagnostic and interventional radiology sections for most of their time, besides informal curriculum related to attendance to scientific meetings and congresses [ 5 ] and attendance to multidisciplinary meetings. From the academic year 2019–2020, we obtained a combined subscription to both two educational electronic databases named RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam) consisting in teaching files which were not freely accessible but only available to radiology residents as training radiology curriculum tool at university of Padova. All radiology residents have personal credentials to access all teaching files present in both electronic databases. No patient data were included in the teaching file databases which provide a detailed description of radiological features of each patology. The implementation of these electronic educational platforms was not related to COVID outbreak since it was implemented before the pandemic and it was associated to planned frontal lectures which were administered consistently to residents during the academic year. RADPrimer is an educational e-learning platform with modules featuring case studies, reference images, and diagnosis solutions. In RADPrimer there are a pool of questions to be addressed during the academic year after reading the content of each dashboard. STATdx is a diagnostic decision support system for radiologists which can ben accessed by each resident or radiologist each time of the working day. STATdx provides instant access to the collective clinical experience and knowledge of renowned sub-specialists in every field of radiology. Each radiology topic, both in RADPRIMER and STATDX, was written and each image was selected by team of specialists include leaders at prestigious institutions around the world. At the beginning of the academic year the RADPRIMER educational content is provided to all residents according to the education topics matched to every residency year. Topics which are related to the school’s residency program were assigned to residents in relation to the year of training based on the curriculum-based residency program which was organized as follows: basic radiology knowledge during the first year of residency; musculoskeletal, urogenital, chest and gastro-abdominal radiology during the second year; neuroradiology and cardiac imaging during the third year; interventional, vascular and breast imaging during the fourth year of residency training. The electronic platform required residents to access e-learning platform by using personal credentials. As a full online course, residents were required to study the e-platform material, take online multiple choice question test, and submit individual tasks for successful completion. Radiology resident had to pass through all electornic assignments written by leading radiology experts, and answer to over 7,000 case-based and traditional questions, overviews that summarize the lesson topics, learning objectives crafted by educators and thought leaders, practice questions to help residents learn as they go. All residents undergo one first multiple choice question test on RADPRIMER (60 questions) after 6 months of each academic year, and a final year multiple choice question test on RADPRIMER (60 other questions). A mean score mark is provided at the end of the academic year based on the percentage of correct answers to multiple choice questions. Data analysis We analysed data collected from january 2020 till january 2022. For this study, a total of 174 residents, including 80 residents in the academic year 2020 cohort − 25 residents in the first year, 24 residents in the second year, 17 residents in the third year, and 14 residents in the fourth year, and 94 residents in the academic year 2021 cohort − 35 residents in the first year, 24 residents in the second year, 17 residents in the third year, and 18 residents in the fourth year - were included. Residents’ total login time, login frequency, login regularity, number of per-topic addressed questions, number of electronic platform content access during the academic year, and final percentage of correct answers on final year electronic test were recorded. Statistical analysis A per-resident analysis was performed between the number of electronic platform content access login including total login times, login frequency per month, number of per-topic addressed questions, and number of topic-verified correct answers to multiple choice test and final percentage of correct answers on final year electronic test (outcome variable). Statistical significance (p < 0.05) was determined using the Spearman correlation analysis. Results There was a progressive increase in the login frequency number into the electronic platform content according to the year of residency with 902 ± 250 (mean ± SD) separate login access for the first year, 2276 ± 570 for the second year, 3106 ± 345 for the third year, and 2108 ± 550 for the fourth year. Pre-test included a perentage of correct answers from 50–65%. The percentage of correct answers increased up to 80% − 97% on the first test taken after 6 months, and up to 87% − 99% on the final year test. The percentage of correct answers was higher for those residents who took pre and post-test