Diagnostic radiology curriculum for emergency medicine trainees in India: comparing simulation and didactics.

Background: Emergency medicine education in India lacks effective diagnostic radiology interpretation curricula. Active learning curricula delivered through virtual asynchronous learning have the potential to fill this gap in international emergency medical education. This study aimed to evaluate an active learning radiology curriculum among Indian emergency medicine (EM) trainees. Methods: We conducted a randomized controlled trial at multiple EM training programs in India. Trainees were randomized to receive an active (experimental) or a passive learning curriculum (control). Trainees took a pretest, initial post-test, and delayed one-month post-test to assess their diagnostic accuracy of computed tomography (CT) brain and musculoskeletal X-ray (MSK XR) interpretation. We obtained surveys assessing perceptions of test difficulty. The primary outcome was the change in pre-test to initial post-test scores. The secondary outcomes were changes in the pre-test to one-month post-test and self-efficacys cores. Results: A total of 79 trainees from 12 sites across North, West, and South India were enrolled, and 59 completed the one-month post-test. The active learning cohort (ALC) showed a significant improvement in CT brain pre-test to initial post-test of 9.8% (95% CI, 3.1% to 16.6%) (p = 0.006) with a medium effect size (d = 0.7). There was no significant improvement at the one-month post-test for the ALC or CT brain post-test for the passive learning cohort (PLC). There was no significant improvement for the MSK XR post-test for either cohort. Linear regressions comparing the ALC and PLC did not find a statistically significant effect to explain the mean score difference between cohorts. Self-efficacy scores significantly increased for both the ALC (p < 0.001) and PLC (p = 0.004). Conclusion: This pilot study showed modest benefits of an ALC compared to a PLC for improving CT brain interpretation in an international setting. Future research can refine active learning curricula to improve diagnostic radiology interpretation among EM trainees in international settings.