New standards for hybrid teaching in radiology using the example of Raditorium.com

Abstract

Purpose

Due to their constant availability and flexibility, digital media offer a cooperative and communicative learning arrangement for student training. These advantages must be integrated into medical didactics as part of a hybrid teaching concept, and the digital potential must be used to improve preparation and follow-up opportunities, increase the effectiveness of face-to-face courses, and optimize learning success. For this purpose, the online learning platform Raditorium.com was developed. The aim of this thesis is to demonstrate the learning success of Raditorium.com as the basis of a hybrid learning concept in the field of medical didactics and to authorize it on the basis of student evaluations.

Materials and Methods

As the core of hybrid learning, the online learning platform Raditorium.com was analyzed in terms of its concept and impact. The website focuses on course preparation and follow-up and combines cursory and associative learning with the motivational strategy of gamification. Raditorium.com embodies a teaching concept for the digital enhancement of face-to-face courses in order to maximize studentsʼ learning success.

Results

The results of the student evaluations show a significant improvement in overall satisfaction since the introduction of Raditorium.com as a learning platform. In the semesters before the introduction of Raditorium.com, the average ranking of radiology among clinical subjects was 24 and subsequently increased to 1.6. The average score of the evaluation issues (1–5; 1: strongly agree, 5: disagree) over a 6-semester period improved from 3.14 to 1.2 and the final grade of the entire course from 3.5 to 1.2. Studentsʼ open comments also emphasized better exams, adjustment to individual needs, and greater learning enjoyment.

Conclusion

Thanks to their flexibility and individual availability, online platforms make it easier for students to learn radiological concepts and provide an intrinsically motivating learning environment through the possibility of innovative learning strategies that can be ideally synchronized with the teaching concept of preparation and follow-up.

Key Points

• Just-in-time teaching optimizes learning motivation by providing instructional materials at the moment of need.

• Structured digital content enhances effectiveness.

• Gamification increases student motivation and participation.

• The introduction of the online platform Raditorium.com improves student satisfaction.

Citation Format

Horr A, Bota S, Huhndorf M et al. New standards for hybrid teaching in radiology using the example of Raditorium.com. Rofo 2025; DOI 10.1055/a-2514-0564

Keywords

Online learning platform - gamification - hybrid learning routine in radiology - preparation and follow-up work - Just-in-Time Teaching

Introduction

The measures put into place in 2020 in response to the corona virus required rapid implementation of fully digital teaching, specifically in the daily university routine, due to the massive restrictions on in-person classes. With the easing of restrictions, in-person teaching at universities became increasingly established again. However, only 14% of students prefer a learning model consisting of only in-person teaching, while 86% prefer a hybrid learning model [1]. Digital media are readily available and provide flexibility and a cooperative and communicative learning arrangement for student and professional training [2]. These known didactic advantages of a hybrid learning concept should also be integrated in didactics in medicine, which experienced a fundamental boost during the pandemic [3].

Due to the wide range of imaging methods, radiology is suitable for such digital integration. Moreover, due to the relevance of radiology for all disciplines, learning success in this area should be maximized to ensure optimal learning of the important principles of imaging. Radiology is extremely important because of its synergy with other disciplines. Since, in our experience, it is difficult to teach all content to be learned during the student training period, we feel that there is a need for new and innovative methods of learning. According to Miller et al., the main responsibility of medical students is to learn medicine [4]. Therefore, medical teaching should allow need-based learning.

As a result, we developed the online learning platform Raditorium.com to allow hybrid teaching and to be used for our core radiology concepts [5].

Raditorium.com is a website that allows students to perform digital preparation and follow-up of radiology concepts by providing handouts, case examples, self-tests, and lecture slides for a particular course (Supp. 1). An analogy can be drawn between this teaching concept and the training concept used in high-performance sports. An athlete goes through different phases of preparation and follow-up when training for a competition in order to achieve optimal performance during the competition and to increase performance in the long term. The use of preparation and follow-up can be identified as a key factor for later success and in the case of teaching allows access to adapted learning content. Raditorium.com offers students flexible access to simple but essential preparation and follow-up, thereby increasing the motivation for and effectiveness of each in-person class.

In the case of digital learning, Reinmann differentiates between e-learning by distributing (distribution), e-learning by interacting (interaction), and e-learning by collaborating (collaboration) and describes the success of a combined method, i.e., blended learning [6]. These concepts are reflected in the design of Raditorium.com. Based on the categories defined by Kerres (content, communication, and construction) [7] and inspired by the behavioral approaches of Gagnés [8], Kerresʼs 3–2-1 model defines specific parameters that allow didactically useful structuring [7]. The preparation of learning material (content) is followed by communication and cooperation (communication) and finally by a self-check (construction) [9].

