Online tutorials train radiologists on the job

Interactive computer-based teaching programs can provide an effective way of training radiologists at their desks, according to experts in medical informatics.

While medical education is often characterized by hours spent in lecture halls and costly trips to training centers, online tutorials eliminate the need for course participants to gather in person, saving money and time.

In late 2000, Dr. Steffen Achenbach left the department of diagnostic radiology at Philipps University in Marburg, Germany, to set up his own business in Web-based learning for professionals. He expects that the teaching packages will be welcomed by hospital-based doctors and physicians in private practice who have to pay for hotel accommodations, meals, and travel to attend traditional medical training courses.

"The major spending for participants was not the course fee, it was the rest of the expenses," said Achenbach, who is now a company director of Samara Academy in Hamburg.

His confidence in the power of the Internet to revolutionize education is based on his experience working in a computer company before training to become a doctor. While completing his internship and postgraduate training at Marburg, he developed a Web-based teaching database that let radiology students track the changes of disease on imaging via patients' virtual records.

Small group size, on-site learning, and interactivity are key elements in effective training, according to Achenbach. The Samara Academy courses are being designed for six remote participants plus one trainer. An online training platform on the Web allows the trainees to share and discuss documents out loud, while teaching is enabled with voice-over IT.

"It's not interactivity between a person and a computer, it's interactivity between people, and that's an important point," he said. "It makes you think and learn and gives you the pressure to do something for the group."

To run the programs, participants must have a desktop PC fitted with a Pentium III processor and a good Internet connection, preferably an ISDN line. Achenbach acknowledges that availability of high-speed Internet connections remains a stumbling block in many parts of Europe, but the communications industry is promoting fast online access.

Interactivity is also central to an online tutorial developed at Humboldt University in Berlin to help medical students, trainee radiologists, and doctors recognize the cost implications of radiology in diagnostic decision-making. As users decide which diagnostic procedures to perform in individual cases, the clinical consequences are recorded and cost calculations performed. The online tutor function provides advice throughout the program to prevent unnecessary procedures and false diagnoses.

Inclusion of cost-effectiveness in the training package was prompted by the introduction of diagnosis-related groups (DRGs) into the German healthcare system, said Dr. Ulf Teichgraber, an instructor in radiology at the university's Charite Campus Virchow-Klinikum. Where reimbursement is based upon standard rates assigned to DRGs, reduction of unnecessary procedures becomes increasingly important.

"If you have the right diagnosis and exceed the cost, then there will be an analysis of the procedure, which will be done by the tutor," Teichgraber said.

The program was written and designed by Dr. Maciej Pech, an IT expert at the Charite. Although the software is still being evaluated, the response from students and physicians at the Free University in Berlin and Humboldt has been positive. A questionnaire returned by 26 registered online users demonstrated high acceptance of the system.

The master program is available on CD-ROM, and a download version is in preparation. All extensions to the program, to update cost information or add new cases, can already be downloaded from the Web. Radiology trainees and medical students will benefit from fast access to updated data via the Internet, Teichgraber said.