Simulation based teaching in interventional radiology training: is it effective?

Advancing IR in Underserved Regions: Interventional Radiology Simulation Near and Far

Simulation facilitates learning by imitating real-world systems or processes utilizing educational tools and models. Various fields, including business, aviation, and education use simulation for training. In healthcare, simulation provides trainees opportunities to develop procedural skills in a safe environment, building their understanding through hands-on interactions and experiences rather than passive didactics. Simulation is classified into low, medium, and high fidelity, based on how closely it mimics real-life experience. Its use in education is a valuable adjunct to instructional support and training with multiple potential benefits. Interventional radiology (IR) trainees can build technical and clinical proficiency prior to working directly on a patient. Simulation promotes experiential learning, constructivist learning, and student centeredness, thus giving students control over their learning and knowledge acquisition. More recently, the creative use of remote simulation has augmented traditional virtual didactic lectures, thereby further engaging international learners and enhancing remote collaboration. Despite the challenges to implementation, the addition of simulation in IR education is proving invaluable to supporting trainees and physicians in underserved regions.

Evaluation of intracranial stenting in a simulated training and assessment environment for neuroendovascular procedures

Purpose

Given the inherent complexity of neurointerventional procedures and the associated risks of ionizing radiation exposure, it is crucial to prioritize ongoing training and improve safety protocols. The aim of this study is to assess a training and evaluation in-vitro environment using a vascular model of M1 stenosis, within a clinical angiography suite, without relying on animal models or X-ray radiation.

Materials and methods

Using a transparent model replicating M1 stenosis, we conducted intracranial stenting procedures with four different setups (Gateway & Wingspan, Gateway & Enterprise, Neurospeed & Acclino, and Pharos Vitesse). A video camera was integrated with the angiography system's monitor for real-time visualization, while a foot switch was employed to simulate live fluoroscopy. Three neuroradiologists with varying levels of expertise performed each procedure for three times. The total duration of fluoroscopy as well as the time from passing the stenosis with the wire to completion of the procedure were recorded using a dedicated software designed for this experimental setup.

Results

Compared to the Gateway & Wingspan procedure, the total fluoroscopy time reduced significantly with the Gateway & Enterprise, Neurospeed & Acclino, and Pharos Vitesse procedures by 51.56 s, 111.33 s, and 144.89 s, respectively (p < 0.001). Additionally, physicians with under 2 years and over 5 years of experience reduced FT by 62.83 s and 106.42 s, respectively, (p < 0.001), compared to a novice physician. Similar trends were noted for the time of wire distal to stenosis, with significant reductions for Neurospeed & Acclino and Pharos Vitesse compared to both Gateway & Wingspan as well as Gateway & Enterprise (all p < 0.001).

Conclusion

Procedures requiring wire exchange maneuvers exhibited nearly twice the fluoroscopy time in comparison to balloon-mounted stenting or stent-placement via PTA balloon catheters. The more experienced neuroradiologist demonstrated significantly quicker performance in line with expectations in a real-life clinical setting, when compared to the less experienced interventionalist. This in-vitro setup allowed the evaluation of alternative technical approaches and differences in experience of operators without the use of animal models or X-ray. The setup combines advantages of simulators and silicone vessel models in a realistic working environment.

Implementation and Evaluation of a Comprehensive Simulation Curriculum for the IR/DR Integrated Residency

RATIONALE AND OBJECTIVES

Endovascular simulation is a validated training method, allowing residents to improve technical skills with interventional equipment in a risk-free environment. The purpose of this study was to assess the utility and efficacy of supplementing the IR/DR Integrated Residency training program with a dedicated 2-year endovascular simulation curriculum.