The learning and motivation concepts used in Raditorium.com are cursory and associative learning as well as gamification to increase the intrinsic motivation of students. Cursory reading or learning corresponds to the SQ3R method. By skimming the content to be learned, the key points can be grasped in a short period of time. This information is then reviewed and discussed in depth during the in-person class [10]. Gamification meaning game-like presentation of new learning content helps to ensure higher productivity while simultaneously increasing user satisfaction [11]. Bettina Baesler, co-founder of the online learning platform LernRad, describes higher long-term learning success as a result of independent learning [12]. Raditorium.com is also based on this principle.

The goal of the present study is to compare the evaluation results of students at our site before and after the introduction of the online learning platform Raditorium.com in order to quantify the benefits of the new learning platform.

Materials and Methods

Our learning concept is comprised of three important components: 1) preparation, 2) in-person class, and 3) follow-up. Raditorium.com represents a key medium particularly for preparation and follow-up.

Basic idea and structure of Raditorium.com

Raditorium.com was established as an online learning platform to accompany classes at the local campus for students in their clinical semesters. It provides students with free access to additional learning materials and methods in order to increase the value of in-person classes and to enhance learning success.

This analysis was approved by the local ethics committee.

The preparation for a particular in-person class consists of a handout for students and a patient case suitable for the particular class including image material that can be processed digitally with conventional radiological tools. Both content and construction are communicated as initial learning activities as in a preliminary stage of a flipped classroom [13]. The cursory reading principle is used. Our teaching experience has shown that students can have difficulty, particularly in the case of complex subjects (e.g., magnetic resonance imaging, MRI), depending on their prior knowledge to fully comprehend in-person classes and thus to achieve the greatest possible learning success. This is expressed, for example, as a lack of participation as well as difficulty articulating and discussing specific comprehension questions.

Preparation principle

In the case of cursory learning, i.e., when reading or learning technical or informational texts, the reader should begin by skimming the text to obtain an initial impression of the content. When the text is then subsequently closely read, the detailed content supplements the already acquired preliminary information resulting in higher learning success. Our teaching concept uses precisely this strategy and allows students to get an initial impression of learning content based on handouts, lecture slides, and lecture-relevant case studies. Dosing of preliminary information is extremely important in order to prevent students from being overwhelmed and to increase motivation to analyze the content in advance. The presentation of the content also plays an important role since visually interesting learning materials promise to be more engaging [13]. Thus, e-learning by distributing is ensured by the provision of important materials. The learning process thus takes place with support but is typically independent as recommended by Bettina Baesler [14].

Follow-up principle

Follow-up mainly consists of a quiz with questions based on the preceding lecture to be answered on Raditorium.com. The responses to the questions are evaluated by the next class and are briefly discussed at the start of the class. As a result, learning mistakes and questions can be addressed quickly. The brief recapitulation also helps to achieve long-term learning success. The digital learning content is optimally linked to in-person teaching in terms of a hybrid teaching concept. The fact that the learning content is still fresh in the mind at the time of the in-person class results in significant added value. This is an advantage compared to other learning methods in which the student evaluation and difficulties understanding technical content are often not known until the end of the semester. To encourage student motivation, we used a point system for the quiz and gamification as the motivation principle. The integration of games in the learning process, e.g., the collection of points, and the possibility of being named the winner at the end of the semester can make learning more exciting and motivate students in this established principle. At the end of the semester, the students with the most points receive an award. According to Reinmann, e-learning by interacting is combined here with e-learning by distributing. At the same time teachers receive important information about the level of knowledge and understanding of students and can adapt future courses. As in high-performance sports, in-person classes are able to be adapted on a more individual basis during the entire semester in order to achieve the best possible learning success for the students.

Collecting evaluation results

The concept and the effect of Raditorium.com were analyzed by evaluating the rankings from the studentsʼ semester evaluations starting in winter semester (2018/19 (WS 18/19), i.e., for a total of seven semesters prior to the introduction of Raditorium.com and 3 semesters after the introduction. The inclusion of evaluation results starting in WS 18/19 shows the expected influence of the corona virus pandemic and additionally allows comparison of the results after the pandemic with those before the pandemic.

The numeric evaluation is first assessed starting with summer semester 2020 (SS 20) because there has since been a change in the evaluation sheets used by the local medical school. School grades 1–5 were used with 1 indicating complete agreement and 5 indicating complete disagreement.

