Development Strategies in Medical Education

Introduction
The process of medical education has changed from traditional teacher-centered methods to more modern learner-centered methods in which students actively participate in the learning process. Case-based learning (CBL) is one of the best methods to enhance student learning. In recent decades, technical and scientific advances in radiology have made imaging technique more important in clinical settings. Consequently, there is a growing need to design an appropriate radiology curriculum. There is evidence of lack of radiology training in students, which can lead to their lack of self-confidence in using radiology tools. Prescribing errors in clinics and misinterpretation of radiology images can impose additional costs on patients and the health system. The current study aims to determine the effect of using CBL technique on the imaging prescription skills of medical interns in Iran.

Methods
This is a quasi-experimental study on medical students at Mashhad University of Medical Sciences in 2021-2023 who were interns in the radiology departments of Imam Reza and Qaem hospitals in Mashhad. Of 568 students, 126 were selected using a convenience sampling method. They were divided into two groups of control and intervention. The intervention group participated in two imaging prescription writing classes taught by radiology professors based on the CBL method during the radiology course. The focus of this educational program was on presenting 66 medical scenarios related to common medical complaints where the use of appropriate imaging method was decisive for diagnosing or managing the patient. The education was provided face-to-face during the internship period of students in the radiology department. The students’ knowledge of imaging prescription writing were assessed before and after the educational course using a questionnaire with 20 open-ended questions regarding writing an imaging prescription. One point was assigned to each question. The total score ranged from 0 to 20. The students in the intervention group also completed a satisfaction questionnaire. SPSS v.26 software was used to analyze the data. Student’s t-test was used to compare scores, independent t-test was used for quantitative variables, and chi-square or Fisher’s test was used to compare qualitative variables in two groups. The level of significance was set at 0.05.

Results
Participants included 58 students in the intervention group (22 males and 36 females) and 44 students in the control group (19 males and 25 females). The mean age of students was 22.82±0.683 in the control group and 23.58 ± 1.86 years in the intervention group. The score of satisfaction with the educational course was higher than the average score. The pre-test score of imaging prescription was 9.40±2.36 in the control group and 9.74±2.43 in the intervention group. The post-test score was 10.39±2.32 in the control group and 11.34±2.4 in the intervention group. The groups were significantly different in the post-test score (P=0.047). Considering that the two studied groups had significant differences in some baseline variables, the linear regression model was used to adjust their effects on the difference in post-test scores. Finally, it was found that, after adjusting the effects of age and number of passed internship wards (major and minor) before entering the radiology department, the regression coefficient was not significant. 

Conclusion
Teaching based on the CBL method can increase radiology interns’ imaging prescription writing knowledge. Although a significant increase in imaging prescription writing knowledge of interns was found after education in the intervention group, this increase was not significant in the regression model after adjusting the effects of confounders. The main reason can be the lack of matching two groups for the number of passed internship wards (pediatric and emergency wards) which led to the participation of interns with different levels of experience and knowledge. Further studies should be conducted with a larger sample size and in other universities or departments to increase the generalizability of the results. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Mashhad University of Medical Sciences (Code: IR.MUMS.MEDICAL.REC.1399.72).

Funding
This study was extracted from a PhD thesis in General Medicine, funded by Mashhad University of Medical Sciences.

Authors' contributions 
Conceptualization: Masoud Mahdavi Rashed amd Amir Arefi Eivari; Methodology: Majid Khadem Rezaiyan; Validation:Masoud Mahdavi Rashed, Farzaneh Khoroushi and Amir Arefi Eivari; Data analysis: Masoud Mahdavi Rashed amd Majid Khadem Rezaiyan; Resources and writing initial draft: Amir Arefi Eivari; Editing & review: Majid Khadem Rezaiyan and Amir Arefi Eivari;  supervision, project administration: Masoud Mahdavi Rashed; Investigation: All authors.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellor for Research of by Mashhad University of Medical Sciences for their financial support and all the students who participated in this study for their cooperation.

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