assessment for each topic and for those who took an higher number of pre and post-tests during the academic year based on RADPRIMER educational content provided at the beginning of academic year. Subcategories that showed a statistically significant positive correlation with the final percentage of correct answers on final year multiple choice question test included total login times (OR, 3; 95% CI, 2.2 -4), login frequency per month (OR, 4; 95% CI, 3.1–5.3), the number of per-topic addressed questions (OR, 3; 95% CI, 2.2 -4), and the number of topic-verified correct answers to multiple choice test (OR, 30.5; 95% CI, 12.8–80.9) (Table 1 ). Spearman correlation was significant (ρ = 0.38; P < 0.05) for the number of login times and the number of correct question on the final year multiple choice question test (Fig. 1 ). Table 1 Correlation between final test result and e-platform frequency Independent Variables OR (95% CIs) with final percentage of correct answers Total login time 3 (2.2–4) P < 0.05 Total login frequency per month 4 (3.1–5.3) P < 0.05 Per-topic addressed questions 3 (2.2–4) P < 0.05 Topics verified by multiple choice test 30.5 (12.8–80.9) P < 0.05 Table caption – Correlation and Odds Ratio (OR) between final test result and e-platform frequency Discussion The primary aim of a radiology residency program is to train residents to become well-educated, independent, professional, and skilled radiologists [ 4 ]. We aimed to do a single-center retrospective study to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology resident to predict a successful final year multiple choice test. We found that number of total login times, login frequency per month, number of per-topic addressed questions, and number of topic-verified correct answers to multiple choice test all showed. We added electronic platform – based educational material to the formal curriculum to conver all possible field of radiology trainings which are not possible to be covered through frontal lectures. Our results seem to confirm the importance of electronic scores in multiple choice question tests and, most likely, in all professional life of radiologists. The formal curriculum consists on reading electronic assignments, lectures, and other learning activities formally assigned to learners by adding electronic-based educational material to formal frontal lectures during residency from RADPRIMER and STATDX platform. Electronic-based educational material provides several advantages over frontal lectures including the possibility to access educational material from virtually any site that has a computer and an internet connection and at virtually any time of the day or night [ 5 ], to integrate text, images, and sounds in ways that standard textbooks cannot, to access and customize educational materials for to their own learning preferences [ 6 ], and the greater degree of interaction they permit. Electronic educational material can be presented through electronic didactic sheets and in multiple-choice test format that helps learners evaluate their performance and identify their own strengths and weaknesses and make teachers aware of their progress in knowledge. Electronic-based educational material is widely used in educational sciences, including medical education courses. This paradigm shift challenges the tradition of lectures and shifts the educational experience in a learner-centred [ 7 ] way since each resident is empowered to organize his own curriculum based on electronic materials instead of frontal lectures. This shift was pushed even further by the COVID-19 pandemic. At a time when usual active learning practices have been stopped or, at least, changed, trainees have found electronic-based educational platform a very useful online learning tool to keep their learning going. Our study provides incremental data to the existing literature that offers insight into factors that contribute to a successful radiology residency program based on electronic-based educational material. According to a previous survey [ 8 ] which included 200 radiology residents in USA, the average radiology resident works 50 hours per week excluding time on call (range, 40–60 hours) and 67 hours per week including time on call. Residents at all levels spent an average of 9 hours per week studying with a range from 2 to 27 hours per week. Most of that time was spent reading textbooks (4–5 per year), followed by journals (mainly during the third and fourth year of residency), notes and teaching files. Residents spent an average of 7 hours per week attending lectures and conferences. Beside the changes in didactic flow due to COVID outbreak, regardless of how effective electronic-based material is, frontal lecture should not be entirely supplanted. Many important lessons about excelling as a physician can only be learned in actual practice [ 6 ]. The numerous weekly hours dedicated to the assistance activity by residents often do not allow adequate coverage of the hours of frontal teaching required by the program. The use of an electronic-based educational platform, allows the availability of a vast network of information that can potentially partially replace the traditional frontal lectures. The use of electronic-based educational platform