MATERIALS AND METHODS

Trainees participated in a 2-year curriculum that included the completion of 8 modules using a high-fidelity endovascular simulator (Mentice AB, Gothenberg, Sweden). Procedural modules included IVC filter placement, transarterial chemoembolization, trauma embolization, uterine artery embolization, prostate artery embolization, and peripheral arterial disease interventions. Each quarter, two trainees were filmed while completing an assigned module. Sessions led by IR faculty were held with film footage review and didactics on the assigned topic. Pre- and postcase surveys were collected to evaluate trainee comfort and confidence and assess the validity of the simulation. At the conclusion of the 2-year period, a postcurriculum survey was sent to all trainees to determine how residents viewed the utility of the simulation sessions.

RESULTS

Eight residents participated in the pre- and postcase surveys. The simulation curriculum significantly increased trainee confidence for these 8 residents. A separate postcurriculum survey was completed by all 16 IR/DR residents. All 16 residents felt that simulation was a helpful addition to their education. A total of 87.5% of all residents felt that the sessions improved their confidence in the IR procedure room. A total of 75% of all residents believe that the simulation curriculum should be incorporated into the IR residency program.

CONCLUSION

Adoption of a 2-year simulation curriculum can be considered for existing IR/DR training programs with access to high-fidelity endovascular simulators using the described approach.

The Development and Application of a Cost-Effective Cervical Spine Phantom for Use in Fluoroscopically Guided Lateral C1-C2 Spinal Puncture Training

BACKGROUND AND PURPOSE

Lateral C1-C2 spinal punctures are uncommon procedures performed by radiologists for access to CSF and contrast injection when a lumbar approach is contraindicated and an alternate method of access becomes necessary. There are limited opportunities to learn and practice the technique. We aimed to develop and assess the efficacy of a low-cost, reusable cervical spine phantom for training in fluoroscopically guided lateral C1-C2 spinal puncture.

MATERIALS AND METHODS

The phantom was constructed with a cervical spine model, an outer tube representing the thecal sac, an inner balloon representing the spinal cord, and polyalginate to replicate soft tissue. The total cost of materials was approximately US $70. Workshops were led by neuroradiology faculty experienced in the procedure using the model under fluoroscopy. Survey questions were assessed on a 5-point Likert scale. Participants were given pre- and postsurveys assessing comfort, confidence, and knowledge of steps.

RESULTS

Twenty-one trainees underwent training sessions. There was significant improvement in comfort level (Δ: 2.00, SD: 1.00, P value < .001); confidence (Δ: 1.52 points, SD: 0.87, P value < .001); and knowledge (Δ: 2.19, SD: 0.93, P value < .001). Eighty-one percent of participants found the model "very helpful" (5/5 on Likert scale), and all participants were "very likely" to recommend this workshop to others.

CONCLUSIONS

This cervical phantom model is affordable and replicable and demonstrates training utility to prepare residents for performing lateral C1-C2 spinal puncture. This is a rare procedure, so the use of a phantom model before patient encounters is invaluable to resident education and training.

3D Printed Percutaneous Transhepatic Cholangiography and Drainage (PTCD) Simulator for Interventional Radiology

PURPOSE

Learning how to perform percutaneous transhepatic bile duct drainage (PTCD) is challenging for interventional radiology (IR) trainees. Therefore, simulators are crucial for IR training and are being increasingly demanded in the evolving healthcare environment of value-based care. To facilitate interventional training, we tried to evaluate our newly developed liver phantom for further use in IR training.

METHODS

We developed a liver phantom with a flexible hollow biliary tree, hydrogel-based liver parenchyma, plastic ribs, and silicone skin. The phantom was evaluated by 20 radiology residents from two hospitals. After an introduction, all participants tried to obtain biliary access by fluoroscopic guidance within 25 min. Puncture time, fluoroscopy time, and kerma area product were measured. After 7 days, the participants repeated the procedure on an altered and more difficult model. Additionally, a survey was handed out to every participant (20 residents, 5 experts, and 5 IR fellows) to evaluate the phantom in terms of accuracy and haptic feedback, as well as general questions regarding simulation.

