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Objective:
In recent decades, education has become increasingly virtual, augmented by the COVID pandemic. More educators are turning to online modules to deliver material to students, allowing them to learn on their own time and at their own pace. However, whether or not these modules are as effective as traditional lectures is uncertain. The purpose of this study was to determine whether in-person lectures or online modules are more effective in teaching radiology to residents.

Materials and Methods:
All seven first-year radiology residents at the Penn State College of Medicine were tested on their ability to identify acute hip fractures on an x-ray. Only first-year residents were used because of their relatively minimal exposure to radiology. Residents were randomly assigned to one of two groups: an in-person lecture or an online, self-paced module. During their orientation week, the residents were given a 25-question pretest with a mix of cases showing hip fractures of varying difficulty as well as normal hips, and asked to score each case as "fracture" or "no fracture". Notably, they did not receive any feedback on which questions answered right or wrong or their score. The following day, the lecture group received an in-person lecture given by a board-certified MSK radiologist, while the module group was sent an online teaching module to complete based on the same material as the in-person lecture. They were asked to complete the module independently and on their own time. One week after the lecture was given, the residents were then emailed a 25-question posttest containing the same cases as the pretest but in a different order. Differences between the scores for each group were calculated and analyzed using the T-test, and p-values were calculated.

Results:
The lecture group, on average, scored a 62.7% on the pretest and a 78.7% on the posttest, improving by 16%. The online module group, on average, scored a 70% on the pretest and a 69% on the posttest, performing 1% worse. The p-value for this difference was calculated to be 0.023, indicating that the group receiving the in-person lecture performed significantly better than the group assigned to the online module.

Conclusion:
This study supports the hypothesis that in-person lectures are more effective at teaching radiology to first-year residents than online modules. This could be due to a variety of reasons. For one, those attending the in-person lecture were likely to be more engaged, as they are required to be present and have “protected” time for this learning to occur. In contrast, those given the online module were told to complete it on their own time, meaning they were not actually required to complete the module. Additionally, completing an online module independently leads to a greater chance of distractions and thus less attention being paid to the material. Lecture attendees also have the opportunity to ask clarifying questions, whereas online learners may not fully understand the material. Our study suggests that the widespread use of online teaching modules in radiology resident education should perhaps be reconsidered.