RSNA: Simulations effective learning tools for learning to handle contrast reactions

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 - Safety First

CHICAGO—High fidelity simulations are a promising learning tool for radiology residents, fellows and instructors and can help radiolgists differentiate between moderate and severe reactions effectively, according to a recent study presented Dec. 1 at the annual meeting of the Radiological Society of North America (RSNA).

Presented by Kyle E. Pfeifer, MD, of Yale New Haven Hospital in Connecticut, the research assessed the effectiveness of high fidelity simulation in managing patient contrast reactions during diagnostic radiology.

Pfeifer noted that severe reactions to contrast agents are rare in radiology, making up less than .01 percent of all contrast administrations.

“Radiologists are primarily positioned to be responsible for the management of contrast reactions,” Pfeifer said. “Unfortunately since the occurrences are low frequency, this leads to having low experience in management. One study demonstrated that over half of radiologists didn’t know the accurate dose of epinephrine to administer in severe contrast reactions.”

Using simulations to practice these scenarios offer numerous benefits to radiologists, according to Pfeifer.

“They allow for a safe environment for people to practice without allowing for harm to actual patients,” he said. “They also allow for routine exposure of the same event.”

To conduct their study, the team used a 20-question multiple choice test and Likert scale questions to assess participants comfort levels and knowledge of management of contrast reactions.  “In these questions we assessed two key areas—the comfort level of participants in managing contrast reactions before and after simulations, as well as feelings toward using high fidelity simulations as an educational tool,” Pfeifer said.

They set up three simulation scenarios of varying reactions to contrast agents (moderate, severe and reaction mimic) and each course was completed in an hour with groups of eight to 10 respondents per simulation.

All participants (151 radiologists) completed pre-test, post simulation debriefing and a post test to determine effectiveness on test scores and the scale of comfort using the Likert ratings.

The study showed a significant increase in post-test scores after the simulation, and post-test Likert scores regarding comfort in managing adverse contrast events significantly improved across all three reaction types.

“The most dramatic results we saw were in the Likert scale questions,” Pfeifer said. “Every question we asked in the Likert scale showed dramatic statisically significant responses.”

He said the overall comfort level of participants in managing all three levels of contrast reactions (moderate, severe and reaction mimic) dramatically improved. Additionally, Pfeifer said the team found using the simulations as an education tool rose dramatically on the Likert scale among participants.

“People thought it was an effective learning tool. They felt comfortable differentiating contrast reactions from other emergencies and differentiating moderate from severe contrast reactions,” he said.