RESULTS

The residents performed significantly faster and were more self-confident on Day 7 than on Day 1, significantly decreasing puncture time, fluoroscopy time, and kerma area product (p ≤ 0.0001). The participants were very satisfied with their simulation experience and would trust themselves more in real-life scenarios.

CONCLUSION

We were able to develop a phantom with high anatomical accuracy for fluoroscopy and ultrasound-guided interventions. The phantom successfully helped residents learn and improve their PTCD performance.

Complication Management and Prevention in Vascular and non-vascular Interventions

PURPOSE

 This overview summarizes key points of complication management in vascular and non-vascular interventions, particularly focusing on complication prevention and practiced safety culture. Flowcharts for intervention planning and implementation are outlined, and recording systems and conferences are explained in the context of failure analysis. In addition, troubleshooting by interventionalists on patient cases is presented.

MATERIAL AND METHODS

 The patient cases presented are derived from our institute. Literature was researched on PubMed.

RESULTS

 Checklists, structured intervention planning, standard operating procedures, and opportunities for error and complication discussion are important elements of complication management and essential for a practiced safety culture.

CONCLUSION

 A systematic troubleshooting and a practiced safety culture contribute significantly to patient safety. Primarily, a rational and thorough error analysis is important for quality improvement.

KEY POINTS

· Establishing a safety culture is essential for high-quality interventions with few complications.. · A rational and careful troubleshooting is essential to increase quality of interventions.. · Checklists and SOPs can structure and optimize the procedure of interventions..

CITATION FORMAT

· Weiss D, Wilms LM, Ivan VL et al. Complication Management and Prevention in Vascular and non-vascular Interventions. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1829-6055.

Augmented reality in interventional radiology education: a systematic review of randomized controlled trials

BACKGROUND

Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures.

OBJECTIVE

To compare AR with other learning methods in interventional radiology.

DESIGN AND SETTING

Systematic review of comparative studies on teaching techniques.

METHODS

We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model.

RESULTS

Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR.

CONCLUSION

AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model.

SYSTEMATIC REVIEW REGISTRATION NUMBER

DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.

A model for training ultrasound-guided fine-needle punctures

OBJECTIVE

To evaluate the efficacy of a training program in ultrasound-guided fine needle puncture using a cost-effective model.

METHODS

We evaluated the training of 20 resident radiology physicians, based on a theoretical course and a practical simulation part with models that focused on the puncture technique of thyroid nodules. The total time to perform the procedure, the number of punctures on the model surface, and the application of a questionnaire were used to assess the performance and confidence of the resident physicians in performing the procedure.

RESULTS

The training model used was easy to reproduce, inexpensive, versatile, and capable of simulating the echotexture of thyroid tissue. There was a significant reduction in the total time needed to perform the procedure with a mean of 173.7 s±91.28 s from R1 and 112.8 s±17.66 s from R2 before the course vs. 19.2 s±112.8 s and 14.3 s±9.36 s, respectively, after the course (p<0.0001); as well as the number of superficial punctures, with a mean of 2.2 punctures±0.92 from R1 and 1.5 punctures±0.32 from R2 before the course vs 1.1 punctures±0.71 and 1.0 puncture±0.0, respectively, after the course (p<0.0001). There was also a subjective improvement in the performance and confidence in performing this procedure.

CONCLUSIONS

An inexpensive and easy-to-reproduce gelatin-based model enabled adequate training of resident physicians and proved capable of improving their skills and confidence in simulating the procedure, even with a short period of training.

Can training on ex-vivo models increase neurointerventionalists’ subjective self-confidence in the operating room?

In a changing learning environment where young neurointerventionalists spend less time in the operating room, computer simulators have been established as a new training model. Our aim was the comparison of silicone models and computer simulators, and the evaluation of their influence on subjective self-confidence of operators. Pre- and postquestionnaires of 27 participants and 9 tutors were evaluated after the participation in a three-days interventional stroke course using silicone models and computer simulators. Training on computer simulators was considered as more realistic and important before patient contact than training on silicone models. Participants rated their own abilities as significantly better after participation in the course and felt significantly better prepared for patient care. Training on computer simulators can increase the subjective self-confidence of trainees. We suggest a stepwise training program, comprising both ex-vivo and the porcine in-vivo model, finished by conventional operating room teaching, to prepare neuroradiologists for optimal patient care when performing interventions.

