"I'd be watching him contour till 10 o'clock at night'': Understanding Tensions between Teaching Methods and Learning Needs in Healthcare Apprenticeship

Document Title

“I’d be watching him contour till 10 o’clock at night”: Understanding Tensions between Teaching Methods and Learning Needs in Healthcare Apprenticeship

Document Information

• Subject Area: Medical Education and Human-Computer Interaction
• Keywords: Medical Training, Cognitive Apprenticeship, Contouring, Healthcare, Human-Computer Interaction, Boundary Variability, Feedback Mechanisms, Radiation Oncology, Assisted Learning Tools

Research Background and Problem

• Identified Problems or Challenges:

  1. Medical skill training in radiation oncology primarily relies on the apprenticeship model, but the dynamics of feedback mechanisms remain underexplored.
  2. Contouring, as a critical skill, exhibits significant variability and high error rates, which can severely impact patient survival rates.
  3. There is a notable mismatch between teaching methods and the learning needs of residents, including issues such as lack of timely, targeted, and diverse feedback.

• Significance of the Research: Errors in contouring may lead to excessive radiation to healthy organs or insufficient radiation to tumor areas, thereby affecting treatment outcomes. Improving medical training is directly linked to enhancing patient treatment results.

• Motivation and Related Work: In contouring, radiation oncology residents must learn complex cognitive skills from limited teaching resources. Cognitive apprenticeship theory can reveal tacit knowledge (e.g., decision-making processes), but current training models have yet to fully integrate its six principles. Additionally, human-computer interaction and educational technologies have demonstrated potential in improving learning outcomes in other fields, offering valuable insights for medical training.

Solution

• Proposed Methods or Solutions: Investigate current training practices through interviews and design thinking workshops, and design feedback interfaces to assist residents in learning. Specific innovations include:

  1. Using design thinking to guide collaboration between instructors and residents in designing ideal feedback tools.
  2. Surveying 67 medical practitioners from 31 countries to assess the effectiveness of interface elements.

• Innovations:

  1. Proposed feedback improvement methods based on cognitive apprenticeship, including real-time video feedback, "similar case" references, and multi-user distribution analysis tools.
  2. Systematically explored how technological support can reduce instructors' workload while enhancing residents' learning experiences.

• Implementation Steps:

  1. Interviews and Observations: Conduct interviews with residents and instructors and observe the contouring process to understand existing educational workflows.
  2. Design Workshops: Use design thinking methods to generate feedback interfaces that integrate cognition and practice.
  3. Global Survey Study: Distribute questionnaires to collect global opinions on feedback interface design.
  4. Qualitative and Quantitative Analysis: Analyze interview, survey, and design results to generate widely applicable design principles.

Research Outcomes

• Specific Outcomes:

  1. Identified three main teaching methods through interviews: case assignment with written feedback, synchronous watch-along contouring, and impromptu support from senior residents.
  2. Workshops generated multiple feedback interface prototypes, including statistical distribution charts, comparative case databases, and real-time video feedback tools.
  3. Global surveys revealed that "providing supportive resources within contouring interfaces" and "real-time case comparisons" were the most desired features for residents.

• Comparison with Existing Solutions:

  • Clarified how traditional apprenticeship teaching methods fail to meet the personalized learning needs of residents.
  • New solutions, such as video feedback and diverse case references, address the lack of real-time and precise feedback in traditional methods.

• Experimental or Evaluation Results:

  • Survey analysis indicated that interface design impacts usability and learnability, with left-panel support designs (e.g., providing real-time prompts and progress tracking) receiving the highest scores.
  • Heatmap analysis showed that textual explanations and expert preference maps were highly valued by users.

• Limitations and Future Directions:

  1. Limitations: Respondents were primarily from a single hospital, which may affect the generalizability of results; hierarchical relationships between residents and instructors may influence the authenticity of workshop interactions.
  2. Future Directions: Recommend expanding larger-scale global surveys, developing immersive tools to evaluate the feasibility of solutions, and exploring more multimodal feedback mechanisms.