allows immediate and exhaustive access to the essential information necessary to correctly propose a differential diagnosis relating to the radiological findings identified during the evaluation of the images and described in the report. In addition, electronic-based educational platform allows learners to conduct a personal test to evaluate the degree of self-learning achieved within the various teaching modules and verify the increase in knowledge in the various areas of imaging. Constant and immediate access to more detailed information relating to the different pathological findings, and formulation of the main differential diagnoses for each pathological finding. Interactive learning is crucial for effective medical, and particularly radiology education, since it provides active retention of informations [ 9 , 10 ]. In particular, the use of multiple-choice questions contributes to develop a critical thinking which is essential in the clinical practice. Students must take time to apply concepts, already consolidated, to answer multiple-choice questions even during recorded lectures. Multiple-choice questions will invariably lead to a higher level of learning concepts and solicitate learners to read more about a specific topic [ 11 ]. The use of electronic-based educational platform provides a complete coverage of the whole theoretical knowledge which otherwise could not have been covered by the lectures only and allows radiology residents to have basic knowledge in all areas of radiology diagnostics, from a theoretical point of view. Previously, it was impossible to cover such a vast amount of information based solely on the lectures or on the study of traditional texts. Conclusions In conclusion, the number of correct answers to multiple choice test was related to the number and frequency of login access number, the number of per-topic addressed questions and the number of topic-verified correct answers to multiple choice test. The electronic-based educational material contributes significantly to a successful radiology residency program. Declarations Ethics approval and consent to participate: Data on radiology resident survey data, based on RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam), are not publicly available. Data analysis was performed in accordance with relevant guidelines and regulations with resident name anonymization. Consequently resident data (names, age), were not included in data analysis and the need for ethics approval was waived by ethics committee of Hospital of Padova. Consent for publication: Not applicable. Availability of data and materials: The data that support the findings of this study are at https://app.radprimer.com/faculty/assignments but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Elsevier Competing interests: The single author declare that he has not competing interests Funding: N/A Authors’ contribution statement: E.Q. wrote the manuscript text and performed statistica analysis on recorded data. E.Q. revised the manuscript. Acknowledgements: I thank dr Filippo Crimi for the kind assistance in manuscript review References Sarkany DS, Shenoy-Bhangle AS, Catanzano TM, Fineberg TA, Eisenberg RL, Slanetz PJ. Running a radiology residency program: strategies for success. Radiographics 2018; 38: 1729 – 1743 Alvin MD, George E, Deng F, Warhadpande S, Lee SL The Impact of COVID-19 on Radiology Trainees. Radiology 2020; 296: 246 – 248 Gupta Y. Residents Remaining Flexible During COVID-19 Pandemic. https://www.theabr.org/blogs/residents-remaining-flexible-during-covid-19-pandemic. Published 2020. Accessed March 24, 2020 Horn GL, Herrmann S, Masood I, Andersen CR, Nguyen QD. Predictors for Failing the American Board of Radiology Core Examination. AJR Am J Roentgenol 2019; 213: 485-489 Gunderman RB (ed) Achieving Excellence in Medical Education. Springer London Dordrecht Heidelberg New York, 2006 Osguthorpe RT, Graham CR (2003) Blended learning environments: definitions and directions. Quarterly Review of Distance Education. 4(3):227–233 Mehta NB, Hull AL, Young JB, Stoller JK (2013) Just imagine: new paradigms for medical education. Acad Med. 88(10):1418–1423 Slone RM, Tart RP. Radiology residents' work hours and study habits. Radiology https://doi.org/10.1148/radiology.181.2.1924814 Fotos JS, Beatty-Chadha J, Goldenberg M. Purposeful remote radiology education: strategies and recommendations. RadioGraphics 2021;41(4): E109–E116. Subramanian A, Timberlake M, Mittakanti H, Lara M, Brandt ML. Novel educational approach for medical stu-dents: improved retention rates using interactive medical software compared with traditional lecture-based format. J Surg Educ 2012;69(4):449–445 Awan OA. Invited Commentary: The Need for interactive Radiology Education. Radiographcis 2021; 41: E117 – E118 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Mar, 2023 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Major revision 02 Jan, 2023 Reviews received at journal 02 Jan, 2023 Reviews received at journal 15 Dec, 2022 Reviewers agreed at journal 23 Nov, 2022 Reviewers agreed at journal 22 Nov, 2022 Reviewers invited by journal 12 Nov, 2022 Editor assigned by journal 12 Nov, 2022 Editor invited by journal 09 Nov, 2022 Submission checks completed at journal 