Objective
The purpose of this article is to discuss the use of simulation in radiology education.
Conclusion
Simulation is an engaging way to educate radiology trainees. It allows trainees to improve their procedural and clinical skills in a calm, supportive environment that optimizes patient safety. Familiarity with the principles of simulation education may help radiologists evaluate their training curricula to identify skills that could be augmented with simulation training.
An eager resident excited to start her interventional radiology rotation approached me several years ago with a predicament. Ever diligent, she had been practicing ultrasound-guided biopsies on a chicken breast and venous access with a phantom limb, but was limited in her ability to practice percutaneous abscess drainage within the institution’s current resources. Inspired by her proactive efforts, I sought to create a simulator that would allow her to practice percutaneous abscess drainage. There were no existing tools to help my resident practice this important skill before starting her work with interventional radiology patients. Most training programs teach ultrasound-guided fluid aspirations and drain placements via faculty supervision of trainees performing the procedures on a patient, ie, the “in vivo” training. Although there is close supervision of the trainee, there is still room for error. There is also a challenge from the faculty’s perspective. When training with a real patient, the faculty is ultimately responsible for that patient and may feel it necessary to interrupt trainees’ attempts owing to inaccuracy or potential for patient harm. Because the patient is often conscious, the faculty may find it difficult to verbally coach the resident. Surely, it would be in everyone’s best interest if the trainee was able to practice a skill like percutaneous abscess drainage with simulation to meet an experience threshold before performing procedures on a live patient.
Simulation is the act of imitating a process by means of something equivalent. It is commonly applied in educational scenarios to allow the learner the opportunity to repetitively practice a skill in a safe environment. Unlimited guidance and supervision can be provided to the learner as the skill is being mastered. Educational simulation techniques were initially developed in the aviation and military fields. Edwin Link was a pioneer of simulation education in 1929 when he developed the first flight simulator. Link’s flight simulator grew in popularity and use before and during World War II as the United States Army employed the simulator to train pilots in the wake of multiple crashes. In fact, more than 500,000 US pilots were trained on the Link flight simulator .
Likewise, simulation techniques have vast potential for medical education to bridge the gap between the classroom and the patient. Students are able to simulate a hands-on experience with a “patient” in a nonthreatening manner that is not limited by time or patient anxiety. The acquisition of appropriate clinical skills is essential to health education . However, in a healthcare environment that increasingly emphasizes quality and patient satisfaction, it has become more difficult for trainees to acquire procedural skills directly on patients. Simulation options in medical education have arisen in part from patients becoming increasingly concerned that trainees were “practicing” on them . The advantages of simulation in medical education are many; clinical simulation integrates bedside teaching with traditional medical education while maintaining and fostering patient safety and procedural quality. It allows the trainee repetitive practice and personal feedback in a controlled, calm environment. Furthermore, simulation provides the capability to tailor specific simulation tasks to each learner, as well as allowing training programs to establish curriculum competencies and assessments. Medical schools, the Accreditation Council for Graduate Medical Education, and medical boards have all integrated simulations into training, assessments, and licensing exams .
Multiple types of simulators have been developed for use in medical education . For example, simulated physician-patient interactions can be accomplished with either standardized patients or mannequin simulators. Standardized patients are actors trained to simulate various symptoms, give medical histories, and display emotions during an examination or interaction . This approach helps learners develop their interpersonal patient skills in a supportive setting. Radiology training programs may use standardized patients in an objective structured clinical examination format to develop and assess communication and interpersonal skills for roles such as procedure consent, breaking bad news, and conveying results. The use of mannequin simulators may allow students to practice physical exam approach and technique. Educational documents with detailed simulated animations can be made to supplement trainees’ self-directed learning. Simulation procedures may be used in preparedness training for casualty assessment or emergency response scenarios. Finally, procedural or surgical simulation can be implemented with the use of either high- or low-fidelity simulators.
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