Interactive teaching environment for diagnostic radiography with real-time X-ray simulation and patient positioning

Purpose

Traditional undergraduate radiographer training mixes academic lectures and clinical practice. Our goal is to bridge the current disconnection between theory and practice in a safe environment, avoiding the risk of radiation for both practitioners and patients. To this end, this research proposes a new software to teach diagnostic radiography using real-time interactive X-ray simulation and patient positioning.

Methods

The proposed medical simulator is composed of three main modules. A fast and accurate character animation technique is in charge of simulating the patient positioning phase and adapts their internal anatomy accordingly. gVirtualXRay is an open-source X-ray simulation library and generates the corresponding radiographs in real time. Finally, the courseware allows going through all the diagnostic radiology steps from the patient positioning and the machine configuration to the final image enhancing.

Results

A face and content validation study has been conducted; 18 radiology professionals were recruited to evaluate our software using a questionnaire. The results show that our tool is realistic in many ways (72% of the participants agreed that the simulations are visually realistic), useful (67%) and suitable (78%) for teaching X-ray radiography.

Conclusions

The proposed tool allows simulating the most relevant steps of the projectional radiography procedure. The virtual patient posing system and X-ray simulation module execute at interactive rates. These features enable the lectures to show their students the results of good and bad practices in a classroom environment, avoiding radiation risk.

Can empathy be taught? A cross-sectional survey assessing training to deliver the diagnosis of end stage renal disease

Background

Receiving the diagnosis of kidney failure has a major impact on patients. Yet, the way in which this diagnosis should be delivered is not formally taught within our medical curriculum. To fill this gap we set up a training course of kidney failure diagnosis delivery for nephrology trainees since 2016. This study assessed the effectiveness of this educational intervention.

Methods

The primary outcome was change in the empathy score immediately after the training session and several months afterward, based on the Jefferson Scale of Physician Empathy (JSPE). Self-reported change in clinical practice was also evaluated. As control groups, we assessed empathy levels in untrained nephrology trainees (n = 26) and senior nephrologists (n = 71). Later on (>6 months) we evaluated participants’ perception of changes in their clinical practice due to the training.

Results

Six training sessions permitted to train 46 trainees. Most respondents (76%) considered the training to have a durable effect on their clinical practice. Average empathy scores were not significantly different in pre-trained trainees (average JSPE: 103.7 ± 11.4), untrained trainees (102.8 ± 16.4; P = 0.81) and senior nephrologists (107.2 ± 13.6; P = 0.15). Participants’ empathy score significantly improved after the training session (112.8 ± 13.9; P = 0.003). This improvement was sustained several months afterwards (average JSPE 110.5 ± 10.8; P = 0.04).

Conclusion

A single 4-hour training session can have long lasting impact on empathy and clinical practice of participants. Willingness to listen, empathy and kindness are thought to be innate and instinctive skills, but they can be acquired and should be taught.

Training of CT-guided Periradicular Therapy in a Realistic Simulation Environment - Evaluation and Recommendations for a Training Curriculum

RATIONALE AND OBJECTIVES

To evaluate the training of computed tomography (CT)-guided periradicular therapy in a realistic simulation environment and to derive recommendations for a training curriculum.

MATERIALS AND METHODS

A novel simulation environment including the use of a 3D printed, patient-mimicking phantom was used to train medical students to perform CT-guided periradicular therapy of the lumbar spine. Seventeen participants underwent three training sessions (day 0, day 7, and after day 28) with six procedures per session. Procedure duration and the number of fluoroscopy image acquisitions were recorded. Participants' performance was assessed by an independent investigator using a six-point checklist scale (0 = lowest, 6 = highest). In addition, participants self-evaluated their skills and the simulation training in questionnaires.

