Robertson HJ, Piage JT, Bok JT, eds. Simulation in Radiology. Oxford University Press; 2012; 336 pgs.; $69.99.
Medical training has undergone a gradual transition by developing more rigorous methods for teaching all aspects of medical care from the physical exam to complex procedures. The traditional written examination assessment for medical knowledge works fairly well for information that is critical to know but did not assess skills that a physician needs to perform. Oral examinations sought to tease out some of these skills, as did clinical skill assessments using actors as patients. Volunteers for more complex procedures like colonoscopies, endoscopies, and intubations are probably harder to recruit than those for a simple physical exam, and there are ethical dilemmas using volunteers for complex procedures. Standardization in live volunteers is also challenging. Simulation training with cadavers and mannequins gradually became an answer to this difficult dilemma. One of the earliest and most famous mannequins was introduced in 1960 to teach CPR and was known as Resusci Annie. Medical Schools have slowly introduced a variety of simulation techniques including the HARVEY cardiology simulator developed at the University of Miami. Radiology, however, has been generally slower to adopt simulation training but as the “see one,” “do one,” “teach one,” mentality for graduate medical education wanes, it is more important for training programs to develop rigorous simulation training techniques and for potential trainees to seek those kinds of opportunities out in their training programs. This book serves as a thorough guide to simulation training in radiology education.
The book is fairly broad and divided into 3 sections. The first section, entitled Simulation: Technical Considerations, reviews fundamentals and technical aspects of simulation, including basic definitions, types of simulation, and ethics and regulations regarding cadaver use. Discussions are then provided of computerized simulation and various types of simulation equipment. Black-and-white photos of the various commercial and non-commercial options are provided along with addresses, email, and phone numbers of vendors.
The second section, entitled Simulation in Education, provides general guidance in creating a simulation program applicable to any specialty in medicine, but with one chapter specifying its use in a radiology residency program. Basic educational principles are reviewed, including an entire chapter devoted to proper assessment of skills learned using simulators. Documentation of correct, meaningful assessment is important to the ACGME and often poses a challenge to residency and fellowship programs. The last chapter in section 2 provides the reader with a very nice guide towards developing and operating a physical simulation lab and a training institution serving all medical specialties.
The third section, entitled Applying Simulation in Radiology, includes 18 chapters of training areas pertinent to radiology practice. These include basic and complex vascular, neuro, pediatric, musculoskeletal, and body interventional radiology techniques. More fundamental but pertinent medical skills such as knot-tying, contrast reactions, sedation/analgesia, and emergency radiology and workload management are included. For the purposes of this review, only the three neuroradiology-related chapters will be discussed individually, although the previously mentioned fundamental skill chapters certainly apply to neuroradiologists.
Chapter 16 describes neurointerventional applications where simulation-type training would be useful and how they could be implemented. Procedural descriptions of arteriography, lumbar puncture, C1-2 puncture, cisternal puncture, spinal biopsy, vertebrae biopsy, needle placements, and PMMA injections are discussed among other topics. Because simulators have not necessarily been developed for these procedures, the chapter points mostly describe why the procedures would benefit from simulator training and the challenges in performing procedures. Simulator developers would be wise to carefully review this chapter for ideas and needs of the field.
Chapter 17 describes simulation in spinal pain management and describes a variety of simulator tools. Simulation techniques for patient history-taking and performing invasive procedures on mannequins and cadavers are discussed. Available products are described with Web sites and listed manufacturers. Facet injections, intralaminar and transforaminal epidural steroid injections, and paravertebral blocks are reviewed for what makes those techniques challenging and why simulators are helpful training aides.
Chapter 18 describes cervical transforaminal epidural steroid injections. A thorough review of the technique—including indications, contraindications, complications, and concerns during the procedure—is reviewed. The chapter convinces the reader that on the basis of complexity, simulation training would be useful if developed.
This book would be useful for radiologist educators looking to increase the rigor of their training programs. Radiology practice and hospital administrators who want to make sure their radiologist staff stay safely trained on the most up-to-date techniques may be interested in implementing some of these systems. Radiologists who do not perform procedures often might benefit from simulation review training before performing the procedure on a patient. I found the chapters to be thorough and convincing. Literature cited appeared appropriate, and the text is well written. Images are appropriate to the topic. Overall, this book is a thorough treatise on this important educational topic.
