title: The Learning Curve in Prostate MRI Interpretation: Self-Directed Learning Versus Continual Reader Feedback.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the roles of self-directed learning and continual feedback in the learning curve for tumor detection by novice readers of prostate MRI.
  
  
  METHODS
  A total of 124 prostate MRI examinations classified as positive (n = 52; single Prostate Imaging Reporting and Data System [PI-RADS] category 3 or higher lesion showing Gleason score ≥ 7 tumor at MRI-targeted biopsy) or negative (n = 72; PI-RADS category 2 or lower and negative biopsy) for detectable tumor were included. These were divided into four equal-sized batches, each with matching numbers of positive and negative examinations. Six second-year radiology residents reviewed examinations to localize tumors. Three of the six readers received feedback after each examination showing the preceding case's solution. The learning curve, plotting accuracy over time, was assessed by the Akaike information criterion (AIC). Logistic regression and mixed-model ANOVA were performed.
  
  
  RESULTS
  For readers with and without feedback, the learning curve exhibited an initial rapid improvement that slowed after 40 examinations (change in AIC > 0.2%). Accuracy improved from 58.1% (batch 1) to 71.0-75.3% (batches 2-4) without feedback and from 58.1% to 72.0-77.4% with feedback (p = 0.027-0.046), without a difference in the extent of improvement (p = 0.800). Specificity improved from 53.7% to 68.5-81.5% without feedback and from 55.6% to 74.1-81.5% with feedback (p = 0.006-0.010), without a difference in the extent of improvement (p = 0.891). Sensitivity improved from 59.0-61.5% (batches 1-2) to 71.8-76.9% (batches 3-4) with feedback (p = 0.052), though did not improve without feedback (p = 0.602). Sensitivity for transition zone tumors exhibited larger changes (p = 0.024) with feedback than without feedback. Sensitivity for peripheral zone tumors did not improve in either group (p > 0.3). Reader confidence increased only with feedback (p < 0.001).
  
  
  CONCLUSIONS
  The learning curve in prostate tumor detection largely reflected self-directed learning. Continual feedback had a lesser effect. Clinical prostate MRI interpretation by novice radiologists warrants caution.
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Abimbola
authors.initials: A
authors.lastname: Ayoola
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: David
authors.initials: D
authors.lastname: Hoffman
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Anunita
authors.initials: A
authors.lastname: Khasgiwala
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Vinay
authors.initials: V
authors.lastname: Prabhu
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Paul
authors.initials: P
authors.lastname: Smereka
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Molly
authors.initials: M
authors.lastname: Somberg
authors.affiliation: 2 Department of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, NY.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data; D004521:Educational Measurement / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D059032:Learning Curve; D008279:Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009518:New York; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D011871:Radiology / Q000193:education*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013663:Teaching / Q000706:statistics & numerical data
keywords: MRI; education; learning curve; prostate cancer