Authors Souzen Mirza and Sriharsha Athreaya are to be commended for their excellent article, “Review of Simulation Training in Interventional Radiology,” in this issue of Academic Radiology . Their review is comprehensive and timely, and appropriately enlightens the reader on the current state of simulation training of interventional radiology practitioners and trainees.
In addition to discussing the commercially available simulation units, the authors explain the acute need for simulation training in interventional radiology training programs. They appropriately describe not just the technical and physical simulators used in procedural training but also the more cognitive-based simulators, such as those used to respond to patients with adverse contrast reactions. Both types of simulators are necessary in order to provide appropriate training in the simulation environment.
As pointed out by the authors, several factors demonstrate the need for simulation training in today’s learning environment. Some situations have always called for the use of simulators, such as the need to protect patients from a failed procedure or complications arising from the lack of familiarity with specific devices or unique patient populations. Some factors, however, are more contemporary to the trainees of today. There may be a paucity of specific procedures in training programs, and simulators may provide the experience needed for better patient outcomes with more advanced procedures. As fewer diagnostic angiograms are being performed, trainees may struggle to gain the experience needed to proceed with interventional procedures such as angioplasty or arterial stenting. Restricted work hours for trainees poses another challenge for them to gain the experience needed in the full range of both diagnostic and interventional procedures. Finally—and this is potentially an inflammatory issue—the authors raise the possibility of training individuals outside the field of interventional radiology in the performance of image-guided interventional procedures. Although it should not be, one cannot help but wonder whether this is a cause of angst among members of the interventional community that may lead, in the worst-case scenario, to obstructing the advancement of simulators in training.
Simulators provide a valuable tool in the education of trainees and are here to stay, both inside and outside of the field of interventional radiology. The era of “see one, do one, teach one” is now grossly outdated. However, the “practice” of medicine remains, in training paradigms as well as in name. The publications that clearly demonstrate the direct correlation between the number of procedures performed and better clinical outcomes are too numerous to count . The experience gained from the number of procedures performed on living patients can be supplemented, by many orders of magnitude, by simulators. If other options such as interventional simulators are available, then using patients—patients trusting their care to us—as the only population on which to gain experience should now be considered unethical.
In the recent past, detractors of simulators had appropriately expressed the opinion that simulators had not yet reached the level of sophistication that was necessary to train the next generation of physicians. In the past, one could even make the argument that simulators were disadvantageous to learners if they simply taught bad habits; it is better to come from a position of a beginning learning than to try to reverse bad habits. As the authors point out in detail, that argument is now null and void. Simulators are now advanced enough that the concern about training bad habits has been put to rest.
In summary, the article by Mirza and Athreaya provides the reader with an inclusive review of the current state of simulator use in interventional radiology. The opportunities for the advancement of both trainees and practicing physicians through the use of cutting-edge technology are limitless. These technologies should be fully acknowledged and completely embraced; their role in defining the future of procedure-based interventional radiology programs has arrived.
References
1. Sarwar A., Zhou L., Novack V., et. al.: Hospital volume and mortality after trans-jugular intrahepatic portosystemic shunt creation in the United States. Hepatology 2017; Epub ahead of print
2. Shishehbor M.H., Venkatachalam S., Gray W.A., et. al.: Experience and outcomes with carotid artery stenting: an analysis of the CHOICE study (Carotid stenting for high surgical-risk patients; evaluating outcomes through the collection of clinical evidence). JACC Cardiovasc Interv 2014; 7: pp. 1307-1317.
3. Verma D.R., Pershad Y., Pershad A., et. al.: Impact of institutional volume and experience with CT interpretation of sizing of transcatheter aortic valves: a multicenter retrospective study. Cardiovasc Revasc Med 2016; 17: pp. 566-570.