Simulation in Radiology Education Ellen C. Benya, MD Department of Medical Imaging, Ann & Robert H. Lurie Children s Hospital of Chicago Department of Radiology, Northwestern University Feinberg School of Medicine
Definition Simulation is a technique, not a technology, to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. Gaba DM. Sim Healthcare 2007; 2:126-135.
Key Components of Simulation Education Clearly stated objectives presented to student prior to simulated experience Student prepared with basic knowledge of clinical material Hands-on deliberate practice Debriefing with feedback on performance
Evolution or Revolution in Medical Education
Apprenticeship Model Objectives/Competency Based Model
Apprenticeship Model Strength Trainees learn skills with oversight on real patients Weakness July Effect Learning is dependent on exposure to clinical material
Objectives/Competency Based Model ACGME Milestone Project Designed to help all residencies and fellowships produce highly competent physicians Provide more explicit and transparent expectations of performance Support self-directed learning and assessment Facilitate better feedback for professional development
Pediatric Radiology Milestones
Keys to Developing Competence Identify training goals Motivation to improve Opportunity to repeat and refine performance Critique/Feedback to Trainees Ericsson KA. Deliberate Practice and Acquisition of Performance: A General Overview. Acad Emerg Med 2008; 15: 988-994.
Key Components of Simulation Education Clearly stated objectives presented to student prior to simulated experience Student prepared with basic knowledge of clinical material Hands-on deliberate practice Debriefing with feedback on performance
Achieving Competence with Simulation Identify training goals Motivation to improve Opportunity to repeat and refine performance Critique to Trainees Clearly stated objectives prior to simulated experience Student prepared with basic knowledge of clinical material Hands-on deliberate practice Debriefing with feedback on performance
Type of Simulators Standardized patients Low fidelity High fidelity Part-task trainers Virtual reality Mannequins
Anesthesiology - 60-70 high-fidelity anesthesia simulation centers in the US for med students and trainees - Mandatory simulation for MOC Surgery - 40 centers with advanced simulation training worldwide run by the ACS CS Park. Simulation and quality in Anesthesiology. Anesthesiol Clin 2011; 29(1): 13-28.
Simulation in Radiology Contrast Reactions high fidelity mannequins low fidelity computer based model
Simulation in Radiology Procedural Simulations US guided foreign body removal pioneered by WE Shiels, DO. Turkey breast simulation model developed in 1989 with annual hands on RSNA workshops beginning in 1991 Georgian-Smith D. Look Ahead: The Evolution of Hands-on Simulation and Phantom Training. www.rsna.org/news.aspx?id=17928
Simulation in Radiology Procedural Simulations Fluoroscopy guided Intussusception Lumbar puncture CT guided Lumbar puncture Stein-Wexler R, et al. Pediatr Radiol 2010; 40: 1810-1815
Simulation in Radiology Interpretive Simulations Fluoroscopy UGI and Enemas in Neonates PACS on call ipad model Benya EC, Wyers MR, et al. Pediatr Radiol 2015; 45:1431-1416.
Potential Barriers Cost of buying or making simulation device Time to train residents and fellows Lack of experience using this educational technique
So where do we go from here?
Translational Research Assessing Effect of Simulation Experience Develop simulation models/devices/scenarios for Radiology T1 Evaluate educational outcomes looking for improved knowledge, skills, behaviors T2 Assess for skill transfer from simulation laboratory to observed clinical practice T3 Identify improvement in clinical outcomes due to simulation experience CS Park. Simulation and quality in Anesthesiology. Anesthesiol Clin 2011; 29(1): 13-28.
T1 Research - Severe contrast reaction emergencies high-fidelity simulation training for radiology residents and technologists in a children s hospital. Tofil NM, et al. Acad Radiol 2010; 17(7): 934-940.
T1 Research - Prospective randomized study of contrast reaction management curricula: computer-based interactive simulation versus high fidelity hands-on simulation. Wang CL, Schopp JG, et al. Eur J Radiol 2013; 82:2247-2252.
