title: A Vertically Integrated Online Radiology Curriculum Developed as a Cognitive Apprenticeship: Impact on Student Performance and Learning.
abstract: OBJECTIVE
  The principles of Collins' cognitive apprenticeship model were used to design a radiology curriculum in which medical students practice radiological skills using online case-based modules. The modules are embedded within clinical third-year clerkships, and students are provided with personalized feedback from the instructors. We describe the development of the vertical online radiology curriculum and evaluate its impact on student achievement and learning process using a mixed method approach.
  
  
  METHODS
  The curriculum was developed over a 2-year period. Student participation was voluntary in the first year and mandatory in the second year. For quantitative curriculum evaluation, student metrics for voluntary versus mandatory groups were assessed using independent sample t tests and variable entry method regression analysis. For qualitative analysis, responses from a survey of students about the value of the curriculum were organized into defined themes using consensus coding.
  
  
  RESULTS
  Mandatory participation significantly improved (p = .001) the mean radiology examination score (82 %) compared to the voluntary group (73%), suggesting that mandatory participation had a beneficial effect on student performance. Potential preexisting differences in underlying general academic performance were accounted for by including mean basic science grades as the first variable in the regression model. The significant increase in R(2) from .16 to .28 when number of radiology cases completed was added to the original model, and the greater value of the standardized beta for this variable, suggest that the curriculum made a significant contribution to students' radiology examination scores beyond their baseline academic performance. Five dominant themes about curricular characteristics that enhanced student learning and beneficial outcomes emerged from consensus coding. These themes were (1) self-paced design, (2) receiving feedback from faculty, (3) clinical relevance of cases, (4) gaining confidence in interpreting radiological images, and (5) transfer of conceptual knowledge to actual practice.
  
  
  CONCLUSIONS
  The vertically integrated online radiology curriculum can positively impact student performance and learning process in the context of the cognitive apprenticeship model.
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60546. Electronic address: jlim2@lumc.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Lim-Dunham
authors.affiliation: School of Education, Loyola University Chicago, Chicago, Illinois.
authors.forename: David C
authors.initials: DC
authors.lastname: Ensminger
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60546.
authors.forename: John A
authors.initials: JA
authors.lastname: McNulty
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60546.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Hoyt
authors.affiliation: Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60546.
authors.forename: Arcot J
authors.initials: AJ
authors.lastname: Chandrasekhar
mesh_terms: D000124:Achievement; D002982:Clinical Clerkship; D003071:Cognition; D003194:Computer-Assisted Instruction; D003479:Curriculum; D004521:Educational Measurement; D005246:Feedback; D006801:Humans; D037141:Mandatory Programs; D009862:Online Systems; D018794:Problem-Based Learning; D016730:Program Development; D015397:Program Evaluation; D011871:Radiology / Q000193:education*; D012649:Self Concept; D012655:Self-Evaluation Programs; D013337:Students, Medical / Q000523:psychology; D014163:Transfer, Psychology; D035141:Voluntary Programs
keywords: Cognitive apprenticeship; medical student education; mixed methods; online learning; vertical curriculum