SIR/RSNA/CIRSE Joint Medical Simulation Task Force Strategic Plan Executive Summary

Strategic Mission 

The Executive Council of the Society of Interventional Radiology (SIR), the Board of Directors of the Radiological Society of North America (RSNA), and the Executive Council of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have charged their Medical Simulation Task Forces and Work Groups to cooperate to achieve excellence and safety in interventional radiology (IR) patient care by jointly recommending and guiding implementation of a robust infrastructure and process to support IR simulation development, assessment, validation, application, and dissemination.

Introduction 

The goal of medical training is to create practitioners who demonstrate mastery of the professionalism (skills, knowledge, attitudes, and behavior) required for the successful delivery of medical therapy (1). A well-designed and fully integrated curriculum is the essential mechanism by which this mastery is achieved. Since ancient times, mastery of the curriculum's clinical, cognitive, psychomotor, and attitudinal skills have been acquired in the master-apprentice training model (MAM). After initially observing the instructor, the trainee is eventually allowed “hands-on” experience under supervision: this has in the past been supplemented with training on physical and animal models, cadavers, and, more recently, analog, digital, and hybrid simulation (2).

The limitations of the traditional MAM to learn in patients include a need for expert supervision, the potential for suboptimal results or harm, time constraints, rising costs, stress, ethical considerations, and an adversarial medico-legal milieu. In addition, diagnostic imaging advances have all but eliminated the need for straightforward invasive diagnostic procedures that had been used to train basic skills in IR. These difficulties have led to a reappraisal of alternative training methods for the 21st century to augment and segmentally replace the traditional training methods.

Teaching models and tools must be cost-effective, adaptable to change, and proven to develop skills that transfer to clinical circumstances. Where this gold standard validation proves elusive, these new medical simulators must be reconfigured to optimize the probability of validation. Medical simulation, using a combination of physical models and computer simulations, holds considerable promise for training but to do this effectively requires accepted principles of educational methodology, including the need to obtain procedural skills within an overarching curriculum, with comprehension of the underlying condition and the risks and benefits of various therapies. Yet while standards exist for aviation, there are as yet none for the methodology and validity of medical simulations.

Validation 

Public and professional acceptance of the use of simulation as a component of training high-stakes IR skills requires proof (validation) of effectiveness. Validation of “testing” requires an ability to accurately assess knowledge and performance as they relate to learning objectives. The requirements for validating the use of a training device as a part of a curriculum depend on considerations such as a need:

For these reasons, development of recommendations for validation and defined standards (including those specified within a curriculum) underpins the Joint Medical Simulation Task Force strategic plan (3, 4).

A Strategy for Implementation 

To safely implement simulator-based training in a curriculum requires evidence of clinical relevance; yet continued technology development might rapidly render well-conducted validation studies obsolete. It therefore seems prudent to adopt new technology for use within its areas of known efficacy (3) as determined by development history, metrics, validation studies, and the standards that are to be set in consequence of this strategy. Indeed, clinically appropriate innovation, development, and instructional design should facilitate validation, opening up a new era in medical procedural training.

To increase the role of simulation in correctly training the cognitive and clinical knowledge necessary for the practice of IR requires thoughtful development and careful, yet expeditious, incorporation into official training curricula. This requirement has been identified by the Executive Councils of the SIR and CIRSE and the Board of Directors of the RSNA (5). The Joint Simulation Task Force (JSTF) has been charged with recommending to their leadership a plan to integrate throughout their divisional structures the analysis, development, assessment, application, and dissemination of medical simulation in IR. This includes professional education, standards, research (principally: direction, advice, and support), economics, practice building, and public information. The JSTF is not a credentialing body: its recommendations will include professional education, standards, research, economics, practice building, and public information. They will be derived from evidence-based and subject matter expert advice. The RSNA continues to work with the SIR and CIRSE on the vision, mission, and goals for simulation in IR and beyond, as well as an implementation plan.

The 2010 Vision of the Societies 

By 2010, a growing number of validated IR simulation training modules will (a) have been shown to transfer skills and reduce procedural error, (b) be delivering clinical benefit to patients, and (c) have been integrated into a standardized IR training curriculum and certifying examinations: the newly formed American Board of Radiology Foundation is planning on a major role for simulation in its early initiatives.

Specific Goals to Attain the Mission of the JSTF 

Strategy Outline 

This two-stage strategy (3, 4) aims to achieve the stated goals for medical simulation with specific reference to financial implications and expected timeframes. Although not intended to be prescriptive, the Societies recognize the pressing need for such an initiative in the field of IR simulation, recognizing that periodic updates and modifications will be needed to address evolving technology and political issues. The JSTF will work to develop the strategy objectives and disseminate findings, collaborating with others as required to meet the Societies' mission of excellence in IR patient care.