Simulators in Interventional Radiology Training and Evaluation: A Paradigm Shift Is on the Horizon

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WHAT IS MEDICAL SIMULATION?

So, how would one define medical simulation: does it have to be based on “virtual reality” alone? In fact, there are many definitions of medical simulation. In the context of training and evaluation, the authors identify some definitions. One variant is “the act of imitating the behavior of some situation or some process by means of something suitably analogous (especially for the purpose of study or personnel training)” (11). Dawson defines it as “the creation of an educational environment in

SIMULATOR TAXONOMY

Simulators in medicine lie on a continuum ranging from mannequins to immersive virtual reality simulators (or augmented reality). Although many schemes can be used to categorize these simulators, albeit in a somewhat arbitrary fashion, one simple categorization is into physical model, computer-based simulator, hybrid simulator, and immersive simulator (Table 3).

Another classification system, complimentary to the above is outlined in Table 4. The more rigorous taxonomies for simulators are not

ARGUMENTS FOR SIMULATION

It is unlikely that either the patient or the mentor in the MAM can be totally replaced by the available alternatives. Working within the limitations of the medical education system, the MAM can certainly be augmented, possibly extensively so, using various medical simulations. These procedure simulations are based on animal tissue, physical model simulators, computer-based simulators, and hybrid simulators. Using the latter, an operator can perform a simulated but realistic procedure in a

THE FUTURE OF IR TRAINING

Now that we have a background in what simulation is and is not, let us discuss how it can be used in IR training, and also consider its future. It is unlikely that with the current state of technology simulation will supplant the apprenticeship model of graduate medical training. However, as mentioned before, it can certainly augment it. Simulators may be used for a range of applications in IR (Table 5). High fidelity and complexity may introduce more “realism” but carry a financial tradeoff

THE FUTURE OF IR EDUCATIONAL ASSESSMENT

As the MAM shifts, perhaps the time-based advancement will be changed to the more appropriate proficiency-based advancement. For radiology and especially for IR, simulators may play a large role in assessing this proficiency.

Assessment of a candidate's fund of knowledge of radiology and IR using written and oral examinations has stood the test of time; however, these methods are woefully inadequate at assessing the trainee's technical skills. If the trainees are to be given the authority to

DESIGNING AND VALIDATING SIMULATORS

When designing simulators, several factors must be considered (Table 6). The purpose of the simulator must be defined in detail. This must include the tasks to be performed, metrics to be measured, how the metrics are to be measured, software environment defined, hardware (computational and haptics) requirements defined, and haptics-computer interface defined. The definition of the task or procedure is not always easy. For example, there may be multiple valid pathways and integral steps that

CHALLENGES AND OPPORTUNITIES FOR THE SIMULATION INDUSTRY

The simulation industry is tiny when compared with the vast pharmaceutical and medical device industries. However, as the drive to improve efficacy, safety, and efficiency in our undergraduate and postgraduate medical education picks up speed, the demands on the industry to provide relevant and valid simulations will increase. It will require millions, perhaps billions, of dollars and decades for the industry to evolve and mature. Ultimately, simulation may allow the suspension of an operator's

Standards for Curriculum Development and Human Factors

Much of the impetus to develop medical simulation has been through concerns regarding patient safety. The great promise of the simulation industry in this respect has rightly placed it at center stage. The more affluent medical device industry is also keen to adopt simulation, which may be used to train a range of specialties to use its products (45, 46, 47). Almost universally this lies outside the remit of statutory training organizations' curricula, where ironically it is even more important

POTENTIAL PITFALLS

Simulation in its many forms has proven to be an excellent tool in fields such as aviation and space exploration. It is poised to become an even more significant tool in procedural medicine. However, the road of adoption and education may be full of pitfalls. One such pitfall is to inadvertently (or otherwise) overstate the evidence. To gather the evidence needed, we must begin to experience the use of these devices in conjunction with traditional training. Some ethical issues also arise. When

SIMULATION IN THE REAL WORLD

The practice of IGI requires specific knowledge, cognitive and technical skills, and professionalism in attitudes and behavior (56). These are gleaned and assessed in a carefully designed curriculum, with certification dependent on satisfactory attainment of a series of performance objectives. Even as IGIs increase in number and complexity, the demise of invasive diagnostic imaging (because of a trend toward noninvasive diagnosis) and concern for patient safety have resulted in decreased

THE FUTURE OF SIMULATION

Simulation in IR or IGI is here to stay and its incorporation in training is inevitable. The form it will take and its time to maturity will depend on many factors including funding, research, multilateral collaboration, and legislation. It will also depend on how fast those involved in current teaching methods—the mentors, the trainees, the patients, and governmental organization charged with training and assessment—awaken to the limitations of the current medical system. One can imagine

Acknowledgment

The authors would like to thank Drs Steven Dawson and Gary Becker for reviewing the manuscript.

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