Clinical simulation in IR training
BY ERIC J. HOHENWALTER, MD, FSIR WINTER 2017
As an educational methodology, simulation has its origins in the field of flight preparation. Using simulation as an aid allows one to transform from novice (where one rigidly adheres to rules) to expert (where one begins to apply knowledge situationally). Simulation programs are also well established in both undergraduate and graduate medical education programs.
In interventional radiology, much of the simulation experience has been focused on procedural training. IR training programs use simulation to educate and assess residents and fellows, especially in regards to intraprocedural skills since trainee experiences can vary both within individual training programs and between different institutions.
Clinical simulation using standardized patients can provide learners with an opportunity to develop their clinical and patient assessment skills in a low-risk environment. This is especially important in the current fellowship model in that many fellows are transitioning from a diagnostic radiology residency with little patient interaction. While spending time in clinic is extremely valuable, there are some inherent flaws. The model in which a trainee first sees a clinic patient then presents the information to a faculty MD does not allow for any feedback related to the interaction, since it was not witnessed by the faculty MD. In addition, when patients are seen together (trainee and MD), then the patients may defer answers to the faculty, thus taking away from the trainee’s experience.
At the Medical College of Wisconsin, we developed and implemented a clinical simulation program that presented fellows with four different clinical scenarios with standardized patients:
- Two of the scenarios involve evaluation and management of a new cancer patient (with differing levels of disease, performance status and liver function) in an outpatient clinical setting.
- One scenario involves evaluation and management of a patient with short-distance claudication.
- The final scenario involves communicating a severe, unexpected procedural complication to a patient’s family.
Each simulation is observed on closed-circuit television by an IR MD as well as a PhD educator, who provide immediate feedback to the fellow. The simulations are also recorded for evaluation and additional feedback. In addition, the simulations are performed at different times throughout the year. That is, two simulations are performed in the fall during the early part of a fellow’s training and two simulations are performed in the second half of the fellowship year. This allows for evaluation of progress and improvement throughout the year, especially in communication skills, while providing an opportunity to direct further learning, if necessary.
In addition, with the development of the IR Residency, a clinical simulation program such as ours at MCW could be enhanced with scenarios that increase in complexity as the residents progress through their training.
In addition, under current Accreditation Council for Graduate Medical Education (ACGME) requirements, all training programs are utilizing competency-based education and training. The six basic competencies are
- Patient care
- Medical knowledge
- Practice-based learning and improvement
- Interpersonal and communication skills
- Systems-based practice
Because of this, standardization of training should be pursued and clinical simulation could be utilized to fill in curricular gaps to enhance training, increase patient safety and ensure the achievement of critical milestones in a residency.
Bonus video: Sample medical simulation
If the above link does not work, you may view the video here.
Video courtesy Medical College of Wisconsin Division of Interventional Radiology.