09 Nov, 2022 First submitted to journal 19 Aug, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1978691","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":150670825,"identity":"e813cf29-7eff-4549-aac9-bfebcbdf750c","order_by":0,"name":"Emilio Quaia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYFACxsYDCRBGA8MHBgYeBoYEhgMEtDTAtTDOgGkhoAdhJjMPmEpgwGsNv9jhhgMPKhhkNxw/3PjZtu2OjDl7AuPhD3i0SM5OBDrsDIPxhjOJzdK5bc94LHse4HeYwW2glsQ2hsQNBxIbgFoO8xjcIOAXe7iW8w+bf1sSo8VAGqblRmKbNCMxWiRug/0iYTzzxsM2y55zh4F+edhw4AweLfyz0x8+/FFhI9t3Pv3xjR9lh+3N2ZMPf6jAowVmGTDqYU5lQLDxAmQto2AUjIJRMApQAQDWwl8NqI7aOQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Padova","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Emilio","middleName":"","lastName":"Quaia","suffix":""}],"badges":[],"createdAt":"2022-08-19 14:44:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1978691/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1978691/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-023-04190-8","type":"published","date":"2023-03-30T20:16:26+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":28957347,"identity":"e057f26b-fd03-47eb-b415-8f335c639f12","added_by":"auto","created_at":"2022-11-11 15:46:05","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":102462,"visible":true,"origin":"","legend":"\u003cp\u003eIncrease in score based on number of practice test and access to electronic-based educational material.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1978691/v1/4dbeb3e9504ded5c5609fcad.jpeg"},{"id":44723987,"identity":"2285a1e6-9d7a-4962-8186-c0cae5c43cbe","added_by":"auto","created_at":"2023-10-16 20:23:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":221119,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1978691/v1/b51f9154-cf89-46cd-a130-a1077a430dcf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Electronic Platform-based Education for Radiology Residents: Results of a Two-Year Survey","fulltext":[{"header":"Background","content":"\u003cp\u003eThe primary goal of a residency program is to graduate prepared and professional radiologists who are able to add value to the health care team and radiology departments must invest time and money to provide innovative educational opportunities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRadiology residency education must evolve to meet the growing demands of radiology training. Traditionally, residents have been learning radiology through didactic frontal lectures and observational experience on extensive reading sessions. Radiology resident education in the era of COVID-19 was modified according to restrictions placed by health authorities, medical schools, and universities [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, traditional in-person teaching lectures, meetings, and conferences have been widely replaced by virtual live or recorded conferences [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Few published data are available investigating the radiology resident improvement in knoweldge based on unconventional educational supports including electronic platform-based education.\u003c/p\u003e \u003cp\u003eWe herby report the results of a two-year survey on radiology residents education based on electronic platform-based educational material organized in different sections related to different educational topics of diagnostic radiology. This study investigated residents\u0026rsquo; self-regulated learning ability as well as their online behavioral patterns such as their login time and frequency. The aim of the present study was to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology resident which can predict a successful final year multiple choice test.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eData on radiology resident survey data, based on RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam), are not publicly available. Data analysis was performed in accordance with relevant guidelines and regulations with resident name anonymization. Consequently resident data (names, age), were not included in data analysis and the need for ethics approval was waived by ethics committee of Hospital of Padova.\u003c/p\u003e \u003cp\u003eIn Italy, the radiology residency program lasts four years with an increasing clinical responsibility of the resident through each year of curriculum. Beside frontal lectures, which correspond roughly to 10% of each resident time, all radiology residents undergo professional activity in diagnostic and interventional radiology sections for most of their time, besides informal curriculum related to attendance to scientific meetings and congresses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and attendance to multidisciplinary meetings. From the academic year 2019\u0026ndash;2020, we obtained a combined subscription to both two educational electronic databases named RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam) consisting in teaching files which were not freely accessible but only available to radiology residents as training radiology curriculum tool at university of Padova. All radiology residents have personal credentials to access all teaching files present in both electronic databases. No patient data were included in the teaching