What makes an effective radiography simulation

The goal of any medical imaging program is to prepare students to practice competently and effectively as radiologic technologists (radiographers) in medical centers and hospitals.

To achieve this a number of courses offer papers such as Patient Care, Imaging Physics, Human Anatomy & Pathology, Image Analysis, and Clinical Education.

Currently, there is no formal recognition of Simulation-based learning in the USA. This is despite the fact that Simulation-based training is increasingly recognized as a part of health care education and as a means to improve patient safety (1).

Simulation can offer learners access to events that can otherwise not be directly observed, and in a safe and controlled environment. Simulation can also prepare learners for more complex procedures that they may not see many of or at all during their training but may see in their work environment after they graduate. Simulation can prepare learners technically so valuable time spent at the clinical site is more appropriately used as they are more technically competent from their time in simulation and can be more useful to their colleagues in the workplace. This also allows greater opportunities for learning soft skills in the clinical environment which are harder to master in a simulation environment. (2-4)

“Most importantly, simulation has a positive impact on patients reducing patient harm and improving quality of care independent of condition. Simulation is now “firmly established as a central constituent of healthcare education.”

A paper on Clinical Simulation in Nursing shows that simulation has been proven as a beneficial teaching method for undergraduate students and furthermore that replacing part of the required clinical practice hours with simulation has shown to be equivalent with regards to traditional clinical practice in regards to skills, knowledge, and confidence. The results were from several studies throughout the USA and UK. (3)

A surprising side result of the simulation studies found that having increasing numbers of undergraduate students on clinical placements has led to industry partners feeling stretched and fatigued. This has led to inadequate supervision and in extreme cases discontinuing the relationship. Substituting some of the clinical time with simulation has allowed the students the experience they deserve and need and allowed industry partners to slow down.

Another paper on nursing education suggests 50% of clinical hours can be replaced by simulation. (4) This paper is based on nursing education in the USA and suggests that with limited clinical opportunities Virtual simulations are supplementing the learning and are really paying off. Nursing programs are now requesting permission from boards to allow simulations for nursing education. Their recommendations include that Nursing programs using simulation need to ensure that simulation is purposefully integrated into the curriculum with clear connections toward the achievement of course and program outcomes. It was stressed though that all simulations used to replace clinical hours must be of a required standard. Interactive simulation with real-time feedback was stressed as important.

Other models have used the concentrated experience available in a simulation environment to be worth twice as much time in a real clinical environment due to the fact that some time in a clinical environment may include time without patients and general downtime. (5)

Simulation must be realistic and allow learners to make mistakes in a controlled environment. Process orientated software merely directs the students through a single pathway and does not provide a learning opportunity. For example - if a learner cannot incorrectly position a patient or radiographic tube and see the result on the image so that they can critique the radiograph and make alterations the simulation is not adequately providing learning opportunities.

Similarly, if radiographic exposure factors cannot be altered by the students (kVp, mAs, etc) and the resulting image show clearly that the student has correctly chosen an exposure or incorrectly chosen the factors and whether they have too much contrast or density they cannot learn how to fix these issues as they will not see them in a clinical environment.

Virtual Medical Coaching simulations offer hundreds of thousands of potential patient and tube positions which all result in realistic radiographs which reflect the position the learner has positioned the patient and tube. Furthermore, the exposure factors reflect exactly what has been selected on the radiographic console and the learner can appreciate incorrect and correct contract and density prior to any post-processing.

Students receive immediate comprehensive feedback on their imaging and are able to download and keep all of their images for use in a portfolio. From a Faculty perspective, immediate visibility on learners who are engaged or not performing well is available on dashboards which can be manipulated to show any number of appropriate data about a learner or group of learners.

References

1. McIntosh, Cate; Macario, Alex; Flanagan, Brendan; Gaba, David M Simulation: What does it really cost?, Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare: Summer 2006 - Volume 1 - Issue 2 - p 109
2. Zendejas B, Brydges R, Wang AT, Cook DA. Patient outcomes in simulation-based medical education: a systematic review. Journal of General Internal Medicine. 2013 Aug;28(8):1078-1089. DOI: 10.1007/s11606-012-2264-5.
3. Pian-Smith MC, Simon R, Minehart RD, Podraza M, Rudolph J, Walzer T, Raemer D. Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. Simul Healthc. 2009 Summer;4(2):84-91. doi: 10.1097/SIH.0b013e31818cffd3. PMID: 19444045.
4. Kneebone, Roger L. "Simulation reframed." Advances in Simulation 1, no. 1 (2016): 1-8.
5. Roberts, E., Kaak, V. and Rolley, J., 2019. Simulation to replace clinical hours in nursing: a meta-narrative review. Clinical Simulation in Nursing, 37, pp.5-13.
6. Hayden, J.K., Smiley, R.A., Alexander, M., Kardong-Edgren, S. and Jeffries, P.R., 2014. The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), pp.S3-S40.
7. 4.Curl, Eileen D.; Smith, Sheila; Chisholm, Le Ann; McGee, Leah Anne; Das, Kumar Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students, Nursing Education Perspectives: March/April 2016 - Volume 37 - Issue 2 - p 72-77
8. Carruthers KH, McMahan JD, Taylor A, Pearson G, Tiwari P, Kocak E. Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations. J Surg Educ. 2015 May-Jun;72(3):477-82. doi: 10.1016/j.jsurg.2014.11.009. Epub 2015 Jan 6. PMID: 25572941.
9. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Med Educ. 2010 Jan;44(1):50-63. doi: 10.1111/j.1365-2923.2009.03547.x. PMID: 20078756.

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