Results

The present results are anonymized and were obtained from the semester evaluations of the medical school at Christian-Albrechts-University Kiel. The evaluation participants were medical students in their first clinical year.

The teaching of students was fully expanded to include the online platform Raditorium.com in the Clinic for Radiology and Neuroradiology at the university hospital Schleswig-Holstein, Campus Kiel in SS 22. In WS 21/22, initial learning content was offered online as a test phase. A positive trend in the results of student evaluations of the medical school – compared to the corona virus pandemic – was already able to be identified. In SS 22, an improvement in ranking to 16 was seen followed by a further improvement to a ranking of 2 in SS 22 and 23 ([Fig. 1]). In the four evaluations prior to complete implementation of Raditorium.com, the average ranking of radiology among clinical subjects was 25. It subsequently improved to 1.6 after the introduction. Although the conditions for teachers in clinical subjects were the same during the corona virus pandemic, the evaluation results in the three semesters prior to the introduction of Raditorium.com can be partly attributed to the corona virus pandemic. However, the average evaluation results with Raditorium.com are significantly better than before the pandemic when the average was 13. The best ranking in the teaching evaluation prior to the introduction of Raditorium.com was 10. This increased to 1 after the introduction of Raditorium.com.

Fig. 1 Ranking of the Clinic for Radiology and Neuroradiology at the university hospital Schleswig-Holstein, Campus Kiel between winter term 2018/19 and summer term 2023.

Grading of the evaluation questions and the number of questions regarding teaching content (grade 1–5; 1: strongly agree, 5: disagree) has been expanded at this location since the corona virus pandemic and this expanded system has been used since then. A significant improvement in all points ([Table 1]) has been seen since this time. The mean value of all evaluation questions from WS 20/21 to SS 23 even improved from 3.14 to 1.2. The final grade for the entire course improved from 3.5 to 1.2. Raditorium.com can be identified as a central change with a causal effect on this improvement.

Table 1 Questions and results of the student evaluation of teaching at the school of medicine showing a comparison of the mean results of summer semester 2020, winter semester 2020/21, and summer semester 2023 with 1 indicating full agreement and 5 indicating disagreement.

Questions regarding learning content		Mean values
		SS 20	WS 20/21	SS 23
1	All information needed for the course was available in a timely manner.	2	3.5	1.2
2	The structure of the course content was clear.	2.1	3.7	1.3
3	The learning objectives of the course were clearly communicated.	2	3.7	1.2
4	The course supported my interest in the learning content.	1.6	2.9	1.2
5	I learned a lot of new information in the class.	1.9	2.8	1.4
6	The provided materials facilitated good exam preparation.	2.1	3.5	1.1
7	The tempo of the course was appropriate for me.	2.9	2.3	1.1
8	The material to be learned in the course was appropriate for me.	2.9	2.4	1.1
9	Overall, I am very satisfied with the course.	2.1	3.5	1.2

In the evaluation of SS 23, 91.3% of students gave the courses a very positive rating. Evaluation of the open comments shows a definitive relationship to the online learning platform Raditorium.com. Students are in favor of independent learning and describe the advantage of being able to subjectively adjust to their own learning tempo.

[Fig. 2] shows a graph of the differences in the average evaluation between WS 20/21 and SS 23. The most important improvements were seen with regard to the following points: 1) All information needed for the course was available in a timely manner, 2) The content of the course had a clear structure, 3) The learning objectives of the course were clearly communicated, 6) The provided materials allowed proper exam preparation, and 9) I am very satisfied with the course.

Fig. 2 Graphic representation of the mean values from student evaluation of teaching from winter semester (WS) 2020/21 until summer semester (SS) 2023 based on rating of questions 1–9 from [Table 1].

In-depth study of the learning content is also important and was performed by 86.4% of the students. The game-like presentation of learning content, e.g., in the form of quizzes, is described as particularly engaging in the open comments section of the evaluation. Therefore, 95.2% of students stated that they felt well prepared for the examination. Particular emphasis was placed on the four main areas of Raditorium.com: 1) Uniform lecture slides, 2) Handouts, 3) Lecture-based case studies, and 4) Self-tests. Digital access to lecture slides is considered especially helpful for subsequent follow-up. Students can follow lectures without having to write down all necessary information. This allows them to concentrate fully on what is being said. In addition, the early availability of learning content makes it possible for students to prepare topics before class. Students stated that this allows them to follow content better and to participate more actively in questions and examples.

The digital handouts for courses provide an overview of examination-relevant content and thus have a positive effect on individual course and examination preparation. Students highlight the advantages of flexible access to such summaries in the free-text comments since the content can be read and learned on their preferred device.

