Rationale and Objectives
Radiology residents have variable training in managing acute nonrenal adverse reactions to iodinated contrast media because of their rarity. Preliminary results show positive feedback and knowledge gain with high-fidelity simulation-based training. Financial costs and the time required to implement a high-fidelity simulation curriculum are higher than for a lecture series. The objective of this study was to provide a financial and time cost-benefit analysis for high-fidelity simulation training of acute adverse reactions to iodinated contrast media.
Materials and Methods
Forty-four radiology residents were divided into lecture and simulation groups. Five simulation scenarios were created, with core education content mirrored in the lecture. Lengths of faculty time commitment and resident training were recorded. Financial costs, including manikin and simulation facility rates, were recorded and divided by the number of residents to obtain per resident simulation and lecture costs. A written evaluation of the experience, with Likert-type items and unstructured response items, was conducted.
Results
Cost per resident for simulation training setup was $259.76, and $203.46 for subsequent years, compared to <$5 for lecture. Faculty time was 7 academic days for simulation versus 2 days for lecture format. Resident simulation commitment was 3 hours 30 minutes. Time to train technologists to run the simulation was 3 hours. All residents provided positive feedback regarding the simulation curriculum, with mean feedback scores statistically higher than lecture group ( P < .05).
Conclusions
This study illustrates that financial costs of implementation are low compared to the potential cost of morbidity associated with the life-threatening event of an acute adverse reaction to iodinated contrast media.
Acute nonrenal adverse reactions to nonionic iodinated contrast media are life-threatening events in radiology departments. The overall incidence of acute adverse reactions to iodinated contrast media from several prior studies is estimated to be 0.05% to 3.1% . The incidence of a moderate to severe adverse reactions is even lower, reported at 0.04% to 0.08% . However, the mortality associated with a moderate-severity to high-severity acute adverse reaction to iodinated contrast media is significant, estimated at approximately 1 per 168,363 patients receiving contrast media . The likelihood of a radiologist having to manage a life-threatening reaction during his or her career is almost inevitable. A recent mail survey indicated that 69% of practicing radiologists and residents had been involved in treating moderate or severe reactions .
Several studies have provided alarming results regarding radiologists’ abilities to manage these emergency scenarios. A survey assessing knowledge and skills for treating acute adverse reactions to iodinated contrast media showed that only 53% of management questions were answered correctly . A more recent study indicated that only 41% of radiologists provided acceptable medication doses and routes of administration, while 17% of radiologists administered overdoses. Only 11% knew the equipment required in an emergency box to manage an adverse reaction . Both of these studies suggest that many radiologists’ knowledge for treating adverse reactions to iodinated contrast media is deficient.
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Materials and methods
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Educational Curriculum
Lecture Group
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Table 1
Critical Teaching Points Included in Both Lecture and Simulation Training
Administration of oxygen via proper route and dose Administration and correct dosing of atropine for vasovagal reactions Avoidance of diphenhydramine hydrochloride in a hypotensive patient Avoidance of subcutaneous epinephrine in a hypotensive patient Alternative route of epinephrine administration when no intravenous access is available Correct dosing of epinephrine via different routes of administration Management of a contrast reaction in a pediatric patient Recognition and management of contrast reactions in sedated patients Management of bronchospasm Management of upper airway/laryngeal edema Activation of a code team
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Simulation Group
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Curriculum Rating
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Table 2
Likert-type Scale Feedback Questions Given to Both Resident Groups
1. Learners should spend more time (working in the simulator/in lecture). 2. The course enhanced my understanding of how to handle critical incidents, situations, and crises. 3. The (simulation/lecture) was an effective educational tool. 4. The (simulation/lecture) experience provides a realistic model of working in a clinical setting.
Responses were on a scale ranging from 1 (“strongly disagree”) to 5 (“strongly agree”).
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Time
Lecture Group
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Simulation Group
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Financial Costs
Lecture
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Simulation
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Results
Educational Curriculum Grading and Comments
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Table 3
Mean Feedback Scores for the Four Likert-type Written Questions Rating the Lecture and Simulation Curricula
Question Mean Lecture Score Mean Simulation Score_P_ 1 1.76 4.39 <.0001 2 3.85 4.82 <.0003 3 3.80 4.95 <.0001 4 3.00 4.60 <.0001
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Lecture Group
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Simulation Group
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Time
Lecture
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Simulation
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Financial
Lecture
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Simulation
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Table 4
List of Supplies, Number Used, per Cost Use, and Total Cost Use for Each Supply in Training 23 Radiology Residents Through Five Scenarios
Material Number Used Cost per Use ($) Total ($) 25-gauge short needle 308 0.17 52.36 25-gauge long needle 308 0.03 9.24 4×4 gauze 44 0.08 3.52 Fisherman’s tool box 1 7.21 7.21 Nasal cannula 1 2.65 2.65 Facemask 1 0.88 0.88 Walkie-talkies 1 22.95 22.95 Earphone for walkie-talkie 1 4.99 4.99 Red dots 1 6.49 6.49 DVD for recording session 23 0.25 5.75 Paper 1 4.59 4.59 Total 120.63
Table 5
Summary of Cost Differences Between the Two Groups
Lecture Curriculum Simulation Curriculum Analysis Item Setup Cost Recurring Cost Setup Cost Recurring Cost Faculty time (academic days) 2 1 7 5 Resident time (h:min) 1:10 1:10 3:30 3:30 Financial cost (per resident) <$5 <$5 $259.76 $203.46
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Discussion
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