Rationale and Objectives
Knowledge of the management of acute contrast reactions is lacking among radiologists. Training in the management of acute contrast reactions occurs at the investigators’ institution and others, but the durability of that training and the need for refresher training have not been assessed.
Materials and Methods
A prospective assessment of changes in trainees’ knowledge and confidence following a required educational course concerning reactions to contrast material was conducted. Assessments were performed prior to and immediately following the course and at 1, 3, 6, and 9 months after the course.
Results
Trainees’ knowledge significantly improved following the course and remained improved for 6 months ( P < .0001). By 9 months, knowledge was no longer improved over baseline ( P = .0644). Trainees’ confidence also improved following the course and remained improved throughout follow-up ( P = .0356 at 9 months). At 6 months, however, confidence had significantly declined relative to levels immediately after the course ( P = .0241). Trainees’ knowledge was not dependent on postgraduate year (PGY), but PGY-2 residents were significantly less confident in their ability to manage a contrast reaction than PGY-5 and PGY-6 trainees. Trainees who managed contrast reactions during the follow-up period were more confident in their abilities than trainees who did not ( P = .0097).
Conclusions
These data suggest the need for biannual refresher training in the management of acute contrast reactions to maintain trainees’ knowledge and confidence.
Acute reactions to contrast material represent one of the few clinical emergencies faced by diagnostic radiologists acting as primary caregivers. Because these reactions are rare, radiologists have little experience managing them, and there is little reinforcement of the knowledge needed to manage these reactions. As a result, skills for treating adverse contrast reactions are generally lacking in both trainees and practicing radiologists . In 1994, surveys of radiologists in the United Kingdom found that only 24% had formal training in cardiopulmonary resuscitation, only 68% knew the correct dose of epinephrine to administer for an anaphylactic-like contrast reaction, and only 2% managed severe contrast reactions according to published guidelines . Several studies have advocated different methods of either teaching this material or improving radiologists’ performance in managing simulated contrast reactions . Each of these studies demonstrated improved knowledge and/or performance, but the effect of these interventions on the management of real-life contrast reactions and the durability of this effect is not known.
At our institution, trainees are required to participate in an annual contrast reaction course that covers the recognition, pathophysiology, treatment, and prevention of contrast reactions. The course, which has been in place for >10 years, includes didactic lectures, low-fidelity simulations and scenarios, and hands-on sessions at which participants practice preparing and administering intravenous fluids and medication and using a defibrillator. As a result, radiology residents are exposed to the material four times over the course of their training.
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Materials and methods
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Statistical Analysis
Pilot study
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Assessment of trainees’ learning and retention
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Results
Pilot Study (Validation of Test Equivalence)
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Assessment of Trainees’ Learning and Retention
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Table 1
Participant Numbers for Each Time Point
Time Point PGY-2 PGY-3 PGY-4 PGY-5 PGY-6 Precourse 9 11 8 6 20 Postcourse 11 11 7 7 17 1 mo 6 6 8 4 5 3 mo 7 8 8 5 5 6 mo 7 8 5 4 5 9 mo 4 8 4 0 0
The 9-month follow-up time point occurred after the PGY-5 and PGY-6 participants had completed training for the year.
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Knowledge (Quiz scores)
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Table 2
Comparison of Knowledge Scores between Time Points
Time Point Mean Score (95% Confidence Interval) Postcourse 1 Month 3 Months 6 Months 9 Months Precourse 10.9 (10.4–11.3) <.0001 ∗ <.0001 ∗ .0446 ∗ <.0001 ∗ .0644 Postcourse 12.4 (11.9–12.8) .8016 .5105 1.0000 .9550 1 mo 12.9 (12.5–13.3) .0884 .8782 .5253 3 mo 11.5 (10.9–12.1) .6536 .9981 6 mo 12.4 (11.8–13) .9672 9 mo 12 (11.2–12.8)
Statistical comparisons are based on Scheffé’s test.
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Confidence
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Table 3
Comparison of Confidence Scores between Time Points
Time Point Mean Score (95% Confidence Interval) Postcourse 1 Month 3 Months 6 Months 9 Months Precourse 3.1 (2.9–3.3) <.0001 ∗ <.0001 ∗ <.0001 ∗ .0002 ∗ .0356 ∗ Postcourse 4.2 (4.0–4.4) .9656 .3909 .0241 ∗ .0503 1 mo 4.1 (3.9–4.4) .8954 .2310 .2387 3 mo 4.0 (3.7–4.2) .8775 .7360 6 mo 3.8 (3.4–4.1) .9954 9 mo 3.7 (3.3–4.0)
Statistical comparisons are based on Scheffé’s test.
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Table 4
Comparison of Baseline (Precourse) Confidence Scores Based on PGY
PGY Mean Score (95% Confidence Interval) PGY-3 PGY-4 PGY-5 PGY-6 PGY-2 1.6 (1.1–2.1) .0029 ∗ .0329 ∗ .0004 ∗ .0004 ∗ PGY-3 3.3 (2.9–3.7) .9893 .4269 .9788 PGY-4 3.3 (2.6–3.9) .2961 .8597 PGY-5 4.3 (4.0–4.7) .6503 PGY-6 3.6 (3.3–3.9)
PGY, postgraduate year.
Statistical comparisons are based on Scheffé’s test.
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Table 5
Mean Trainee-reported Confidence Scores Subdivided by PGY
Precourse Postcourse 1 Month 3 Months 6 Months 9 Months PGY-2 1.6 ± 0.86 3.8 ± 0.4 3.3 ± 0.82 3.4 ± 1.27 2.9 ± 0.9 2.7 ± 1.53 PGY-3 3.3 ± 0.79 4.1 ± 0.54 4 ± 0.63 3.9 ± 0.69 3.9 ± 0.35 3.8 ± 0.46 PGY-4 3.3 ± 1.04 3.9 ± 0.69 4.3 ± 0.49 4.1 ± 0.69 3.3 ± 0.96 4 ± 1 PGY-5 4.3 ± 0.52 4.6 ± 0.53 4.8 ± 0.5 4.4 ± 0.55 4.8 ± 0.5 PGY-6 3.6 ± 0.78 4.2 ± 0.44 4.4 ± 0.55 4.2 ± 0.45 4 ± 0
PGY, postgraduate year.
Data are expressed as mean ± standard deviation. Nine-month follow-up testing occurred after the PGY-5 and PGY-6 trainees had graduated from the program.
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Discussion
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Conclusions
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Acknowledgment
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