Radiology Education in 2005: World Wide Web Practice Patterns, Perceptions, and Preferences of Radiologists
Abstract
Internet use has increased greatly in the past decade across all demographic sectors in the United States, and the World Wide Web currently serves as a valuable informational resource for physicians. A study was conducted in 2005 to evaluate the role of the Web in radiology education. A 28-question multiple-choice survey was administered during two institutionally run continuing medical education (CME) conferences. Questions addressed perceptions and use of the Web, as well as preferred resources for radiologic information and radiology education. Surveys were submitted by 92 radiologists, 97% of whom use the Web for radiology education. The reliability of information on the Web was deemed equal to that of information from traditional sources by 69% of respondents. Forty-five percent use the Web for CME; however, an institutionally run course was selected most frequently as the preferred method of CME, as well as the most effective and efficient. The search engine used by the largest number of participants to identify radiologic information is Google. For reading journal articles, 67% of respondents prefer hard copy. Monthly review of publications made available online before the print version is performed by only 26%. The results of the survey indicate that, despite an increase in Internet use and the perception that Web-based information is reliable, most practicing radiologists still prefer traditional educational resources for radiologic information and radiology education.
© RSNA, 2007
Introduction
The Internet has evolved into a widely used means of disseminating medical information and a valuable resource for medical education (,1). Use of the World Wide Web for education is of particular interest to us, since our computed tomography (CT) department has operated an educational Web site dedicated to body CT (http://www.ctisus.com) since 1999. In addition, our involvement in the education of physicians and technologists includes 8–10 continuing medical education (CME) courses each year, as well as numerous refresher courses and educational exhibits presented at national meetings. Accordingly, feedback from practitioners who require radiologic information and CME is essential to guiding our efforts. With this in mind, we distributed a questionnaire to practicing radiologists to determine perceptions and use of the Web, as well as preferred resources for radiologic information and radiology education. In this article, we present all the available data from the survey, thereby providing insight into how radiologists currently use the Web for education.
Materials and Methods
A 28-question multiple-choice survey was administered to radiologists during two institutionally run CME conferences in 2005. These questions addressed perceptions and use of the Internet, as well as preferred resources for radiologic information and radiology education. The questions were designed to determine specific information about the respondents’ Internet access, experience, and preferences, as well as how the respondents viewed the Web compared with traditional educational resources. In addition, a number of questions were presented to learn specifically about the use of programs available on our Web site.
Results
Demographics
Surveys were submitted by 92 radiologists, most of whom were between 30 and 60 years old (,Fig 1). The majority of the respondents work at non-teaching hospitals or in private clinical practices and have Internet access with either a cable modem or a DSL (digital subscriber line) connection.
Web Use
User perceptions about the Web were also addressed in our survey, with 69% of respondents saying that information available on the Web is as reliable as information from traditional sources. Only 18% said that information found on the Web is less reliable. Major perceived drawbacks of Web use included slow loading of Web site data and lack of portability (,Table 5). However, the responses to the question that addressed the perceived reliability of Web-based sources of information versus more traditional sources (aimed at determining respondents’ primary incentive for visiting a Web site) could not be analyzed because respondents were unclear on how to answer the question.
User Needs Assessment
Many of our questions were designed to assess the current and future educational needs of radiologists. Each set of questions related to a section that is currently offered on our Web site or to a “tentative” section that we are considering offering. However, responses to the question that specifically addressed the use of educational programs provided on our Web site could not be analyzed.
Previous data collected from our Web site in 2002 revealed that CT scanning protocols and teaching files were among the most frequently requested content (,2). Our current survey revealed that 70% of respondents prefer to view digital teaching files as opposed to prints or films (,Fig 2). However, the Internet was not the primary source accessed for multi–detector row CT scanning protocols in the group of radiologists we surveyed; the three most common sources were colleagues, CME meetings, and peer-reviewed print journals (,Table 6). Additional results revealed that only 9% of respondents ever use a personal digital assistant (PDA) to view or download content from the Web.
Discussion
The Web is being widely used as an educational tool by radiologists over a considerable age range, with Web use increasing over the past 3 years. In 1999, an Austrian survey found that 27% of responding radiologists had no Internet access at all (,3). The growth of Internet use by physicians was revealed in data published by Casebeer et al (,4) in 2002 and Bennett et al (,1) in 2004. In both studies, surveys were administered to physicians. Casebeer et al (,4) surveyed 2200 physicians and found that 80% used the Internet to obtain medical information, a mild increase relative to the Austrian data from 1999 (,3). The subsequent survey of 3347 physicians by Bennett et al (,1) revealed a slight increase in Internet use by physicians (84% of respondents). However, comparison of this data with that obtained by Casebeer et al 2 years earlier demonstrated that the average amount of time physicians spent using the Internet to obtain clinical information doubled from 2001 to 2003. In addition, results revealed a significant shift from journals and local courses to computer and audiovisual resources as sources of clinical information (,1). The results of our survey demonstrate an ongoing increase in Web use for obtaining medical information or for educational purposes (97% of respondents). The means with which our respondents seek radiologic information on the Web is not limited to medical sites or search engines, and most respondents believe that the information available online is reliable.
The 2004 study by Bennett et al (,1) also reported that journals, national CME courses, CD-ROMs, audiotape, and videotape all ranked higher than Web sites in terms of importance as sources of clinical information.
Our findings, along with other published studies, help explain the limited incorporation of the Web into educational endeavors.