On the whole, the evaluation results thus show an enormous improvement in the satisfaction of students, particularly due to Raditorium.com being established as a hybrid teaching medium. These results confirm our innovative teaching approach and are the basic requirement for a modern radiological teaching concept.

Conclusion

Training regarding imaging modalities is extremely important due to the their key interdisciplinary role and the strong synergy between radiology and other disciplines. Finally due to the plurality of imaging and interventional methods, radiology is a core discipline. Using learning and motivation principles like cursory learning and gamification, complex learning content can be processed as effectively as possible, resulting in long-term learning success. Raditorium.com combines the needs of students and effective learning strategies with a focus on the preparation and follow-up of in-person classes. As an online learning platform, it provides one of foundations of hybrid teaching. This concept can be used for additional areas of didactics in medicine in order to communicate learning content to students in a practical manner while ensuring long-term success.

Discussion

In the wake of digitalization, a hybrid learning concept is highly desirable for students at medical schools. Digital learning platforms as exemplified by Raditorium.com allow flexible access to learning content for preparation and follow-up. Only a digital device is needed. Game-like websites use the concept of gamification, for example, in the form of integrated self-tests with rankings, to ensure greater intrinsic motivation and thus higher learning success. The provision of relevant content also allows better focus and participation on the part of students during in-person teaching since the students do not need to take notes and can actively participate during class time. The teaching evaluations in particular show that the majority of surveyed students felt well prepared for in-person classes due to the supportive function of preparation and follow-up and this increased their motivation for further study of the topics.

The online learning platform Raditorium.com is the core of our concept and offers students simple access to all relevant materials so that they can implement the principle of preparation and follow-up. Studies performed to date show the positive effect of e-learning sites on learning success, i.e., a study by Scott et al. from the year 2017. In this study, 76% of surveyed medical students stated that they use e-learning resources of other universities or institutions [15]. In our opinion this need should ideally be met by each medical school individually since the content can thus be optimally adjusted to the schoolʼs own courses, content, examinations, and teaching concepts.

The development of Raditorium.com required prior analysis of e-learning in order to be able to integrate the online learning platform into the structure of the school in a didactically useful manner. It is important to note that e-learning is significantly more significant than the simple provision of texts and multimedia materials on platforms on the Internet [16]. The results of Raditorium.com provide new insight into the proper use of a digital learning platform based on the concept: content, communication, and construction. However, it is important to determine the best presentation of these areas prior to designing such an online learning platform. The mere availability of a digital learning platform does not ensure a didactically useful teaching concept. Finally, as a result of the increasing number of digital online teaching options, a number of digital learning resources in medicine and radiology are already available and could provide initial orientation to facilitate the creation of an own website [17].

When developing Raditorium.com, the preparation of the learning content as well as the creation of the website were very time-intensive. The initial creation of a digital learning platform requires a wide range of competencies in the field of IT and digitalization [18] and can be very expensive. However, as the medical schoolʼs own solution, Raditorium.com allows a high degree of flexibility in the preparation of learning content. New content can be entered easily and quickly in a well-structured website. This results in increased learning success for students as well as a time savings for instructors. The linking of external learning content (third-party providers) is advantageous for several reasons but it may not be coordinated with oneʼs own teaching concept, e.g., with regard to unnecessary redundancy and content that is not suitable for the particular semester.

A further advantage of Raditorium.com is the just-in-time evaluation of self-tests completed by students. This allows early detection of learning deficits among students that can be immediately corrected with additional information provided via Raditorium.com or in the next in-person class. Upcoming classes can also be adapted.

One main aspect of an online learning platform is data protection. It is important to allow students secure access to learning content even online. Therefore, Raditorium.com is password-protected and meets the requirements for a secure website – by anonymizing data among other things [19].

It should be noted that the present evaluation data only show the development for one year. Since the online learning platform Raditorium.com was first fully implemented in SS 22, long-term results regarding academic performance or long-term improvement in student satisfaction cannot yet be shown. However, the results obtained to date show a causal relationship between the evaluation results and Raditorium.com. The online learning platform became fully established between evaluation points SS 22 and SS 23 as a key medium that combines flexibility and individuality and meets the requirements for hybrid teaching. Since the introduction of Raditorium.com was the main project in this period, other third-party variables can be largely ruled out. However, to be able to compare the relationship between Raditorium.com and the learning success of individual students, additional long-term studies are needed in the future. Nevertheless, the results clearly show the benefit of digital learning platforms.

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Publication History

Received: 10 July 2024

Accepted after revision: 30 December 2024

Article published online:
03 March 2025