Development of a gynecologic brachytherapy curriculum and simulation modules to improve radiation oncology trainees’ skills and confidence

Abstract

PURPOSE: Brachytherapy in the management of cervical cancer is directly linked to improved survival. Unfortunately, we continue to see a decline in its utilization. A recent survey of U.S. residents demonstrated limited caseload as the greatest barrier to achieving independence in brachytherapy practice. To improve residents' brachytherapy skills and confidence in performing brachytherapy independently, a gynecologic brachytherapy simulation course was developed and tested. METHODS AND MATERIALS:The gynecologic brachytherapy curriculum and simulation modules were developed using a combination of didactic education, self-study, practicums, and patient-centered cases. The simulation modules consisted of 2-h sessions. The first hour occurred within a simulated OR environment, where residents independently performed all aspects of applicator insertion in a cadaver model. The second hour consisted of contouring, dosimetric planning, and treatment evaluation. A brachytherapy training survey developed by the Association of Residents in Radiation Oncology was given before and after the course. RESULTS: The perceived ability to perform brachytherapy independently for a given disease site correlated directly with number of cases performed. Most residents believed that after performing five cases they would be capable of performing additional cases independently (10 of 18). All strongly agreed (8 of 18) or agreed (10 of 18) this to be true after 15 cases. Compared with survey data before the brachytherapy simulation course, trainees felt that their ability to independently perform brachytherapy ( p ! 0.001) improved. CONCLUSIONS: A brachytherapy simulation course can be used to gain further experience in a controlled environment. Our results demonstrate that gynecologic brachytherapy simulation increased trainees' confidence in performing the procedures independently.

Gynecologic interstitial brachytherapy curriculum using a low-cost phantom with ultrasound workshop and a treatment planning workshop is effective

“…As previously mentioned, there are a few encouraging simulation-based workshops for prostate and gynecologic malignancies developed at other academic centers ( 23 − 28 ), ( 40 ). Among the programs for gynecologic brachytherapy, there are curriculums that have been developed that are MR-based ( 41 ), virtual reality-based ( 42 ), and cadaver-based ( 26 ). This initiative builds on the foundation already developed at other institutions with the hopes to increase the training specifically for gynecologic IS BT.…”

Education in gynecological brachytherapy

“…The feasibility of pelvic model based SBME for gynecological brachytherapy training has been established in multiple scenarios: single institutional, multi-institutional, and at national meetings 22–24 27 33 34 36 50. Is it time to move beyond feasibility and start using these training sessions more broadly and consistently?…”

“…For even more reality, and a chance to practice interstitial applications, cadaveric models have been used both by the Northwestern Radiation Oncology Department as well as the MS Ramaiah Medical College in India 27 28. The trainees at Northwestern had a curriculum that included didactics and self-study, hands-on applicator insertions on cadaveric pelvic models, followed by contouring, treatment planning and plan evaluation 27. Similarly, the experience in India included the entire brachytherapy workflow, from applicator selection and insertion to treatment planning and optimization 28.…”

“…In clinical practice, careful tandem placement relies on ultrasound guidance and contouring and treatment planning requires volumetric imaging with CT or MRI, none of which are available with the gynecological skills model due to the material used and the air cavities. Creative solutions have been arrived at, including the development of imaging-compatible mannequins as well as using cadavers as models [26][27][28] (Figure 1).…”

“…27 28 The trainees at Northwestern had a curriculum that included didactics and self-study, hands-on applicator insertions on cadaveric pelvic models, followed by contouring, treatment planning and plan evaluation. 27 Similarly, the experience in India included the entire brachytherapy workflow, from applicator selection and insertion to treatment planning and optimization. 28 These workshops show how SBME can be used for end-to-end testing for workflow, team building and safety evaluations, in addition to trainee education.…”