file databases which provide a detailed description of radiological features of each patology. The implementation of these electronic educational platforms was not related to COVID outbreak since it was implemented before the pandemic and it was associated to planned frontal lectures which were administered consistently to residents during the academic year. RADPrimer is an educational e-learning platform with modules featuring case studies, reference images, and diagnosis solutions. In RADPrimer there are a pool of questions to be addressed during the academic year after reading the content of each dashboard. STATdx is a diagnostic decision support system for radiologists which can ben accessed by each resident or radiologist each time of the working day. STATdx provides instant access to the collective clinical experience and knowledge of renowned sub-specialists in every field of radiology. Each radiology topic, both in RADPRIMER and STATDX, was written and each image was selected by team of specialists include leaders at prestigious institutions around the world.\u003c/p\u003e \u003cp\u003eAt the beginning of the academic year the RADPRIMER educational content is provided to all residents according to the education topics matched to every residency year. Topics which are related to the school\u0026rsquo;s residency program were assigned to residents in relation to the year of training based on the curriculum-based residency program which was organized as follows: basic radiology knowledge during the first year of residency; musculoskeletal, urogenital, chest and gastro-abdominal radiology during the second year; neuroradiology and cardiac imaging during the third year; interventional, vascular and breast imaging during the fourth year of residency training. The electronic platform required residents to access e-learning platform by using personal credentials. As a full online course, residents were required to study the e-platform material, take online multiple choice question test, and submit individual tasks for successful completion. Radiology resident had to pass through all electornic assignments written by leading radiology experts, and answer to over 7,000 case-based and traditional questions, overviews that summarize the lesson topics, learning objectives crafted by educators and thought leaders, practice questions to help residents learn as they go. All residents undergo one first multiple choice question test on RADPRIMER (60 questions) after 6 months of each academic year, and a final year multiple choice question test on RADPRIMER (60 other questions). A mean score mark is provided at the end of the academic year based on the percentage of correct answers to multiple choice questions.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eWe analysed data collected from january 2020 till january 2022. For this study, a total of 174 residents, including 80 residents in the academic year 2020 cohort \u0026minus;\u0026thinsp;25 residents in the first year, 24 residents in the second year, 17 residents in the third year, and 14 residents in the fourth year, and 94 residents in the academic year 2021 cohort \u0026minus;\u0026thinsp;35 residents in the first year, 24 residents in the second year, 17 residents in the third year, and 18 residents in the fourth year - were included. Residents\u0026rsquo; total login time, login frequency, login regularity, number of per-topic addressed questions, number of electronic platform content access during the academic year, and final percentage of correct answers on final year electronic test were recorded.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eA per-resident analysis was performed between the number of electronic platform content access login including total login times, login frequency per month, number of per-topic addressed questions, and number of topic-verified correct answers to multiple choice test and final percentage of correct answers on final year electronic test (outcome variable). Statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was determined using the Spearman correlation analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere was a progressive increase in the login frequency number into the electronic platform content according to the year of residency with 902\u0026thinsp;\u0026plusmn;\u0026thinsp;250 (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) separate login access for the first year, 2276\u0026thinsp;\u0026plusmn;\u0026thinsp;570 for the second year, 3106\u0026thinsp;\u0026plusmn;\u0026thinsp;345 for the third year, and 2108\u0026thinsp;\u0026plusmn;\u0026thinsp;550 for the fourth year.\u003c/p\u003e\n\u003cp\u003ePre-test included a perentage of correct answers from 50\u0026ndash;65%. The percentage of correct answers increased up to 80% \u0026minus;\u0026thinsp;97% on the first test taken after 6 months, and up to 87% \u0026minus;\u0026thinsp;99% on the final year test. The percentage of correct answers was higher for those residents who took pre and post-test assessment for each topic and for those who took an higher number of pre and post-tests during the academic year based on RADPRIMER educational content provided at the beginning of academic year.