The use of ‘Think-Out-Loud’ methodology in the development of teaching materials for abbreviated breast Magnetic Resonance Imaging scan (FAST MRI) interpretation, and a comparison of the learning experience of two reader cohorts

Abstract

Aim FAST MRI is an abbreviated breast MRI technique, proposed as a screening tool for breast cancer. This study aims to explore how ‘Think-Out-Loud’ (TOL) methodology can effectively develop and shape training to interpret standard breast MRI on readers’ learning experience. Materials and methods TOL methodology asks people to speak their thoughts while performing a task; to say whatever they are looking at, thinking, doing, and feeling at each moment. It helps determine expectations and identify aspects of confusion. This methodology was adopted with two groups of image readers to develop training materials for FAST MRI interpretation. Eight image readers (readers); 4 NHS Breast Screening Programme (NHSBSP) breast MRI and mammogram readers (Group 1) and 4 NHSBSP mammogram readers who do not read breast MRI (Group 2) were audio and video recorded during training. Content analysis was undertaken. Results TOL was well received by the readers and allowed iterative development and refinement of a training package. Challenges relating to introducing new concepts and managing uncertainty were identified through the analysis of the TOL audio data. Additionally, Group 2 asked for more clarification than Group 1, of both the teaching materials and how to use the image-manipulation software. Conclusion TOL methodology allowed effective training of both groups of readers. The iterative nature of individual training ensured production of user-friendly materials including frequently-asked-questions sheets. It allowed for each person to feel that their views were fully listened to and incorporated into the training package, allowing for training materials with high face validity.

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation training for mammogram readers: a multi-centre study assessing diagnostic performance, using an enriched dataset

“…The structured training package [ 21 , 27 ] was adapted to enable in person, small-group training, delivered by two radiologists experienced in fpMRI reporting Additional file 1 (Appendix 2: example study day agenda). Table 1 documents participants’ and trainers’ mammogram and fpMRI interpretation experience.…”

“…A previous single-centre study, of 8 readers from the UK National Health Service Breast Screening Programme (NHSBSP), suggested that NHSBSP mammogram readers could be effectively trained to interpret abMRI with a single day’s one-to-one training [ 21 , 27 ]. Other international publications describe specific abMRI interpretation training for radiologists reading abMRI [ 1 , 28 , 29 ], but there is little published evidence evaluating abMRI interpretation training.…”

The potential utility of abbreviated breast MRI (FAST MRI) as a tool for breast cancer screening: a systematic review and meta-analysis

“…Published studies of abMRI techniques have used expert MRI readers for interpretation, and this has been suggested as a potential barrier to expansion of the technique for personalised screening with abMRI 24 . However, with a single day's standardised training 33 to interpret the simplest of the abMRI techniques (FAST MRI), an early study suggests that professionals who are already competent at reading mammograms can achieve similar levels of accuracy of interpretation of abMRI to that of expert breast MRI readers 34 . If these results should be validated in subsequent studies 35 , limitation to expansion of the role of abMRI (FAST protocol) on the grounds of workforce feasibility will have been reduced.…”

Evaluating the effectiveness of abbreviated breast MRI (abMRI) interpretation-training for mammogram-readers: a multicentre study assessing diagnostic performance, using an enriched dataset

“…The structured training package (21,27) was adapted to enable in person, small-group training, delivered by two radiologists experienced in fpMRI reporting (Appendix 2: example study day agenda). Small group presentations on aspects of abMRI interpretation alternated with guided hands-on workstation Throughout the training, mammogram-readers' prior knowledge was utilised and activated by repeated reference to similarities and differences between the two breast imaging modalities (abMRI and mammogram) and the varied appearances of cancer, and of other common breast pathologies, as displayed by each modality (33).…”

“…A previous single-centre study, of 8 readers from the UK National Health Service Breast Screening Programme (NHSBSP), suggested that NHSBSP mammogram-readers could be effectively trained to interpret abMRI with a single day's one-to-one training (21,27). Other international publications describe speci c abMRI interpretation training for radiologists reading abMRI (1,28,29), but there is little published evidence evaluating abMRI interpretation-training.…”