RESULTS

Procedure durations and image acquisitions decreased after one training session (p < 0.001) without further improvement thereafter (p > 0.6). They also decreased within training sessions and were lowest after five procedures in all sessions. Performance scores improved after the first session to nearly perfect scores in the second session (mean 5.7; 95%CI: 5.5-6.0; p < 0.001) and decreased again in the third session (mean 4.9; 95%CI: 4.6-5.3; p = 0.008). Participants were satisfied with their training progress and felt adequately prepared to perform CT-guided periradicular therapies on patients after the training.

CONCLUSION

Simulation-based training of CT-guided periradicular therapy in a realistic environment is effective and should ideally be performed with one training session consisting of five procedures shortly before treating the first patient.

Percutaneous transhepatic biliary puncture simulator: a cord network prototype

Background

The aim of this study was to present a percutaneous transhepatic biliary puncture simulator that can be used without radiation exposure and that reflects the conventional anatomy of the biliary ducts and its vicinity structures.

Methods

An anatomically based model of the biliary tree was developed using a cord network fixed to a wooden frame. The skin, ribs, intercostal muscles, and right lower lobe pleura were simulated using foam sponge, plastic tubes, a polystyrene foam panel, and an air pad, respectively. For the puncture, we used a 20-G Chiba needle and a wire with distal double arches; these were used to troll a cord, simulating the successful puncture of a bile duct. A camera was also placed above the model to allow the trainees to train eye-hand coordination while viewing the image on a monitor in real time. The simulator was tested with 60 radiology residents to evaluate the confidence and skills transferability of the training model.

Results

After receiving an introduction of the system and 5 min of training under tutor surveillance, all participants were able to troll a cord of the biliary simulator by themselves in less than 4 min. Only one participant punctured the simulated pleura. The participants’ evaluations showed positive results, with increased user confidence and skills transferability after the training session.

Conclusions

This proposed simulator can be an effective tool to improve a trainee’s confidence and competence while achieving procedural and non-procedural interventional radiology skills related to the liver.

Trial registration

Retrospectively registered

CIRSE Clinical Practice Manual

Background

Interventional radiology (IR) has come a long way to a nowadays UEMS-CESMA endorsed clinical specialty. Over the last decades IR became an essential part of modern medicine, delivering minimally invasive patient-focused care.

Purpose

To provide principles for delivering high quality of care in IR.

Methods

Systematic description of clinical skills, principles of practice, organizational standards and infrastructure needed for the provision of professional IR services.

Results

There are IR procedures for almost all body parts and organs, covering a broad range of medical conditions. In many cases IR procedures are the mainstay of therapy, e.g. in the treatment of hepatocellular carcinoma. In parallel the specialty moved from the delivery of a procedure towards taking care for a patient’s condition with the interventional radiologists taking ultimate responsibility for the patient’s outcomes.

Conclusions

The evolution from a technical specialty to a clinical specialty goes along with changing demands on how clinical care in IR is provided. The CIRSE Clinical Practice Manual provides interventional radiologist with a starting point for developing his or her IR practice as a clinician.

Virtual reality in interventional radiology education: a systematic review

The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases-Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature-for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.

Simulation-based assessments of fire emergency preparedness and response in virtual reality

The current study aimed at evaluating the prospects of a three-dimensional gas power plant (GPP) simulation in an immersive virtual reality (IVR) environment for fire emergency preparedness and response (EPR). To achieve this aim, the study assessed the possibility of safety situational awareness, evacuation drills and hazard mitigation exercises during a fire emergency simulation scenario. The study likewise evaluated the safety and ergonomics of the environment while addressing this aim. We employed the virtual reality accident causation model (VR-ACM) for the assessment with 54 participants individually in IVR. Participants were grouped into two according to whether they had work experience in engineering or not. The obtained results suggested that IVR can be realistic and safe, with the potential for presenting hazardous scenarios necessary for fire EPR. Furthermore, the results indicated that there were no statistically significant differences in the perceptions of both groups regarding the prospects of IVR towards EPR.