\u003c/p\u003e\n\u003cp\u003eSubcategories that showed a statistically significant positive correlation with the final percentage of correct answers on final year multiple choice question test included total login times (OR, 3; 95% CI, 2.2 -4), login frequency per month (OR, 4; 95% CI, 3.1\u0026ndash;5.3), the number of per-topic addressed questions (OR, 3; 95% CI, 2.2 -4), and the number of topic-verified correct answers to multiple choice test (OR, 30.5; 95% CI, 12.8\u0026ndash;80.9) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Spearman correlation was significant (\u0026rho;\u0026thinsp;=\u0026thinsp;0.38; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) for the number of login times and the number of correct question on the final year multiple choice question test (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCorrelation between final test result and e-platform frequency\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eIndependent Variables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eOR (95% CIs) with final percentage of correct answers\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal login time\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.2\u0026ndash;4) \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTotal login frequency per month\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (3.1\u0026ndash;5.3) \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003ePer-topic addressed questions\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.2\u0026ndash;4) \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTopics verified by multiple choice test\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e30.5 (12.8\u0026ndash;80.9) \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\"\u003eTable caption \u0026ndash; Correlation and Odds Ratio (OR) between final test result and e-platform frequency\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe primary aim of a radiology residency program is to train residents to become well-educated, independent, professional, and skilled radiologists [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. We aimed to do a single-center retrospective study to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology resident to predict a successful final year multiple choice test.\u003c/p\u003e \u003cp\u003eWe found that number of total login times, login frequency per month, number of per-topic addressed questions, and number of topic-verified correct answers to multiple choice test all showed. We added electronic platform \u0026ndash; based educational material to the formal curriculum to conver all possible field of radiology trainings which are not possible to be covered through frontal lectures. Our results seem to confirm the importance of electronic scores in multiple choice question tests and, most likely, in all professional life of radiologists. The formal curriculum consists on reading electronic assignments, lectures, and other learning activities formally assigned to learners by adding electronic-based educational material to formal frontal lectures during residency from RADPRIMER and STATDX platform.\u003c/p\u003e \u003cp\u003eElectronic-based educational material provides several advantages over frontal lectures including the possibility to access educational material from virtually any site that has a computer and an internet connection and at virtually any time of the day or night [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], to integrate text, images, and sounds in ways that standard textbooks cannot, to access and customize educational materials for to their own learning preferences [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and the greater degree of interaction they permit. Electronic educational material can be presented through electronic didactic sheets and in multiple-choice test format that helps learners evaluate their performance and identify their own strengths and weaknesses and make teachers aware of their progress in knowledge.\u003c/p\u003e \u003cp\u003eElectronic-based educational material is widely used in educational sciences, including medical education courses. This paradigm shift challenges the tradition of lectures and shifts the educational experience in a learner-centred [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] way since each resident is empowered to organize his own curriculum based on electronic materials instead of frontal lectures. This shift was pushed even further by the COVID-19 pandemic. At a time when usual active learning practices have been stopped or, at least, changed, trainees have found electronic-based educational platform a very useful online learning tool to keep their learning going.