Diagnostic radiology educators aren’t using advanced simulation techniques, but they may soon change their tune

Radiology residency programs are barely using high-fidelity simulation training at all right now, but watch for the technology to begin changing the educational landscape for diagnostic rads-to-be in the years to come.

So concludes a research team led by Tessa Cook, MD, PhD, of the University of Pennsylvania in an original investigation posted online in Academic Radiology.

The authors define high-fidelity simulation (HFS) in diagnostic radiology as simulation that not only provides images for supervised interpretation but also mimics the high-stress, high-stakes clinical environment—complete with workflow interruptions by telephone and other distractions—that the typical radiology resident encounters during the second year of training.

Setting out to find out what barriers have been blocking HFS from penetrating diagnostic radiology—especially in a time when interventional radiology is effectively using the technology and other medical specialties have made sim centers all but ubiquitous—the team surveyed academic radiologists and radiology trainees via email.

They received 68 responses representing 51 programs, or 31 percent of the 166 diagnostic radiology residency programs in the U.S. offering postgraduate year-two positions in the National Residency Matching Program as of 2015.

Individual respondents included program directors, department chairs, chief residents and program administrators.

The most common tool for call preparation involved lectures, which were reported by 49 out of 51 (96 percent) programs, and more than half the programs offered at least 20 hours of lecture time dedicated to call preparation.

So-called “baby call,” defined as after-hours trainee interpretation of emergent and inpatient cases with close faculty supervision, was reported by 45 out of 51 (88 percent) programs.

Shadowing senior residents was used in 41 out of 51 (80 percent) programs.

Among the most frequently cited reasons for non-use of HFS were lack of faculty time (45 percent), lack of radiology faculty training in simulation (37 percent), lack of IT and other support staff for running a sim program (37 percent) and cost of equipment and operations (33 percent).

In their discussion, Cook et al. express their impression that receptiveness to HFS is soon to begin turning in the technology-based method’s favor.

“During a time of increased emphasis on training the ‘everyman’ radiologist who is specialty-trained but also able to effectively practice general radiology, and competent in a slate of noninterpretive skills, residency training is evolving,” they wrote. “In this time, the availability of a simulated environment, in which residents could interpret cases with the real challenges of an on-call shift but not the pressures of potentially harming actual patients, would be extremely beneficial to residents, program directors, and ultimately, our patients.”

HFS also stands to grow as a result of changing educational, economic and regulatory factors, they point out.

“Unlike the oral board exam, where an examinee’s communication skills could easily be assessed during each section, the computerized board exams no longer provide this feedback,” the authors noted. “Simulation could offer a new avenue not only for training future radiologists but also for renewal of ABR license and maintenance of certification.”