Essential Radiology Internet Resources for Decision Support and Learning While You Work

Essential Radiology Internet Resources for Decision Support and Learning

While You Work

Michael P. D'Alessandro, M.D.1 Jeffrey R. Galvin, M.D.2

1 University of Iowa College of Medicine / University of Iowa Children's Hospital 2 University of Maryland School of Medicine / Armed Forces Institute of Pathology

Who We Are, What We're Up To, Some Ground Rules

•  2 generations of medical educators with long history of creating digital teaching tools

•  Hands on tour of radiology educational resources on the Internet that are free to use but may require registration •  = Decision support without Imaging Consult or STATdx

•  We use these tools in the course of our work •  We have experience + opinions + material to cover

•  - But - we want this to be an interactive presentation - We want to learn from you: •  Demographics of audience: > 50% outside US + > 50% in private practice •  You have experience + opinions as well and we want to hear from you and

we want you to ask questions •  So we're going to make this a Web 2.0 presentation taking advantage of

mass collaboration and the wisdom of the crowds

Learning Objectives 1.0

•  Become familiar with authoritative radiology and anatomy educational resources on the Internet that are free to use

•  Learn to use the Internet for decision support to answer questions that arise during clinical work

•  Learn to use the Internet to receive continuing medical education for answering questions that arise during clinical work

•  Learn to use the Internet for informal teaching during clinical work.

•  Learn to use the Internet for radiology communication •  Learn to access the Internet from mobile phones •  Learn to transfer Internet resources into mobile phones

Learning Objectives 2.0 • Because we have repeat attendees… •  Present State-Of-The-Art update session in

radiology decision support, learning and communication

•  Emphasize • What is new in last year on the Web and in your

hand • Web 2.0 over Web 1.0 • Mobile over desktop

Handout Has It All

URL to Remember: www.radiologyeducation.com

Tour - www.radiologyeducation.com/rsna.html

URL to Remember: www.searchingradiology.com

Searches only free radiology journals - no logins required

Relevance of This Talk To Your Practice •  What do radiologists do?

•  We read studies - radiographs, US, CT, MR, etc. - NOT! •  We change data acquired by imaging devices into

knowledge that is used to make diagnoses that ultimately improve patients' care / outcomes / lives

•  We need decision support help while transforming this data into knowledge and storing and making retrievable what we have learned

•  We should be practicing Personalized Radiology for every patient •  Right test selected / correctly performed / accurately

interpreted / diagnosis delivered at the right time to the right person so the right decision can be made

Overview •  Educational theory

•  Why we should situate learning in practice

•  Tour •  Anatomy + Radiology resources on the Internet

•  How to perform decision support during clinical work / How to situate learning in practice •  Radiology search engines to do 2 minute search

•  How to tie CME to practice •  Documenting + getting credit for situated learning

•  Personal learning environments / Learning portfolios / Communities of practice

•  How to do all of this wirelessly •  Mobile phone

Educational Theory

• Why we should situate learning in practice

Patron Saint of Medical Education "In what my be called the natural method of teaching, the

student begins with the patient, continues with the patient, and ends his studies with the patient using books and lectures as tools, as means to an end."

- Sir William Osler

"If the license to practice meant the completion of his education, how sad it would be for the practitioner, how distressing to his patients! More clearly than any other, the physician should illustrate the truth of Plato's saying that education is a life-long process." - Sir William Osler

"The successful teacher is no longer on a height, pumping knowledge at high pressure into passive receptacles…he is a senior student anxious to help his juniors."

- Sir William Osler

"Education is not the filling of a pail, but the lighting of a fire." - William Butler Yeats

•  Learning is an apprenticeship! •  Patient should be at the center of everything we do

educationally •  All students must practice "Inquiry-based learning"

You Learn From Doing, Not Listenting

Our Philosophy • Great potential exists for

improving patients' care, outcomes, and lives

• By changing physician's knowledge, attitudes, and behaviors

•  Through situating learning at the point-of-care

• Giving CME credit for it • And save this learning to

create wisdom

Tour

•  Anatomy + Radiology resources on the Internet

•  Think of a radiology topic you had a question on recently that you will research during this hands-on tour •  Example: What is the radiographic appearance of pyloric stenosis?