Do Video Games Predict an Early Advanced Capacity to Learn Interventional Radiology Skills?

PURPOSE

To elucidate the relationship between video game (VG) play and interventional radiology (IR) technical skills in medical students.

MATERIALS AND METHODS

Twenty medical students recruited at our institution's IR symposium completed a survey to ascertain demographics and prior VG experience, then participated in a 3-part trial of skills assessing IR and VG skill and visuospatial aptitude (VSA). IR skill was evaluated via an endovascular simulation task, VG skill by performance on three separate VGs, and VSA using the Cube Comparison test. Regression analysis was tested the strength of relationship between IR skill and VG experience, VG skill, and VSA, respectively, and participants were stratified by IR skill to top and bottom halves for survey-response comparison.

RESULTS

There was no correlation between either VG skill or visuospatial aptitude and IR skill (r = -0.22, p = 0.35; and r = 0.14, p = 0.57). Greater number of years playing VGs correlated with superior IR skill (Spearman's rho=-0.45, p<0.05). Students who selected IR as their specialty of interest had extensive VG experience, playing for > 15 years (n = 4, 80%), at least 10 hours per week at their peak (n = 3, 60%), and reported being either "skilled" or "highly skilled" at VGs (n = 3, 60%).

CONCLUSIONS

In our study, though limited by power, number of years playing VGs correlated positively with IR skills in medical students. Prior VG experience may predict an early advanced capacity to learn IR skills and an interest in the specialty.

Learning anatomy by virtual reality and augmented reality. A scope review

During the last century, there were no significant changes in the teaching methods of anatomy in universities, predominating expositive lectures, and anatomy laboratory activities. With the advent of new technologies, simulators, augmented reality, and virtual reality, new teaching possibilities have emerged that may provide assistance and, in some situations, replace traditional methods of teaching. In this narrative scope review we evaluate articles that compare traditional methods with virtual reality or augmented reality through a search on Cochrane library, MEDLINE, EMBASE, and LILACS databases, using the MeSH terms "Anatomy", "Virtual Reality", "Augmented Reality", "Video Games", "Education Medical, Undergraduate", "Teaching" and "Simulation Training". We concluded that virtual reality and augmented reality have a promising value for teaching anatomy in addition to a positive economic impact on universities.

Diagnostic and Interventional Radiology Case Volume and Education in the Age of Pandemics: Impact Analysis and Potential Future Directions

RATIONALE AND OBJECTIVES

To assess the immediate impact of the COVID-19 pandemic on Diagnostic and Interventional Radiology education, and to propose measures to preserve and augment trainee education during future crises.

MATERIALS AND METHODS

Diagnostic Radiology (DR) studies and Interventional Radiology (IR) procedures at a single tertiary-care teaching institution between 2015 and 2020 were reviewed. DR was divided by section: body, cardiothoracic, musculoskeletal (MSK), neuroradiology, nuclear medicine, pediatrics, and women's imaging. IR was divided by procedural types: arterial, venous, lymphatic, core, neuro, pediatrics, dialysis, cancer embolization or ablation, noncancer embolization, portal hypertension, and miscellaneous. Impact on didactic education was also assessed. ANOVA, t test, and multiple comparison correction were used for analysis.

RESULTS

DR and IR caseloads decreased significantly in April 2020 compared to April of the prior 5 years (both p < 0.0001). Case volumes were reduced in body (49.2%, p < 0.01), MSK (54.2%, p < 0.05), neuro (39.3%, p < 0.05), and women's imaging (75.5%, p < 0.05) in DR, and in arterial (62.6%, p < 0.01), neuro IR (57.6%, p < 0.01) and core IR (42.6%, p < 0.05) in IR. IR trainee average caseload in April 2020 decreased 51.9% compared to April of the prior 5 years (p < 0.01). Utilization of online learning increased in April. Trainees saw significant increases in overall DR didactics (31.3%, p = 0.02) and no reduction in IR didactics, all online. Twelve major national and international DR and IR meetings were canceled or postponed between March and July.

