UF Radiology Residents Sharpen Skills in Simulator

By Alexander Bolt

The University of Florida College of Medicine is riding the trend of gamification in medical education, developing a new, real-time training simulation for radiology residents akin to a flight simulator. The program, “Simulation in Emergent and Critical Care Imaging,” simulates a typical call rotation in an emergency room.

Flight simulators have proven to be very effective in training pilots to operate aircraft and handle possible equipment malfunctions without putting people at risk. According to UF faculty, scientific research shows that simulation is an effective technique in training medical staff as well, and is especially suited for learning such high-acuity tasks as anesthesia, surgical procedures, and emergent care.

“Now we as radiologists have the tools needed to simulate all of the tasks inherent in emergent care imaging. We can and should use this tool to improve patient safety and optimize quality care,” says Linda Lanier, MD, associate professor and associate chair in the department of radiology in the UF College of Medicine.

The program guides residents through a realistic, full-day exercise in interpreting diagnostic images and patient management in the emergent setting. They are seated in the radiologist’s chair and are presented with cases of patients who would arrive in an emergency room. They must interpret full sets of DICOM images and determine if cases are normal or abnormal. If a case is abnormal, residents must assert the acuity level as well as indicate whom they would contact with results. The ED radiology position is a high-acuity assignment, so it is doubly important to train residents to rapidly and accurately interpret studies and to communicate results clearly.

“Each resident must go through 65 cases during this eight-hour exercise. Each case could have one (chest x-ray) to 3,000 (brain MRI/MRA) images to review at a time,” Lanier says.

The simulation allows for free text responses, which means there is no cueing of responses or gaming the test, as can be the case with multiple choice tests. The simulation is hand-graded by academic faculty in diagnostic radiology at the University of Florida and faculty have been working toward incorporating Natural Language Processing (NLP) which, when available, will enable a computer to accurately grade responses. “NLP is not ready for prime time. That capability could be five years away, but who knows? There are a lot of very bright people actively working on NLP,” says Lanier.

Although the simulation may be a more effective way to gauge radiology resident’s abilities, it’s unlikely that it will make standardized testing obsolete, since both types of assessment play a role in resident evaluation. According to Lanier, “The simulation tests very different things than do standardized tests, like the ability to see all of the findings in a full set of images, to work under pressure in real time, and to follow up with appropriate next steps.”

UF created the web-based simulation platform in collaboration with the American College of Radiology; it is readily available to evaluate residents in institutions across the country by delivering high-resolution diagnostic images via the cloud. Nine institutions have participated in the simulation thus far and several new institutions are actively testing it now.

Alex Bolt is a staff writer at the Association of American Medical Colleges. He can be reached at abolt@aamc.org.

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