Begin Hands-On •  Person to the left take the keyboard and mouse •  Go to http://www.radiologyeducation.com/rsna.html

Web 1.0

• Read-only Web

Apprenticeship and Active Learning

www.askafip.org www.afip.org/hot-topics/ www.rsna.org/Education/ www.myesr.org

The New Anatomists

•  Interest in teaching human anatomy is waning in Anatomy Departments and Medical Schools

• Our ability to image anatomy is increasing

• Radiologists are the anatomists of the 21st century

A Word on Anatomic Variation "Variability is the law of life"

- Sir William Osler

•  There is no such thing as "normal" human anatomy •  All anatomy is variation

•  Anatomic variation is not pathology to be dreaded; instead it is diversity that should be celebrated

•  Each human is anatomically unique •  The fallacy of The Visible Human Project

•  Not knowing variations is dangerous

Anatomy Resources on the Internet

www.anatomyatlases.org www.e-anatomy.org

Radiology Resources - Textbooks

www.emedicine.com www.medcyclopaedia.com www.acr.org

Radiology Resources -Teaching Files

www.eurorad.org rad.usuhs.edu/medpix/ caseinpoint.acr.org Society-based University-based Daily-based

Radiology Resources - Courses

www.med-ed.virginia.edu/courses/rad/ www.cchs.net/pediatricradiology/ www.thoracicrad.org

Radiology Resources - Journals

www.pubmed.org radiographics.rsna.org www.mdlinx.com/radiology

Reusing Copyrighted Content For Teaching •  At point-of-care

•  Not an issue •  In lecture (PowerPoint)

•  Use images licensed by Creative Commons

•  Some rights reserved •  Attribution-Noncommercial-

Share Alike •  search.creativecommons.org

•  If images not licensed by Creative Commons

•  If access to lecture is confined to within your institution, falls under fair use, do not need to seek permission

•  If access to lecture is available outside your institution, need to seek permission

•  Some content owners have published policy for educational reuse - RSNA

Change Hands-On •  Person to the right take the keyboard and mouse •  Go to http://www.radiologyeducation.com/rsna.html

Web 2.0

• Read-write Web

Radiology Resources - Podcasts

www.ctisus.com/vodcasts/ www.learningradiology.com radiology.rsna.org

Radiology Resources - Wikis

www.wikipedia.org www.radiopaedia.org knol.google.com

Radiology Resources - Social Bookmarking + Video

www.delicious.com www.connotea.org www.youtube.com Wisdom of the crowd's opinions of best Web sites Wisdom of the crowd's opinions of best articles

Radiology Resources - Social Networking

www.linkedin.com twitter.com www.facebook.com Connections to professional identity (CV) Connections to news Connections to friends + personal / professional interests

Really Simple Syndication = RSS

reader.google.com Is a newsfeed generated by a Web site when it is updated Lets you subscribe to Web site + be notified when it is updated Lets you take control + filter fire hose of information

Radiology Resources - Virtual Communities

www.auntminnie.com www.sermo.com www.radrounds.com www.radiolopolis.com

Radiology Resources - For Patients

www.medlineplus.org www.radiologyinfo.org

How to Perform Decision Support During Clinical Work How to Situate Learning in Practice

• Radiology Search Engines • 2 minute search

•  = Decision support for free

• What is the difference between StatDX and Radiology Search Engines for Decision Support? •  StatDX helps you quickly find an answer •  Radiology search engine helps you learn and remember the answer,

especially when coupled with learning portfolio •  Radiology search engine allows you to receive CME for the answer

Seeking Answers / Decision SupportSpecialty-Specific Search Engines

www.google.com goldminer.arrs.org www.yottalook.com www.searchingradiology.com images.google.com (multilingual interface) (searches only free journals)

Use and compare these search engines for decision support to find an answer to a clinical question…

Documenting LearningLearning Portfolio

PACS -> USB Excel iPhoto iPod / Lecture Flickr www.pediatriccommons.org •  Why?

