1. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Introduction
Under current Medicare scheduling, podiatrists are able to request funded plain x-ray images of the foot and ankle.
Undergraduate podiatry education needs to provide students with the relevant knowledge regarding the potential risk to patients as a result of their decision to request x-ray imaging.
Objectives
A ‘choose your own adventure’ approach to content delivery has been shown to provide a non-linear narrative with resultant positive effects on student engagement [1].
The aim of this study was to assess the effectiveness of using a clinical case study format to improve podiatry students’ clinical reasoning skills when requesting x-rays.

2. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Methods
An interactive multimedia story was developed by a Medical Imaging lecturer to highlight the appropriate clinical pathways that students should consider when assessing a patient for imaging.
The willing third year podiatry students were randomly divided into a test (n=20) and control group (n=20). The test group were given access to the branching story tutorial supplementary to the resources available to the control group.
A qualitative survey was distributed to ascertain whether students felt that the tutorial assisted in developing their clinical reasoning skills when requesting an x-ray series.
A formative quiz was also released to both groups to quantitatively determine whether the student understanding in the test group was enhanced.

3. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Example
An elderly patient presents to you with mobility impairment after having suffered a frontal lobe stroke 5 years ago
Observation suggests a high level gait disorder
You have performed various functional gait analysis tests but would like to visualise the metatarsals to assess foot pronation and the degree of hallux valgus deformity bilaterally
You are happy with the functional analysis
You are concerned about the patient’s biomechanics
Functional analysis is difficult due to the patient’s brain injury
What x-ray series would you request?
Non Weight Bearing Foot Series
Dorsi plantar
Medial Oblique
Lateral
Base of Gait Foot Series
Dorsi plantar
Lateral
Weight bearing Foot Series
Dorsi plantar
Lateral
You are concerned about the patient’s biomechanics
Response
Ideally this patient would be imaged weight bearing as the true degree of the pronation would only be visualised in both the DP and Lat when a weight loading is applied. If the patient performed the functional analysis well it would be preferable to perform a weight bearing series.
Note - due to the previous brain injury it may be unsafe to get the patient into the appropriate position so a non-weight bearing series would be acceptable in this situation.
Depending on how much structural information you require you may or may not request the Medial Oblique
So you should request - Bilateral Weight bearing feet
Dorsi plantar
Lateral
Example images provided

4. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Example
An elderly patient presents to you with mobility impairment after having suffered a frontal lobe stroke 5 years ago
Observation suggests a high level gait disorder
You have performed various functional gait analysis tests but would like to visualise the metatarsals to assess foot pronation and the degree of hallux valgus deformity bilaterally
You are happy with the functional analysis
You are concerned about the patient’s biomechanics
Functional analysis is difficult due to the patient’s brain injury
What x-ray series would you request?
Non Weight Bearing Foot Series
Dorsi plantar
Medial Oblique
Lateral
Base of Gait Foot Series
Dorsi plantar
Lateral
Weight bearing Foot Series
Dorsi plantar
Lateral
Response
Given that you have been unable to perform a functional analysis it is unlikely that the patient will be able to climb safely onto the weight bearing x-ray apparatus and even less likely they will be able to maintain a base-of-gait position.
A non-weight bearing series should be performed
So you should request - Bilateral non weight bearing feet
Dorsi plantar
Lateral L R
Example images provided L R

5. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Results
The results demonstrated that the group with access to the tutorials performed better on the formative quiz than the control group.
When asked if they felt the tutorial assisted in improving understanding of the most appropriate views, all students indicated that it had been a useful tool (Figure 1).
All qualitative feedback regarding the interactive tutorial was positive.
Examples of responses;
‘Because it allowed me to try and work through my answers and choose what I thought was right. It also explained in detail the correct answer and why as well as explaining why an answer was wrong.’
‘Helped to understand which views were needed and why’
Figure 1
Conclusion
This style of ‘choose your own adventure’ has been shown to stimulate active thinking and the use of simulated case studies allows students to contextualise learning to their professional practice. Providing students with active choices allows them to engage with the educational content which has a positive impact on the learning environment, and student experience [1]. This has been demonstrated in this study.
It is envisaged that the application of enhanced clinical reasoning of students will lead to more appropriate utilisation of diagnostic imaging requests by podiatrists in the future.
References
2.Mundy, D.P. and R. Consoli, Here be dragons: Experiments with the concept of 'Choose Your Own Adventure' in the lecture room. Innovations in Education and Teaching International, (2): p
Acknowledgements: I would like to thank QUT staff and students for their assistance with our research.
Acknowledgements: We would like to thank Queensland University of Technology staff and students for their assistance with our research.

6. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Example
An elderly patient presents to you with mobility impairment after having suffered a frontal lobe stroke 5 years ago
Observation suggests a high level gait disorder
You have performed various functional gait analysis tests but would like to visualise the metatarsals to assess foot pronation and the degree of hallux valgus deformity bilaterally
You are happy with the functional analysis
Functional analysis is difficult due to the patient’s brain injury
Functional analysis is difficult due to the patient’s brain injury
What x-ray series would you request?
Non Weight Bearing Foot Series DP
Medial Oblique
Lateral
Base of Gait Foot Series DP
Lateral
Weight bearing Foot Series DP
Lateral
Response
Given that you have been unable to perform a functional analysis it is unlikely that the patient will be able to climb safely onto the weight bearing x-ray apparatus and even less likely they will be able to maintain a base-of-gait position.
A non-weight bearing series should be performed
So you should request - Bilateral non weight bearing feet AP
Lat L R
Example images provided L R

7. Improving Podiatry students’ clinical reasoning when requesting x-rays: An interdisciplinary approach using multimedia tools
Kelly Wilson-Stewart: QUT
Example
An elderly patient presents to you with mobility impairment after having suffered a frontal lobe stroke 5 years ago
Observation suggests a high level gait disorder
You have performed various functional gait analysis tests but would like to visualise the metatarsals to assess foot pronation and the degree of hallux valgus deformity bilaterally
You are happy with the functional analysis
Functional analysis is difficult due to the patient’s brain injury
Functional analysis is difficult due to the patient’s brain injury
What x-ray series would you request?
Non Weight Bearing Foot Series DP
Medial Oblique
Lateral
Base of Gait Foot Series DP
Lateral
Weight bearing Foot Series DP
Lateral
Response
Ideally this patient would be imaged weight bearing as the true degree of the pronation would only be visualised in both the AP and Lat when a weight loading is applies. If the patient performed the functional analysis well it would be better to do a weight bearing series.
Noting that due to the previous brain injury it may be unsafe to get the patient into the appropriate position so a non-weight bearing series would be acceptable in this situation.
Depending on how much structural information you require you may or may not request the Medial Oblique
So you should request
Bilateral Weight bearing feet AP
Lat
Example images provided