Although these data reveal that traditional forms of CME are still preferred by most respondents (,Fig 5) and perceived as being more effective than Web-based programs (,Fig 6), a literature review from 2002 by Chumley-Jones et al (,8) concluded that Web-based educational programs were equal to, but not superior to, various traditional teaching methods for increasing knowledge. They obtained conflicting results as to whether Web-based instruction was considered more efficient; the investigations included in their review involved students, nurses, residents, and practicing physicians (,8). Thanks to a number of subsequent studies, a body of data has since evolved that specifically addresses the education of medical residents and practicing physicians. These studies have compared Web-based educational programs with other teaching methods, including small discussion groups, a course, a workshop, and printed materials, and the resulting data reveal that Web-based programs have a number of advantages (,Table 7) (,6,,7,,9–,11).
Each of the five studies summarized in ,Table 7 revealed equal knowledge gains when Web-based programs were compared with traditional methods (,6,,7,,9–,11). Web-based resources were shown to be equally (,11) or more (,9) efficient. Satisfaction ratings were higher for Web-based programs than for traditional methods in three of the four studies that made this assessment (,6,,9,,10) and equal to those for traditional methods in the fourth study (,11). One study that included chart review demonstrated that only the Web-based program resulted in a significant change in patient care (,11). In this study, physicians completed a CME training course on cholesterol management, through either a live interactive workshop or a multicomponent Web-based course. Although both methods increased knowledge, chart audits performed before and after intervention revealed that only the Internet-based educational program increased appropriate treatment of high-risk patients (,11). This was the only study identified that used patient care as an outcome measure, which is a limitation of the supportive data from the other four studies. As emphasized by Wutoh et al (,12), the goal of CME is not simply to increase knowledge, but to improve clinical behavior and outcomes.
In addition to evaluating the role of the Internet in radiology education, our survey was aimed at determining usage patterns for the individual programs that constitute our educational site. Therefore, some of the survey questions were geared to determine which Web-based programs are of the most value to radiologists. A 2002 analysis of a body CT Web site used Web tracking to reveal that the most popular content included CT scanning protocols, teaching atlases, CT teaching files, and medical illustrations (,2). Unfortunately, we were unable to analyze the responses to questions that we had formulated to help determine the specific types of Web programs that radiologists use and which characteristics of Web sites are most attractive to users. The responses do reveal that interest in obtaining CME credit may guide radiologists to a particular resource, with 33% and 25% of respondents indicating that obtaining CME credit was “somewhat important” or “very important,” respectively (,Fig 4). The data also provided valuable feedback about PDA use among practicing radiologists, which was useful in helping us determine whether to provide CT scanning protocols that are accessible on PDAs. A recent study suggests that PDA use among radiologists is on the rise (,13), revealing that 45% of 528 radiologists owned or used a PDA on a daily basis. However, only 13.6% of respondents reported using a PDA for Internet access or e-mail (,13). Similarly, only 9% of respondents in our survey reported downloading information from the Internet to a PDA.
Our survey has several limitations, the most significant of which is sample bias. Because the questionnaire was administered to individuals who were attending two institutionally run CME courses, the respondents may not be representative of all radiologists. However, our intent was to survey radiologists who are not necessarily Internet users. In addition, the way in which a survey is distributed (eg, distributed by hand, mailed, presented online) can affect the results. Comparison with the results of a similar survey of Web users that is currently in progress at our institution will be useful in determining if our results were biased owing to the means of administering the survey or to the population who participated. Finally, as discussed earlier, the responses to two questions addressing specific details about Internet resources could not be analyzed because not all respondents interpreted the instructions correctly.
Conclusions
The results of our survey indicate that, in 2005, despite an increase in Internet use and the perception that the information on the Web is reliable, the majority of practicing radiologists still prefer traditional educational resources to the Internet for radiologic information and radiology education. These results support the conclusions of Gunderman et al (,14), who predict that instructional technology will serve as an integral component of radiology education but is not likely to supersede traditional educational resources.
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Figure 1. Chart illustrates the ages of the survey participants. The three largest categories are 40–50 (35% of respondents), 50–60 (28%), and 30–40 (24%) years of age.
Figure 2. Chart illustrates respondents’ preferred methods of viewing teaching files, with hard copy being preferred by only 14%.
Figure 3. Chart illustrates respondents’ use of the Internet for CME, with slightly over one-half of respondents indicating that they do not use the Internet for this purpose.
Figure 4. Chart illustrates survey participants’ response to the question, “How important is it to you that CME credits be available for content you view online?” The question was designed to help determine whether the availability of CME credit was a driving force in guiding radiologists to a Web-based resource.
Figure 5. Graph illustrates respondents’ answer to the question, “Which is your preferred method of CME?” Numbers indicate the actual number of respondents for each category (more than one answer was given by some respondents).
Figure 6. Graph illustrates respondents’ answer to the question, “Which is the most effective method of CME?” Numbers indicate the actual number of respondents for each category (more than one answer was given by some respondents). Traditional methods for CME (course run by institution, journal articles [hard copy], large medical conference) are perceived by most radiologists as the most effective educational vehicles.
Figure 7. Graph illustrates respondents’ answer to the question, “Which do you feel is the most efficient method of CME?” Numbers indicate the actual number of respondents for each category (more than one answer was given by some respondents). Compared with the number of radiologists who selected journal Web sites as the most effective method of CME (cf ,Fig 6), a larger number of radiologists perceived journal Web sites as being among the most efficient methods.
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