Conventional Medical Education and the History of Simulation in Radiology

Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.

Medical education has traditionally revolved around the apprenticeship model outlined by Flexner and Cameron , in which skills are learned under the tutelage of physician mentors and perfected by trainees through extensive hands-on experience in the hospital setting. However, there have been many changes in the way health care is delivered, reimbursed, and perceived by society ( Fig 1 ). Recent cost-containment and quality and safety mandates at the national and local levels challenge this model of medical education. A decrease in hospital length of stay, restrictions on resident work hours, and decreased resident autonomy have led to fewer opportunities for hands-on experience with patients. Work hour regulations, productivity pressures, and patients’ awareness of trainees “practicing” on them has led to a decline in training opportunities . These changes translate to a truncated training experience, fewer direct patient encounters, and fewer opportunities to perform procedures, which complicates traditional models of medical education. Simulation represents an attractive supplement to these traditional training methods in radiology.

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Figure 1

Reasons for increased use of simulation-based training in medical education. (Color version of figure is available online.)

Simulation training allows trainees to practice a procedure or clinical scenario in a simulated environment before treating actual patients. These training modules use different scenarios and equipment and vary in realism.

Simulation is used in many nonmedical settings to teach crisis management skills to professionals such as pilots, military personnel, firefighters, and nuclear power plant workers . Currently, simulation is being expanded in the medical field to enhance clinical training. For example, medical schools use simulated patients to help teach communication and professionalism skills to students, allowing for constructive feedback in a safe environment and at the same time students gain experience. In fact, simulation-based learning in medical school is proving to be superior to problem-based learning for the acquisition of critical assessment and management skills . Medical specialties spanning from general practice to surgical subspecialties use high-fidelity simulation as a promising method for enhancing team training, increasing patient safety, preventing errors, and improving clinician performance .

Computer-based simulations are also being used for enhancing medical training and assessment, such as Advanced Cardiac Life Support recertification through the American Heart Association, which incorporates multiple comprehensive patient scenarios to determine competency in certification. Similar assessment with objective structured clinical examinations for medical students and residents are being used for board certification. Objective structured clinical examinations offer formalized review of necessary clinical skills, including interviewing patients, physical examinations, ordering and interpreting diagnostic tests, performing procedures, peer to peer communication, and patient handover. This kind of training assesses a clinician’s decision-making process with multiple scenarios to test competency and can be both formative if offered mid-course, providing an opportunity for improvement based on feedback, or summative, for a final grade.

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Figure 2

An example of a multifaceted radiology simulation scenario that incorporates procedural skill acquisition as well as professionalism and communication skills is shown. (Color version of figure is available online.)

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Simulation training of procedural skills in radiology

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Pediatrics

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Cross-Sectional Interventional Training of Percutaneous Image-Guided Procedures

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Vascular Interventional Training

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Neuroradiology

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Nuclear Medicine

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Thoracic Radiology

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Simulation training of nonprocedural skills in radiology

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Interpretive Skills

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Team-Based Training and Crisis Management: Contrast Reactions, Sedation Management

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Professionalism and Communication

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Hybrid Simulation

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In Situ Simulation

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Current simulation equipment and software

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Part-task Trainers

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Computer-enhanced Mannequins

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Virtual Reality Simulators

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PACS Simulators

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Assessment methods and measuring competency

Assessment Methods

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Psychometric Tools for Interpersonal/Communications Skills

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Checklists for Procedural Skills

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Pretests and Posttests for Knowledge

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Measuring Competency

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Observational Assessment Tools

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Nonobservational Tools

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Barriers and Strategies for Implementation

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Access

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Cost

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Instructor Availability

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Educational Validity

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Assessment and Outcome Measurement

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Future Directions

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Improvements in Simulation Methods

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Simulation in Medical Curricula, Professional Credentialing, and Recertification Examinations

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Conclusions

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Acknowledgments

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Conventional Medical Education and the History of Simulation in Radiology

Simulation training of procedural skills in radiology

Pediatrics

Cross-Sectional Interventional Training of Percutaneous Image-Guided Procedures

Vascular Interventional Training

Neuroradiology

Nuclear Medicine

Thoracic Radiology

Simulation training of nonprocedural skills in radiology

Interpretive Skills

Team-Based Training and Crisis Management: Contrast Reactions, Sedation Management

Professionalism and Communication

Hybrid Simulation

In Situ Simulation

Current simulation equipment and software

Part-task Trainers

Computer-enhanced Mannequins

Virtual Reality Simulators

PACS Simulators

Assessment methods and measuring competency

Assessment Methods

Psychometric Tools for Interpersonal/Communications Skills

Checklists for Procedural Skills

Pretests and Posttests for Knowledge

Measuring Competency

Observational Assessment Tools

Nonobservational Tools

Barriers and Strategies for Implementation

Access

Cost

Instructor Availability

Educational Validity

Assessment and Outcome Measurement

Future Directions

Improvements in Simulation Methods

Simulation in Medical Curricula, Professional Credentialing, and Recertification Examinations

Conclusions

Acknowledgments

References

Further Reading

Adaptive Tutorials Versus Web-Based Resources in Radiology A Mixed Methods Comparison of Efficacy and Student Engagement

Capricorn–A Web-Based Automatic Case Log and Volume Analytics for Diagnostic Radiology Residents

Case Comparisons