A hinting strategy for online learning of radiograph interpretation by medical students.

Context We examined whether a 'hint' manoeuvre increases the time novice medical learners spend on reviewing a radiograph, thereby potentially increasing their interpretation accuracy. Methods Senior year medical students were recruited into a randomised control, three-arm, multicentre trial. Students reviewed an online 50-case learning set that varied in degree of 'hint' intervention. The 'hint' was a dialogue box that appeared after a student submitted an answer, encouraging the student to re-evaluate their interpretation. The students in the control group received no hints. In the weak intervention group, students received 'hints' with 66% of their incorrect interpretations and 33% of those that were correct. In the strong intervention group, the incorrect interpretation hint frequency was 80%, whereas for correct responses it was 20%. All students completed a 20-case post-test immediately and 2 weeks after the 50 cases. The primary outcome was student performance on the immediate post-test, measured as the ability to discriminate between normal and abnormal films (dPrime). Secondary outcomes included the probability of considering the hint, time spent on learning cases and knowledge retention at 2 weeks. Results We enrolled 117 medical students from three sites into the three study groups: control (36), weak intervention (40) and strong intervention (41) groups. The mean ( standard deviation) dPrime in the control, weak and strong groups were 0.4 (1.1), 0.7 (1.1) and 0.4 (0.9), respectively ( P = 0.4). In the weak and strong groups, participants reconsidered answers in 556 of 1944 (28.6%) hinting opportunities, and those who reconsidered their answers spent a mean (95% confidence interval) of 13.9 (11.9, 16.0) seconds longer on each case. There were no significant differences in knowledge retention at 2 weeks between the groups ( P = 0.2). Conclusions Although the implemented hinting strategy did result in students spending more time considering a proportion of the cases, overall it was not effective in improving student performance. [ABSTRACT FROM AUTHOR]