\u003c/p\u003e \u003cp\u003eOur study provides incremental data to the existing literature that offers insight into factors that contribute to a successful radiology residency program based on electronic-based educational material. According to a previous survey [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] which included 200 radiology residents in USA, the average radiology resident works 50 hours per week excluding time on call (range, 40\u0026ndash;60 hours) and 67 hours per week including time on call. Residents at all levels spent an average of 9 hours per week studying with a range from 2 to 27 hours per week. Most of that time was spent reading textbooks (4\u0026ndash;5 per year), followed by journals (mainly during the third and fourth year of residency), notes and teaching files. Residents spent an average of 7 hours per week attending lectures and conferences. Beside the changes in didactic flow due to COVID outbreak, regardless of how effective electronic-based material is, frontal lecture should not be entirely supplanted. Many important lessons about excelling as a physician can only be learned in actual practice [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The numerous weekly hours dedicated to the assistance activity by residents often do not allow adequate coverage of the hours of frontal teaching required by the program. The use of an electronic-based educational platform, allows the availability of a vast network of information that can potentially partially replace the traditional frontal lectures.\u003c/p\u003e \u003cp\u003eThe use of electronic-based educational platform allows immediate and exhaustive access to the essential information necessary to correctly propose a differential diagnosis relating to the radiological findings identified during the evaluation of the images and described in the report. In addition, electronic-based educational platform allows learners to conduct a personal test to evaluate the degree of self-learning achieved within the various teaching modules and verify the increase in knowledge in the various areas of imaging. Constant and immediate access to more detailed information relating to the different pathological findings, and formulation of the main differential diagnoses for each pathological finding.\u003c/p\u003e \u003cp\u003eInteractive learning is crucial for effective medical, and particularly radiology education, since it provides active retention of informations [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In particular, the use of multiple-choice questions contributes to develop a critical thinking which is essential in the clinical practice. Students must take time to apply concepts, already consolidated, to answer multiple-choice questions even during recorded lectures. Multiple-choice questions will invariably lead to a higher level of learning concepts and solicitate learners to read more about a specific topic [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The use of electronic-based educational platform provides a complete coverage of the whole theoretical knowledge which otherwise could not have been covered by the lectures only and allows radiology residents to have basic knowledge in all areas of radiology diagnostics, from a theoretical point of view. Previously, it was impossible to cover such a vast amount of information based solely on the lectures or on the study of traditional texts.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, the number of correct answers to multiple choice test was related to the number and frequency of login access number, the number of per-topic addressed questions and the number of topic-verified correct answers to multiple choice test. The electronic-based educational material contributes significantly to a successful radiology residency program.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Data on radiology resident survey data, based on RADPrimer (Elsevier, Amsterdam) and STATdx (Elsevier, Amsterdam), are not publicly available. Data analysis was performed in accordance with relevant guidelines and regulations with resident name anonymization. Consequently resident data (names, age), were not included in data analysis and the need for ethics approval was waived by ethics committee of Hospital of Padova.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The data that support the findings of this study are at https://app.radprimer.com/faculty/assignments but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Elsevier\u003c/p\u003e\n\u003cp\u003eCompeting interests: The single author declare that he has not competing interests\u003c/p\u003e\n\u003cp\u003eFunding: N/A\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contribution statement: E.Q. wrote the manuscript text and performed statistica analysis on recorded data. E.Q. revised the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: I thank dr Filippo Crimi for the kind assistance in manuscript review\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSarkany DS, Shenoy-Bhangle AS, Catanzano TM, Fineberg TA, Eisenberg RL, Slanetz PJ. Running a radiology residency program: strategies for success. Radiographics 2018; 38: 1729 \u0026ndash; 1743\u003c/li\u003e\n\u003cli\u003eAlvin MD, George E, Deng F, Warhadpande S, Lee SL The Impact of COVID-19 on Radiology Trainees. Radiology 2020; 296: 246 \u0026ndash; 248\u003c/li\u003e\n\u003cli\u003eGupta Y. Residents Remaining Flexible During COVID-19 Pandemic. https://www.theabr.org/blogs/residents-remaining-flexible-during-covid-19-pandemic. Published 2020. Accessed March 24, 2020\u003c/li\u003e\n\u003cli\u003eHorn GL, Herrmann S, Masood I, Andersen CR, Nguyen QD. Predictors for Failing the American Board of Radiology Core Examination. AJR Am J Roentgenol 2019; 213: 485-489\u003c/li\u003e\n\u003cli\u003eGunderman RB (ed) Achieving Excellence in Medical Education. Springer London Dordrecht Heidelberg New York, 2006\u003c/li\u003e\n\u003cli\u003eOsguthorpe RT, Graham CR (2003) Blended learning environments: definitions and directions. Quarterly Review of Distance Education. 