PACS simulator prepares residents for call
Competency-based training in healthcare requires that physicians show they have been adequately trained in providing a specific level of care prior to delivering that care. This creates the conundrum of how to gain that experience without already having had that experience.

For radiology residents preparing to take call, the traditional method of preparation has involved core rotations; dedicated lectures; so-called “mini-call” with an attending or fellow; and review of the institution’s teaching files. Although these educational stratagems are useful techniques for increasing knowledge, none mimic the experience of independent interpretation of a series of diagnostic images.

A team from the department of radiology at the University of Pittsburgh Medical Center in Pittsburgh has developed a simulator for radiology that approximates the appearance and functionality of the institution’s PACS (iSite, Philips Medical Systems). This tool, according to a recent article in the journal Radiographics, permits residents to gain hands-on knowledge of the experience of taking call.

“Simulators also allow education to be relatively standardized,” the authors wrote. “Every user can simulate the same scenario or case; thus, all users have the same experience. This uniformity also allows a user to become familiar with rare situations.”

In addition to preparing residents to take call, the simulator allows these physicians to gain experience and practice without the potential to affect patient safety.

The University of Pittsburgh simulator works in concert with its PACS, although all simulator cases are anonymized, according to the developers. The interface contains all the image interpretation tools that residents will use when they take call. The only major difference between the simulator and the PACS is the appearance of the case work list.

“The key feature added to the work list on the simulator is the ability to search for studies on the basis of modality, division, disease, call level, and difficulty,” the authors wrote. “Although these categories are designed specifically for our purpose (ie, call preparation), they could easily be modified to fit any purpose.”

Once a resident has selected cases for review and interpretation, the entire study is opened along with a pop-up window that contains pertinent history and a text box in which they can enter their impressions. Once the interpretation is completed, the resident submits his or her findings and is then able to grade their primary impression against the case’s actual primary dictated report, which is presented on screen. A performance report is presented to the resident upon completion of the training session.

“The user has incentive to grade each case accurately because he or she can use the statistics generated in the performance report to find areas of weakness,” the authors reported. “There is also little incentive to cheat, since no one else has access to the user’s results.”

In addition to its use as a resident preparation tool for taking call, the developers noted that it can be used to teach seasoned radiologists a new modality or procedure on an existing modality such as cardiac CT angiography. It also could be deployed for continuing medical education training and credits, a testing tool for the maintenance of certifications, or to augment or replace digital teaching files.

“Simulators have the potential to advance radiology education with the use of an active learning process,” the authors wrote. “Case-based simulators closely mimic the real-world practice of radiology and can help prepare the user for many specific scenarios.”