Implementing Contrast Reaction Management Training for Residents Through High-Fidelity Simulation

Rationale and Objectives

Adverse reactions to intravenous contrast for radiologic examinations can result in significant patient morbidity and mortality. It is critical that radiologists be proficient at recognizing and treating reactions in a timely and appropriate manner. Therefore, we developed a hands-on simulation curriculum to improve residents’ ability and comfort in recognizing and responding to contrast reactions.

Materials and Methods

Contrast reaction management simulations were performed in 2016 and 2017 with 25 and 26 resident participants, respectively. Participants completed pre- and postsimulation surveys both years to assess knowledge and comfort in managing contrast reactions.

Results

In 2016, 25 participants answered 12 questions assessing knowledge of contrast reaction management. Percentage of correct answers increased from pre- to postsurvey in 83% of questions (10/12). Participants indicated their comfort level in managing contrast reactions increased on all six questions from pre- to postsurvey. In 2017, 26 participants answered 14 questions assessing knowledge of contrast reaction management. Similarly, percentage of correct answers increased from pre- to postsurvey in 86% of questions (12/14). Participant comfort levels also increased on all six questions from pre- to postsurvey. Subgroup analysis performed on 19 participants who completed the curriculum both years demonstrated further improvement in knowledge and comfort after completing the second year, showing added benefit of repeated simulation.

Conclusion

These results suggest that incorporating high-fidelity contrast reaction management simulation into resident education improves both residents’ knowledge and comfort in managing reactions. We have therefore incorporated annual contrast reaction simulation as a standard component of our residency curriculum.

INTRODUCTION

Adverse reactions to intravenous contrast administered for radiologic examinations are relatively uncommon, occurring in approximately 0.6% of patients ( ). However, because millions of contrast-enhanced examinations are performed each year in North America, many radiologists will encounter contrast reactions in their career ( ). Moreover, contrast reactions can result in significant patient morbidity and mortality ( ). It is therefore critical that radiologists be proficient at recognizing true reactions and treating patients quickly and effectively when warranted.

Although the radiologist is often the first, and sometimes the only, physician responding to a contrast reaction, his or her comfort level in managing these reactions varies depending on personal experience. Knowledge gaps regarding management of contrast reactions may also exist. A 2014 study found that over 50% of radiologists did not know how to correctly administer epinephrine or the correct dosing to treat a severe contrast reaction ( ). Such knowledge gaps and lack of experience could result in dire consequences for patients undergoing examinations in the radiology department.

Implementing Contrast Reaction Management Training for Residents Through High-Fidelity Simulation

Rationale and Objectives

Materials and Methods

Results

Conclusion

INTRODUCTION

MATERIALS AND METHODS

Curriculum Development

Year 1 (2016) Curriculum Implementation

Year 2 (2017) Curriculum Implementation

Statistical Analysis

RESULTS

Year 1 (2016) and Year 2 (2017) Results

Sub-group Analysis of Participants From Both Years 1 and 2

DISCUSSION

DECLARATIONS OF INTEREST

Acknowledgment

Appendix A

APPENDIX B:

APPENDIX C:

References

Further Reading

“Why We Need a Guide to New Teaching Methods Now”

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