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"Structured Scaffolding for Early Oral Reasoning: A Modern Team-Based Training Model for Radiology Residents"
Brandon Ritchie1, Lesley Summerville1, Daniel Kuo2
1Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, Ohio 44106 (B.R., L.S., N.F.); Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, Ohio 44106 (B.R., L.S., D.K., M.S., N.F.).
Rationale:
In 2023, the American Board of Radiology (ABR) announced the reinstatement of the oral certifying examination after more than a decade of exclusive reliance on a computer-based multiple-choice certifying examination. As residency programs adapt to this transition, educational approaches are needed to intentionally develop oral reasoning skills early in training. We developed a longitudinal, team-based educational framework that applies principles of cognitive scaffolding to early oral board skill development.
Methods:
A prospective educational innovation was implemented over 12 months for 20 first- and second-year diagnostic radiology residents. Faculty-facilitated oral board-style case discussions were organized around six sequential cognitive domains. Learner-reported outcomes were assessed using anonymous pre- and post-intervention surveys.
Results:
Survey response rates were 90% (18/20) pre-intervention and 85% (17/20) post-intervention. Significant improvements were observed across all eight matched learner-reported domains (all p < 0.05). Mean knowledge of oral case presentation increased from 3.06 ± 0.94 to 4.19 ± 0.40, while comfort with oral case presentation improved from 2.39 ± 0.98 to 3.56 ± 0.96 on a five-point Likert scale. Participants also reported favorable perceptions of the team-based format, structured reasoning framework, and educational value of the curriculum.
Conclusion:
A structured, longitudinal, team-based educational framework was associated with improvements in learner-reported oral reasoning skills and perceived preparedness for oral board-style case interpretation. By combining cognitive scaffolding, deliberate practice, and a collaborative, psychologically safe learning environment, the framework provides a reproducible approach for integrating oral reasoning instruction into residency curricula.
