One of the goals of first-year Anatomy curricular redesign efforts at the Johns Hopkins University School of Medicine was to further integrate Radiology into the coursework. The initial efforts for this integration were centered on developing a Medical-Imaging-Resource-Center (MIRC-) based website with relevant teaching files to supplement topics discussed in lecture and corresponding gross dissections [15
]. The goal of the present study was to improve on these initial efforts through the creation of a web portal that would organize existing teaching files as well as newly created educational resources and more fully integrate this material into the existing Anatomy coursework.
A survey from the previous year with student feedback from initial efforts in developing Radiology teaching files in a web-based format for Anatomy was reviewed. The team of attending, residents, and medical students working on the second iteration of development used this feedback to identify several possible areas for improvement with the goal for improved user friendliness and increased utilization of the material. Some of the key changes included integration of the material into a web portal, development of Lab and Study Companion components, and a set of organized links to access the material rather than requiring the user to type in search criteria. The list of features that were created and the rational for their implementation are provided in .
Rational and features of newly created Radiology web portal for Gross Anatomy.
Joomla 1.5 (Open Source Matters, Inc, New York, NY) was utilized as a content management system for creating the web content. Joomla is an open-source application that is freely available on the Internet. It provided the ability to organize and keep track of all content as well as constantly update cases and documents without republishing the web page.
In order to expand the content that would be offered via the web portal, a search for relevant images within the past year was conducted using the Johns Hopkins Hospital Emageon Ultravisual (AMICAS, Inc, Boston, MA) picture archiving and communication system (PACS). There was no copyright protection for these images developed in this iteration of the site development. Although the site was password protected, there was no functionality limiting copying of images from the site by students. This issue will be further addressed in future iterations of the web site development. The effort to obtain several relevant images for each anatomic site was largely in response to student feedback from the prior year that suggested additional imaging teaching files would be beneficial. In order to expand the MIRC content already available, the goal of case acquisition this year was directed towards finding CT and MRI cases where multiple slices could be viewed for each case. Similar to the existing teaching files, the new cases included normal anatomy as well as cases with simple pathology. The cases were initially identified by two of the authors and subsequently reviewed by the senior authors before incorporation into teaching cases. Once selected, the image sets were saved in standard tagged image file format and animated with Macromedia Flash using an open-source student PACS module created by students and residents at the University of Medicine and Dentistry of New Jersey. The new modules allowed users to scroll through images, zoom, and pan while also interacting with labeled structures within the image sets. The decision to utilize Flash was impart based on familiarity of the product by the student developers. In addition, while evaluation of MIRC demonstrated excellent static image teaching file development, it had less robust capabilities compared to the Joomla/Flash combination option for developing more dynamic teaching files with scrolling and highlighting.
The new student PACS modules were combined with last year's MIRC cases to create teaching files that could be accessed during lecture by the instructors and by the anatomy students for review during and following anatomy lectures. MIRC files which were created last year were incorporated into the web site as thumbnails with hyperlinks to the original content, while new thumbnails were created to hyperlink to the students PACS cases. The web portal was designed such that all teaching files were organized by anatomical region. These anatomical regions were defined based on the existing syllabus for the anatomy course. The files were further separated into tutorial files and quiz files. In total, over 100 teaching files were provided (Tables and ).
Characterization of teaching files by question type.
Characterization of teaching files by imaging modality.
In order to create interactive teaching files, relevant anatomy was identified and highlighted on each slice of an image set. A set of questions or relevant teaching points were then linked to each structure so that if the structure was selected on any slice where it could be seen, the questions or teaching points would then appear on the right side of the screen. displays a sample tutorial case where the arch of the aorta was highlighted and relevant information was displayed for that structure. In , a quiz case is displayed where the ascending aorta has been highlighted prompting a multiple choice question related to this structure. For each of the tutorials, there was a page of instructional text, with one associated image set as demonstrated in Figures and and a corresponding set of relevant multiple choice questions.
Figure 1 This is a screen-capture of one of the Thorax tutorial files. After clicking on a structure within the image, the structure will highlight and information will be provided about the structure on the right-hand side of the screen. In this example, the (more ...)
Figure 2 This image illustrates an example of one of the Thorax quiz files. After clicking on a structure within the image, the structure will be highlighted and a question regarding that structure will appear on the right-hand side of the screen. In this example, (more ...)
The web portal was introduced to the medical students on the first day of their anatomy class. The rational for presenting the portal on the first day was to provide students a roadmap to optimize use of Radiology to learn Anatomy and to begin to get them comfortable with the basic layout of the web site. The web address was provided and basic navigation through the site was reviewed. The students were informed that the homepage would be updated a few days prior to each radiology lecture to include pertinent cases (). They were required to look over those selected cases prior to lecture and advised to look over the additional cases found in the corresponding anatomical link for further review.
Figure 3 This screen-capture demonstrates the dynamic portion of the web portal home page which provided prelecture material. For this example, the teaching files were provided on the home page a few days prior to the head and neck imaging lecture. The students (more ...)
Each radiology lecture was divided into two one-hour segments. During the first hour, the lecturer presented a PowerPoint (Microsoft Corporation, Redmond, WA) lecture on material corresponding to the gross dissection scheduled for that day. The students were then given a five-minute break and asked to close all laptops before the second session began. Next, the lecturer broke the classroom up into small groups based on where the students were sitting and quizzed them on each of the cases found on the homepage of the web portal for that day. This process was repeated for each of the radiology-based lectures so that the students were aware of the expectation that they should be familiar with the corresponding cases found on the web portal homepage.
Following the completion of the Gross Anatomy course (Fall 2010), a fourteen question, web-based survey was distributed to the Anatomy students. The survey was similar to the one distributed to the first-year medical students the previous year (Fall 2009) [15
]. provides a complete list of the questions on the survey. In order to evaluate the impact of the web portal compared to the previously available teaching files, the results of the survey from the current year were compared to the results from the previous year.
In order to quantify the utilization of the web site during the anatomy course, a StatistX module was installed into the Joomla content manager. This module allowed a hit counter to be incorporated into the web site which would keep track of all web traffic received by the site. The module provided daily activity, hourly reports, top ten pages hit, and the last twenty pages visited. This module provided information regarding when the students were utilizing the website the most and what content they were looking at. IP addresses were also provided in the statistics indicating whether the students preferred to access the material on or off campus. As previously noted, the teaching files were integrated to a greater extent into the coursework by including the material in discussion groups rather than the lecture-only format utilized during the previous year. The server data from the current year was compared to the server data from the previous year to identify any changes in the student utilization patterns after these changes in the structure of the coursework.