•  For Yourself - Passion + Reflection! "An unexamined life is not worth living" - Socrates •  For Point-of-Care CME - questions are starting point for further learning •  For sharing - individuals in person, groups in conferences / lectures, world on Web

•  Educational construct: Adult learning theory = Learning situated in practice •  [Schon's theory of clinical problem solving / model of reflective practice / learning cycle]

•  For each case: Question ~ Story ~ Answer ~ Impact on Practice ~ Resources Used •  Created + archived on PC ~ Shared on the Cloud •  Is an E-memory system

•  Memories are digital, near-infinite space to store them, ever-improving technology to recall them •  Captures, stores, organizes and makes retrievable your experience + reflected wisdom

Receiving CME For Point of Care Learning

www.cincinnatichildrens.org - Up to 20 hours / year - myrsna.rsna.org

Sharing + TeachingCommunity of Practice

www.pediatriccommons.org

"Communities of practice are groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their understanding of this area by interacting on an ongoing basis."

- Wenger E. et. al. Cultivating Communities of Practice: A Guide to Managing Knowledge

Learning portfolio can be shared with your community of practice for collaborative learning

Evaluation of a Learning Portfolio •  A pediatrician's clinical experiences

coupled with reflection •  5 elements for each case •  Evaluation shows unstructured curriculum

unfolding in practice over 5 years (234 cases) •  Covers 100% of age ranges (n=9) •  100% of specialties (n=42) •  98% of symptoms (n=127) •  55% of diseases (n=707 [50-60% are pediatric]) •  90% of topics in 3 national pediatric curricula •  20 hours of CME / year •  "My reading is now focused on my patients" - D'Alessandro DM, D'Alessandro MP. Formative Evaluation of a

Pediatric Digital Library's Educational Content and Comparison to National Curricular Standards. Medical Teacher. 2008;30(9-10) 880-6.

•  Learner taking control of and assuming responsibility for their own learning by tying their learning to practice + receiving CME for it

•  Learning portfolio documents what you have learned •  Assessment by examination documents what

you don't know

My Personal Learning Environment Results

Tabbed browsing Mashups - www.igoogle.com myrsna.rsna.org

•  This is a way to enjoy rather than endure your 10,000 hour voyage towards expertise

•  My learning has never been so focused, so relevant, so interesting, so meaningful, so enjoyable

•  I have finally become a learning machine, passionately pursuing mastery of medicine

The End ProductThe Personal Learning Environment

•  Place to come learn pediatrics every day •  Personal learning environment

•  Helps learners take control of + manage their own learning •  Enter cases into your learning portfolio

•  Store your experience, reflection, knowledge, wisdom •  MyTeachingFile ~ MyKnowledgeManagementSystem ~ E-

memory system

•  Participate in your community of practice •  Contribute content, Engage in conversations, Make

connections •  Enables peer-to-peer and master-to-apprentice teaching •  Fulfills part of the requirement for Maintenance of

Certification •  Tieing your learning to your practice and awarding you CME

How to Do All of This Wirelessly

• Mobile phone

Mobile Phone Resources •  Time for a paradigm shift!!!

•  Everything we have shown you we have been accessing by wired computer

•  Now we will now show you how to access everything wirelessly by mobile phone

•  Apple iPhone •  Google Android •  Microsoft Windows Phone •  Research in Motion Blackberry

•  This truly brings decision support to point-of care •  State of the mobile phone 2010

•  iPhone has the best Web browser, applications, and applications store

•  Mobile phone apps •  Web browser (Killer app) •  eBooks - PDF, ePub, Kindle (Radiology references + Personal cheat

sheets) •  Life logging / E-memory (Capturing data) •  PACS / Teleradiology (Taking call)

www.radmobs.com

Conclusion - Augmented Reality •  Mobile computing is but a

step towards wearable computing

•  Your Internet connection will follow you everywhere you go through wearable computing •  Minimalist, elegant, mobile

solution

•  You will be presented with an augmented version of reality •  The Internet overlaid upon

what you are seeing

Conclusion •  Radiology decision support can be done easily and quickly using Internet

search engines that search authoritative free Internet resources -- "If you are not in Google, you don't exist" •  You do not need to pay for radiology decision support (Imaging Consult / StatDx)

•  The URLs to walk away with •  http://www.radiologyeducation.com

•  RadiologyEducation.com

•  http://www.searchingradiology.com •  SearchingRadiology.com

•  What is the top site I use? •  SearchingRadiology.com

•  To learn more read •  Net Assets column in Radiology by Stuart R. Pomerantz •  Internet Cool Tools for Physicians by Melissa Rethlefsen, David Rothman and Daniel Mojon

•  Tell us what sites you use that we have not mentioned

•  Please fill out and deposit the evaluation form