26 Education I&TP July 2011 27 Education I&TP July 2011 The RITE Project: Towards a research-led diagnostic radiography curriculum Robert Higgins and colleagues outline an innovative approach to enhancing research awareness and application among student radiographers. Introduction and background In 2009, the BSc (Hons) radiography programme team at the University of Salford proposed changing the curricula for the undergraduate radiography students to become more research-led and expose students to more formal research, within their normal teaching and learning experience. It was envisaged that such an initiative with suitable materials and support could lead to valuable research outputs from their contributions and also facilitate the students’ practice based learning, and understanding of key radiographic concepts. The university has invested in a state of the art building, which includes the Sue Hall imaging suite, comprising of two computed radiography (CR) general x-ray rooms, a CT scanner and a workstation laboratory. This provides the students with a safe environment in which to develop their clinical skills under the supervision of experienced staff. The undergraduate diagnostic radiography course at the University of Salford uses a problem based learning (PBL) approach as one of its key teaching and learning approaches to student education. PBL is deined as ‘the process of acquiring new knowledge based on the recognition of a need to learn. 1 . Students work together in small groups using ‘triggers’ from a problem case study or scenario related to radiography, to deine their own learning objectives 2 . This approach: ◆ Challenges students to work collaboratively to seek solutions to real life problems ◆ Encourages self-directed and student centred learning ◆ Teaches students that there are often no set answers to a particular problem, and ◆ Prepares students to think critically and analytically, and use appropriate learning resources to improve their practice. In this context, the Research Informed Teaching Experience (RITE) project was developed to combine elements of PBL and research. There is limited literature available on the subject of combining PBL with research within a radiographic setting, so a number of parameters were identiied that would need to be included: ◆ The project would involve only Year 1 students initially ◆ The project would be piloted on two separate occasions for one week each ◆ It would need to be student/ facilitator driven with some self-directed study ◆ Use a scenario with learning objectives suitable to Year 1 academic knowledge, eg, exposure factors and image quality ◆ Would incorporate the students undertaking some form of basic research experimentation, research analysis and interpretation of the results ◆ Incorporate a student work book for the students to record and relect upon their experiences of the week ◆ Have some form of analysis to assess whether the RITE project achieved the aims of providing the students with the skills necessary to undertake research and if the project helped with their learning of practice based skills. Developing the RITE project scenario Over an 18 month period the teaching and learning strategy was reined using an iterative, incremental and consultative process in order to identify a clear learning strategy for the students. This strategy would be based upon guided discovery, and provide year 1 radiography students with a week-long set of structured events suitable to their academic level and programme of study. It was identiied that this strategy should incorporate learning objectives that underpin key areas of practice whilst ensuring the students followed an experimental science approach within the scenario. The RITE project team decided that the scenario would ask the students to investigate the relationship between acquisition factors, image quality and dose area product (DAP). The scenario would incorporate some background information and provide a trigger for the students to research. The scenario used in the RITE project introduced the students to the phenomenon of ‘exposure creep’ – a tendency to use more exposure than needed – and used this as the irst trigger, with the second trigger being image density, penetration and image contrast, and manipulation of these by the acquisition factors. The scenario stated that exposure creep had been identiied in an audit of turned lateral knee x-ray examinations. The students were therefore asked to investigate and research the following effects using an anthropomorphic (PIXY) phantom in the turned lateral knee projection with CR equipment: ◆ The effects of altering kVp, with a ixed mAs, on the image quality – image contrast, penetration and image density ONLY ◆ The effect of altering kVp, with a ixed mAs, on DAP and ◆ A kVp, and ixed mAs exposure combination that provided the optimum image quality – image contrast, penetration and image density ONLY – with the lowest DAP measurement to the phantom. As the students only had one week to undertake the work, it was decided they would only investigate the effect of changing kVp over a range, using both broad and ine focus with a ixed mAs setting – and image window settings for analysis. Although DAP does not represent patient dose per se – it is a combination of entrance surface dose and entrance ield area – the choice of DAP was used for the purposes of practicability and because of the widespread use of DAP meters for recording patient dose in the clinical environment 3 . Piloting the RITE project The project was piloted for one week on two separate occasions, using two groups of volunteer irst year radiography students. Each week consisted of two groups of four students. For each pilot week, a timetable outlined the activities the students would be undertaking. Day one included some formal lectures that introduced the scenario and the concept of experimental design and research as well as time for self-directed study. The students then worked in two small groups of four, to design a methodology to investigate the scenario. The students were asked to present and defend their methodology design to the PBL facilitator, following which they were given an accepted RITE methodology that they would use in their research, designed by the programme team, and asked to compare any differences or similarities between their methodology and the RITE methodology. Days two to four involved the students undertaking the research and performing analysis of the images they had acquired under distant supervision by academic staff. For all the images acquired only the kVp and foci – ine/broad – were altered, all other variables such as SID, mAs, position of the PIXY phantom, receptor type and collimation remained ixed. When viewing the acquired images, the students selected the appropriate algorithm speciic to the ‘Look Up Table’ and anatomical area, eg, knee. This was not adjusted by the students and no image post processing eg, adjustment of contrast, was performed during the image analysis to improve any over or under exposed images that had been acquired. The image analysis was performed irstly by each group member scoring the image twice using a score-sheet (Figure 1), before a group score mean and standard deviation were calculated for each image to get the students to identify any differences between these and why. The students also performed quality control measurements on the equipment and calibrated the DAP meter prior to making their acquisitions. They also relected on the day’s events in their workbook regarding what they had learned and reported back to the facilitator/ supervisor on their progress at the beginning of each day. Tutor support was provided at speciic points – an orthotics PhD student provided the students with research skills support during the week and challenged their understanding of what they were researching and the implications of exposure factor manipulation on image quality and DAP. On the inal day, the students relected on the week’s events including what they had learned, and gave a presentation of what they did, identifying any conclusions they reached, eg, the exposure factor(s) that gave optimum image quality for image contrast, penetration and image density and the lowest DAP measurement. Materials used by the students to support their learning during the pilot weeks included: ◆ Record sheet, used in their analysis of the image quality of each image they had acquired (Figure 2). This was adapted and edited from a pre-existing image criteria sheet used by the students to give a psychometric – Likert – scale for scoring their images. ◆ A student workbook, which introduced the students to the scenario and included the learning objectives, group roles within a PBL group and a daily relection log for the students to record their experience ◆ RITE methodology, which included guidance to minimise Image Quality Score Q1. There is suficient density (brightness): 1 2 3 4 5 6 7 8 9 10 Strongly Disagree Strongly Agree Q2. There is suficient penetration: 1 2 3 4 5 6 7 8 9 10 Strongly Disagree Strongly Agree Q3. There is suficient radiographic contrast: 1 2 3 4 5 6 7 8 9 10 Strongly Disagree Strongly Agree Q4. The image quality could NOT be further improved? 1 2 3 4 5 6 7 8 9 10 Strongly Disagree Strongly Agree Diagnostic Acceptability Score Q5. Because of the image quality, this radiograph does NOT require a repeat? 1 2 3 4 5 6 7 8 9 10 Strongly Disagree Strongly Agree Figure 1: Criteria for the appraisal of radiographic images used in the RITE project (this was used in conjunction with a score-sheet).