Research & Scholarly Activity
Promoting Evidence-Based Practice, both Clinically and Didactically
Evidence-based practice (EBP) is a model of professional critical thinking that seeks to achieve the best possible outcomes while ensuring that resources and funding are used wisely. In the EBP model, this is achieved by balancing the best research evidence with clinical expertise and the environmental and personal constraints on the patient. While the initial focus of evidence-based practice was on the practice of medicine by physicians, professionals in a wide range of fields, including medical imaging, are now expected to base their decisions on the best and most current research evidence available in order to ensure the best outcomes for the clients they serve. Implementing evidence-based practice requires research data related to the practice question, the ability to locate, recognize and apply the existing research data, and the ability to identify and evaluate constraints unique to the individual and the environment in which the practice is taking place.
My doctoral preparation in information sciences and learning technologies has equipped me to apply theories of information behavior to the instruction in, practice of and experience with medical imaging. As I pursue the promotion of EBP clinically and didactically, I have involved myself in research activities where I can increase the medical imaging research base in ways that encourage the translation of science to professional practice, or use clinical experience to inform the way science related to radiography practice is performed. Whether we are attempting to improve professional practice, increase student understanding, or facilitate patient needs, the efficacy of the intervention depends on clearly understanding when, why and how people require information as they progress through the change process.
My research activities in medical imaging generally revolve around three themes:
Cultivating Expertise in Medical Imaging
As a radiography educator, I desire to see my students develop into the best imaging professionals they can possibly become. Problem solving, collaboration and decision-making within the professional domain are key skills for professional success, and have been identified by the Pew Commission (Shugars & And Others, 1991) as essential competencies for health professions education. Studies undertaken in this research theme include:
Understanding Visual Knowledge
Examples of Eye Tracking Data – The green dots are fixations which are inside anatomical ROIs bounded by yellow regions. The red lines connecting fixations are saccades that transit visual reasoning from one fixation to another.
I serve as a Research Associate on the National Science Foundation (NSF) funded Visual Knowledge Project. This research group is headed by Dr. Chi-Ren Shyu, Informatics Institute, and Dr. Sanda Erdelez, School of Information Science and Learning Technologies. It is an NSF-funded project using eye-tracking technology to investigate the tacit knowledge involved in obtaining information from medical images, including radiography, computed tomography and pathology. My role in this project involves the design and completion of studies analyzing how radiologic technologists evaluate and gain information from x-ray images. These questions are extremely important to helping develop better ways to teach students these skills. In the classroom, we can teach students the appropriate evaluation criteria, but application of those criteria in the evaluation of images necessitates visual perception knowledge that is primarily tacit. For example, a professional technologist may be able to tell you that the image is rotated, but may not be able to explain what they are seeing on the image that gives them that information. The speed with which the technologists make these determinations (~10-15 msec) makes it even more difficult for the students to pick up these skills by observing. My goal in this project is to better understand the evaluation process from a behavioral standpoint in order to develop strategies to assist students in developing higher quality image evaluation skills.
Serendipity in Research and Clinical Decision-Making
I am partnering with Dr. Sanda Erdelez, School of Information Science and Learning Technologies, in the investigation of the information encountering within medical imaging. Information Encountering is a theory that seeks to describe the role of serendipity in human information behavior. When undergoing an information encounter, seekers bump into and attend to information that is unrelated to their current information search, but instead related to a background problem that the seeker has not yet resolved. This phenomenon is important to the practice of evidence-based radiography. In evaluating images, as we are addressing in the Visual Knowledge Project, we want technologists to perceive and attend to the entire image, not just the aspects of the image they are expecting to see. Information encountering also plays a significant role in problem-based learning, and clinical problem-solving. Patients present with a wide variety of complaints and symptoms; and accurate diagnosis and clinical decision-making often hinges on noticing a piece of information that others overlook. While the study of information encountering is in its infancy, I hope that understanding more about the phenomenon and its triggers can help me develop tactics for improving attentiveness to such information in my students.
Developing Evidence-Based Practice Skills
Evidence-based practice is known to make health care more effective and cost efficient; and the formulation of effective search queries is essential to retrieving relevant and useful research evidence. Yet, little is known about how health professionals learn the inquiry skills needed to engage in evidence-based practice and the support that is needed to develop those skills. This aspect of my research seeks to describe evidence-based practice in the context of medical imaging and explore ways to help learners and practicing technologists develop the information literacy skills necessary to effectively engage in evidence-based practice in the workplace.
Collaborative Concept Mapping
Healthcare professionals rely heavily on teams to achieve effective patient care and safety; therefore, engaging learners in collaborative problem solving constitutes an essential component of healthcare education. In this facet of my research, I have investigated the information sharing patterns exhibited by radiography students engaged in collaborative concept mapping.
I have directed several projects investigating Problem-Based Learning and developing cognitively scaffolded multimedia environments for the health professions. In these studies, we have been investigating the most effective methods of designing PBL courses and the ways in which these methods, while maintaining efficacy, can be translated into an asynchronous electronic environment. Projects include the creation of an electronic web-based learning repository populated with PBL cases, and a University of Missouri – South Africa Education Program Partnership.
In both of these projects, we worked to improve health professions education in both our own courses and world-wide by developing empirically proven PBL curricular components (cases) which can be used by others to improve their students’ critical thinking skills.
Expanding Research Capacity
As a radiography researcher, I recognize the need to support and empower radiographers, and other health professionals, who wish to advance our professions through research. I have engaged in several studies related to this research theme.
International Collaboration in Medical Radiation Sciences
International collaboration is recognised for enhancing the ability to approach complex problems from a variety of perspectives, increasing development of a wider range of research skills and techniques and improving publication and acceptance rates. In this study, I engaged in a collaborative research team with radiographers from Australia and the U.K. to investigate the role that international collaboration plays in advancing the research knowledge base for medical imaging. We found that there are growing numbers of radiographers engaging in international research collaborations, but our overall rate of international collaboration lags behind that of other health professions.
Perceived Value of Scholarly Activity
Given the limited resources of time and money, it is beneficial to understand the perceived value of each type of scholarly activity to academic health professionals. This understanding could guide prioritization of faculty assignments and the allocation of resources. This study canvased academic health professionals regarding their viewpoints on a wide variety of health related research topics. Overall, the importance of scholarly activities was supported by high scores for all areas. Of particular interest, the importance of the application to practice and to teaching was rated and ranked more highly by health professions faculty than scholarship of discovery.
Research Training Needs
Persons with advanced degrees, particularly those affiliated with academic institutions, are often expected to perform research. Yet research productivity among health professionals, even those in academic institutions, remains low (Clifford, 1997; Legg & Fauber, 2005). There are many reasons why these professionals may not be very active in research endeavors, including insufficient discretionary time, inadequate funding, or a lack of essential skills in designing and carrying out research. This study identified the components of research performance that are most troublesome for health care professionals.
Improving Patient Experience
There is a widespread focus on patient satisfaction in healthcare delivery, including the delivery of medical imaging services. While we can implement strategies that we, as healthcare providers, believe will improve patient satisfaction, we cannot be certain that the changes we make will address the patients’ needs without engaging in evidence-based practice. In meeting our patients’ needs, it is important that we take the time to actually determine what their needs are. In this research theme, I have focused on patients’ information experiences as they relate to medical imaging.
Perspectives on Breast Screening
This project focuses on understanding how people obtain, share and use information regarding breast screening and the impact that information has on their compliance with current screening recommendations. Groups of mammographers, breast cancer survivors and women who avoid mammograms will give us a well-rounded perspective of women’s perceptions of current breast screening practice and hope to identify interventions to improve screening compliance.