4(3):227\u0026ndash;233\u003c/li\u003e\n\u003cli\u003eMehta NB, Hull AL, Young JB, Stoller JK (2013) Just imagine: new paradigms for medical education. Acad Med. 88(10):1418\u0026ndash;1423\u003c/li\u003e\n\u003cli\u003eSlone RM, Tart RP. Radiology residents\u0026apos; work hours and study habits. Radiology https://doi.org/10.1148/radiology.181.2.1924814\u003c/li\u003e\n\u003cli\u003eFotos JS, Beatty-Chadha J, Goldenberg M. Purposeful remote radiology education: strategies and recommendations. RadioGraphics 2021;41(4): E109\u0026ndash;E116.\u003c/li\u003e\n\u003cli\u003eSubramanian A, Timberlake M, Mittakanti H, Lara M, Brandt ML. Novel educational approach for medical stu-dents: improved retention rates using interactive medical software compared with traditional lecture-based format. J Surg Educ 2012;69(4):449\u0026ndash;445\u003c/li\u003e\n\u003cli\u003eAwan OA. Invited Commentary: The Need for interactive Radiology Education. Radiographcis 2021; 41: E117 \u0026ndash; E118\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"education, radiology, resident, electronic","lastPublishedDoi":"10.21203/rs.3.rs-1978691/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1978691/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eElectronic platform-based resident education is increasing. The aim of this study was to identify the most reliable predictor variables related to the usage of electronic platform-based educational material for radiology residents which can predict a successful final year multiple choice test.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA two year survey was conducted based on the records of an electronic platform-based educational material for radiology residents. Radiology resident education was based on the educational content of two educational electronic platform databases. A pool of questions were addressed by each resident after reading the content of each electronic section related to a specific topic. A per-resident analysis was performed between the number of per-topic addressed questions and number of electronic platform content access, in terms of login access number, during the academic year (predictor variables) and final percentage of correct answers on final year electronic test (outcome variable). Statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was determined using correlation analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTotal login times (OR, 3; 95% CI, 2.2 -4), login frequency per month (OR, 4; 95% CI, 3.1\u0026ndash;5.3), the number of per-topic addressed questions (OR, 3; 95% CI, 2.2 -4), and the number of topic-verified correct answers to multiple choice test (OR, 30.5; 95% CI, 12.8\u0026ndash;80.9) all showed a statistically significant correlation with final percentage of correct answers on final year electronic test.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe number of correct answers to multiple choice test was related to the number and frequency of login access number, the number of per-topic addressed questions and the number of topic-verified correct answers to multiple choice test. The electronic-based educational material contributes significantly to a successful radiology residency program.\u003c/p\u003e","manuscriptTitle":"Electronic Platform-based Education for Radiology Residents: Results of a Two-Year Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-11 15:46:01","doi":"10.21203/rs.3.rs-1978691/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-01-02T10:45:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-01-02T08:47:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-12-15T16:08:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"5e98fbfc-956e-4d4c-94cb-32abbfe6b933","date":"2022-11-23T07:45:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"88457f97-5dd6-44cc-baf3-eddcaf9de53c","date":"2022-11-22T15:32:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-11-12T11:40:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-11-12T11:36:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-11-09T08:55:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-11-09T08:53:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2022-08-19T14:37:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"51355cf3-8f33-47e1-8efc-c8ad09b11392","owner":[],"postedDate":"November 11th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:21:12+00:00","versionOfRecord":{"articleIdentity":"rs-1978691","link":"https://doi.org/10.1186/s12909-023-04190-8","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2023-03-30 20:16:26","publishedOnDateReadable":"March 30th, 2023"},"versionCreatedAt":"2022-11-11 15:46:01","video":"","vorDoi":"10.1186/s12909-023-04190-8","vorDoiUrl":"https://doi.org/10.1186/s12909-023-04190-8","workflowStages":[]},"version":"v1","identity":"rs-1978691","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1978691","identity":"rs-1978691","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}