T2 Research- Simulation-based educational curriculum for fluoroscopically guided lumbar puncture improves operator confidence and reduces patient dose. Faulkner AR, et al. Acad Radiol 2015; 22: 668-673.
Future Directions Encourage collaboration to foster growth Start a subcommittee within our society to raise awareness Invite experts from other subspecialities to speak at SPR/IPR
References for Simulation in Radiology Education 1. Benya EC, Wyers MR, et al. (2015) Upper gastrointestinal fluoroscopic simulator for neonates with bilious emesis. Pediatr Radiol 45:1431-1416. 2. Chetlen AL, Mendiratta-Lala M, et al. (2015) Conventional medical education and the history of simulation in radiology. Acad Radiol 22:1252-1267. 3. Ericsson, KA (2008) Deliberate practice and acquisition of expert performance: A general overview. Acad Emerg Med 15: 988-994. 4. Faulkner AR, Bourgeois AC, et al. (2015) Simulation-based educational curriculum for fluoroscopically guided lumbar puncture improves operator confidence and reduces patient dose. Acad Radiol 22: 668-673. 5. Gaba DM (2007) The future vision of simulation in healthcare. Sim Healthcare 2:126-135. 6. Gaca AM, Frush DP, et al (2007) Enhancing pediatric safety: using simulation to assess radiology resident preparedness for anaphylaxis from intravenous contrast media. Radiology 245:236-244. 7. Georgian-Smith D. Look Ahead: The Evolution of Hands-on Simulation and Phantom Training. www.rsna.org/news.aspx?id=17928 8. Lerner C, Gaca AM. (2009) Ped Radiol 39:703-709 Enhancing pediatric safety: assessing and improving resident competency in life threatening events with a computer-based interactive resuscitation tool. 9. Mendiratta-Lala M, Williams TR, et al. (2015) Simulation center training as a means to improve resident performance in percutaneous non-continuous CT-guided fluoroscopic procedures with dose reduction. AJR 204(4):W376-386.
References for Simulation in Radiology Education 10. Park CS. (2011) Simulation and quality in Anesthesiology. Anesthesiol Clin 29(1): 13-28. 11. Picard M, Curry N, et al. (2015) Comparison of high-fidelity simulation versus didactic instruction as a reinforcement intervention in a comprehensive curriculum for radiology trainees in learning contrast reaction management. Acad Radiol 22:1268-1276. 12. Robertson HJF, Paige JT, Bok LR (eds) Simulation in radiology. Oxford University Press (2012) New York, New York. 13. Sabir SH, Aran S, et al. (2014) Simulation-based training in Radiology. JACR 11:512-517. 14. Sarwani N, Tappouri R. (2021) AJR 199(2): 244-251 Use of a simulation laboratory to train radiology residents in management of acute radiologic emergencies. 15. Schmidt E, Goldhaber-Fiebert SN, et al. (2013) Simulation exercises as a patient safety strategy. Ann Intern Med 158: 426-432. 16. Stein-Wexler R, Sanchez T, et al. (2010) An interactive teaching devise simulating intussusception reduction. Pediatr Radiol 40:1810-1815. 17. Tofil NM, White ML, et al. (2010) Severe contrast reaction emergencies high-fidelity simulation training for radiology residents and technologists in a children s hospital. Acad Radiol 17(7): 934-940. 18. Towbin AJ, Paterson BE, et al. (2008) Computer-based simulator for radiology: An educational tool. RadioGraphics 28: 309-319. 19. Wang CL, Schopp JG, Petscavage-Thomas JM, et al. (2013) Prospective randomized study of contrast reaction management curricula: computer-based interactive simulation versus high fidelity hands-on simulation. Eur J Radiol 82:2247-2252.
References for Simulation in Radiology Education 20. Wang CL, Schopp JG. (2011) AJR 196(6): 1288-1295 Prospective randomized comparison of standard didactic lecture vs. high-fidelity simulation for radiology resident contrast reaction management training.