By Patrick Kennedy (@DrPatKennedy) and David Landry
(Transitioning between keys stages of training is what the “This Liminal Space” column at ICE blog is all about. Increasingly, educators are being asked to support trainees through their liminality. Today, we have invited the McMaster Radiology program to present a local innovation that might inspire some similar ideas in many other specialties and schools around the world. -Teresa (@TChanMD))
Radiology residents at McMaster University provide on-call radiology service to seven hospitals in the Hamilton region. The responsibilities of the on-call resident include triaging and protocolling imaging studies, interpreting CT and ultrasound studies, interpreting plain film radiographic studies upon request, and relaying findings to referring physicians in a timely manner. Although this role is similar to other programs across Canada, the training of residents for the provision of this service varies substantially between residency programs. The purpose of this article is to describe the design and implementation of a pre-call curriculum created to prepare junior residents for the responsibilities of radiology call.
McMaster’s Diagnostic Radiology residency program incorporates the training of junior residents for radiology call into the weekly academic half day sessions during the summer months. Prior to 2017, the specific instructional objectives and learning outcomes for this curriculum were not clearly outlined. A needs assessment was performed by delivering an online questionnaire to the current radiology residents. Input was requested from residents of all levels so that junior residents could provide input based on their experiences on other services during PGY-1, and senior residents could offer insight from direct experience with radiology call. Residents were asked to state the level of importance of different content areas to be covered by the curriculum. They were also asked for their level of agreement with incorporation of various instructional and assessment strategies to optimize resident learning within the curriculum.
Based on the results of the needs assessment, detailed instructional objectives were created. These objectives were written in accordance with the Royal College CanMEDS objectives and the revised Bloom’s taxonomy, incorporating content areas into the Knowledge dimension and action verbs along a hierarchy in the Cognitive Process dimension [1,2]. Most of the objectives centred around the Medical Expert CanMEDS role; objectives which provide an opportunity to fulfill other CanMEDS roles were specifically identified. Finally, the objectives were separated into nine expertise clusters, which intuitively form each weekly session of a nine-week curriculum.
Each session begins with a didactic lecture providing general concepts and key teaching points applicable to the content of the session. This is followed by separation into three small groups wherein participants protocol cases, interpret the corresponding images, and provide a verbal case presentation to the supervising senior residents. The cases are pre-determined by the session leader and standardized between the small groups. The session ends with residents reconvening in a large group for discussion of difficult concepts and areas, which might have been unclear in the small groups.
A simplified curriculum map was produced which identifies each expertise cluster (or weekly session), links to the learning outcomes and instructional objectives, key learning resources to be reviewed by participants in the curriculum, and evaluations for each session and for the curriculum globally (Figure 1) . This map is available in Google Drive, with access to specific components provided to learners, teachers, and curriculum leaders as appropriate.
Assessment of learner outcomes will determine overall success of the curriculum. Outcomes data will be gathered via a pre-call OSCE, which is delivered to the PGY-2 residents each year in October. This examination includes clinical scenarios, which are frequently encountered on call wherein the learners interpret radiographic, ultrasound, and CT images and provide a diagnosis or differential diagnosis.
Given that the leaders of the PGY-2 Pre-call Curriculum will change each year, a process for ensuring quality education for each resident cohort is essential. A brief written guide was produced for yearly transition, to be reviewed by the incoming chief residents who will be facilitating the curriculum. Included in this document is an introduction to the overall curriculum approach, links to the learning outcomes and instructional objectives, links to learner resources, and guidelines for orienting the teachers to the educational process.
In summary, the PGY-2 Pre-call Curriculum has been designed in a manner, which facilitates deep learning in the participants and ensures a smooth transition of curriculum leadership from year to year. With the inclusion of detailed objectives and assessment strategies, the curriculum will also allow for measurement of competence in Diagnostic Radiology as our specialty training program transitions to Competence by Design . Data collected from curriculum evaluation and resident assessment will lead to improvement in the future deliveries of the curriculum and provide validity evidence for the potential application of this curriculum to other Diagnostic Radiology residency programs.
 Specialty Committee, Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/cs/groups/public/documents/document/y2vk/mdaw/~edisp/tztest3rcpsced000894.pdf. Objectives of Training in the Specialty of Diagnostic Radiology. Published March 2014. Accessed July 2, 2017.
 Anderson LW, Krathwohl DR, Airasian PW, Cruikshank KA, Mayer RE, Pintrich PR, Raths J, Wittrock MC. A taxonomy for learning, teaching, and assessing: A revision of Bloom’s taxonomy of educational objectives. New York, NY: Longman; 2001.
 Harden RM. AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Med Teach. 2001;23(2):123-137.
 Competence by Design. Royal College of Physicians and Surgeons of Canada. http://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e. Accessed July 2, 2017.
Featured image property of the Royal College