CONCLUSION

Decreases in caseload and widespread cancellation of conferences have had significant impact on DR/IR training during COVID-19 restrictions. Remote learning technologies with annotated case recording, boards-style case reviews, procedural simulation and narrated live cases as well as online lectures and virtual journal clubs increased during this time. Whether remote learning can mitigate lost opportunities from in-person interactions remains uncertain. Optimizing these strategies will be important for potential future restricted learning paradigms and can also be extrapolated to augment trainee education during unrestricted times.

Standardizing education in interventional pulmonology in the midst of technological change

Interventional pulmonology (IP) is a maturing subspecialty of pulmonary medicine. The robust innovation in technology demands standardization in IP training with both disease and technology driven training. Simulation based training should be considered a part of IP training as seen in other procedural and surgical subspecialties. Procedure volume is a component of training; however, this does not guarantee or translate into competency for learners. Basic competency skills can be assessed using standardized well validated assessment tools designed for various IP procedures including flexible bronchoscopy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA), rigid bronchoscopy and chest tube placement; however, further work is needed to validate tools in all procedures as new technologies are introduced beyond fellowship training. Currently there are at least 39 IP fellowship programs in the United States (US) and Canada which has led to improved training by accreditation of programs who meet rigorous requirements of standardized curriculum and procedural volume. The challenge is to be innovative in how we teach globally with intention and how to best integrate new evolving technology training for those not only during fellowship training but also beyond fellowship training.

Simulation Training in Neuroangiography: Transfer to Reality

PURPOSE

Endovascular simulation is an established and validated training method, but there is still no proof of direct patient's benefit, defined as lower complication rate. In this study, the impact of such a training was investigated for rehearsal of patient-specific cases as well as for a structured simulation curriculum to teach angiographer novices.

MATERIALS AND METHODS

A total of 40 patients undergoing a diagnostic neuroangiography were randomized in a training and control group. In all training group patients, the angiographer received a patient-anatomy-specific rehearsal on a high-fidelity simulator prior to the real angiography. Radiation exposure, total duration, fluoroscopy time and amount of contrast agent of the real angiography were recorded. Silent cerebral ischemia was counted by magnetic resonance diffusion-weighted imaging (DWI). Additionally, the first 30 diagnostic neuroangiographies of six novices were compared (n_total = 180). Three novices had undergone a structured simulation curriculum; three had acquired angiographic skills without simulation.

RESULTS

No differences were found in the number of DWI lesions or in other quality measures of the angiographies performed with and without patient-specific rehearsal. A structured simulation curriculum for angiographer novices reduced fluoroscopy time significantly and radiation exposure. The curriculum had no influence on the total duration of the examination, the amount of contrast medium or the number of catheters used.

CONCLUSION

There was no measurable benefit of patient-anatomy-specific rehearsal for an unselected patient cohort. A structured simulation-based curriculum to teach angiographic skills resulted in a reduction of fluoroscopy time and radiation dose in the first real angiographies of novice angiographers.

LEVEL OF EVIDENCE

Level 4, part 1: randomized trial, part 2: historically controlled study.

How We Evaluate Postgraduate Medical E-Learning: Systematic Review

BACKGROUND

Electronic learning (e-learning) in postgraduate medical education has seen a rapid evolution; however, we tend to evaluate it only on its primary outcome or learning aim, whereas its effectiveness also depends on its instructional design. We believe it is important to have an overview of all the methods currently used to evaluate e-learning design so that the preferred method may be identified and the next steps needed to continue to evaluate postgraduate medical e-learning may be outlined.

OBJECTIVE

This study aimed to identify and compare the outcomes and methods used to evaluate postgraduate medical e-learning.

METHODS

We performed a systematic literature review using the Web of Science, PubMed, Education Resources Information Center, and Cumulative Index of Nursing and Allied Health Literature databases. Studies that used postgraduates as participants and evaluated any form of e-learning were included. Studies without any evaluation outcome (eg, just a description of e-learning) were excluded.

RESULTS

The initial search identified 5973 articles, of which we used 418 for our analysis. The types of studies were trials, prospective cohorts, case reports, and reviews. The primary outcomes of the included studies were knowledge, skills, and attitude. A total of 12 instruments were used to evaluate a specific primary outcome, such as laparoscopic skills or stress related to training. The secondary outcomes mainly evaluated satisfaction, motivation, efficiency, and usefulness. We found 13 e-learning design methods across 19 studies (4% 19/418). The methods evaluated usability, motivational characteristics, and the use of learning styles or were based on instructional design theories, such as Gagne's instructional design, the Heidelberg inventory, Kern's curriculum development steps, and a scale based on the cognitive load theory. Finally, 2 instruments attempted to evaluate several aspects of a design, based on the experience of creating e-learning.

CONCLUSIONS

Evaluating the effect of e-learning design is complicated. Given the diversity of e-learning methods, there are many ways to carry out such an evaluation, and probably, many ways to do so correctly. However, the current literature shows us that we have yet to reach any form of consensus about which indicators to evaluate. There is a great need for an evaluation tool that is properly constructed, validated, and tested. This could be a more homogeneous way to compare the effects of e-learning and for the authors of e-learning to continue to improve their product.

Development and Utilization of 3D Printed Material for Thoracotomy Simulation

Medical simulation is a widely used training modality that is particularly useful for procedures that are technically difficult or rare. The use of simulations for educational purposes has increased dramatically over the years, with most emergency medicine (EM) programs primarily using mannequin-based simulations to teach medical students and residents. As an alternative to using mannequin, we built a 3D printed models for practicing invasive procedures. Repeated simulations may help further increase comfort levels in performing an emergency department (ED) thoracotomy in particular, and perhaps this can be extrapolated to all invasive procedures. Using this model, a simulation training conducted with EM residents at an inner city teaching hospital showed improved confidence. A total of 21 residents participated in each of the three surveys [(1) initially, (2) after watching the educational video, and (3) after participating in the simulation]. Their comfort levels increased from baseline after watching the educational video (9.5%). The comfort level further improved from baseline after performing the hands on simulation (71.4%).

Simulation-based Training for Interventional Radiology and Opportunities for Improving the Educational Paradigm

The current model for medical education is based on the Master-Apprentice model which was adopted into practice over a century ago. Since then, there have been many changes in healthcare and the environment in which trainees learn, practice and become proficient in procedural and critical thinking skills. The current model for medical education has however, not changed considerably in this time frame, resulting in significant limitations to trainee education. Simulator-based training is a technique which can minimize the limitations of the apprenticeship model by mitigating the effect of time constraints, increased emphasis on patient safety and satisfaction and nonstandardization of Interventional Radiology (IR) curricula. Currently, simulators are utilized in some IR programs, however robust research into simulators must be performed to prove the educational validity of simulators and support formalization and widespread integration of simulation based training into a new, improved and standardized IR curriculum.

What it means 'to teach' as a radiologist in the modern era: a personal perspective

Whether employed in a private practice, a community or academic setting, or even a hybrid practice, radiologists fill many roles in the course of a day. Teaching is one of the most important roles in the dissemination of knowledge and the continued renewal of the health, vibrancy and advancement of our field. In this article the author reviews some of the various facets of what radiology teaching and learning look like in the current era. Highlighted topics include workstation teaching, workshop and small group education, interdisciplinary activities and mentorship.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment

OBJECTIVES

New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum.

METHODS

A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures.

RESULTS

Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound.

CONCLUSION

A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs.

KEY POINTS

• Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.