Simulation-based graduate medical education in MR-guided brachytherapy for cervical cancer

Abstract

PURPOSE: Brachytherapy is critical for the curative treatment of locally advanced cervical cancer. Although brachytherapy use is declining in the United States (U.S.), novel interstitial or intracavitary applicators and advances in image guidance for applicator placement and treatment planning have allowed for tumor dose escalation while reducing normal tissue toxicity. Recent survey data have suggested insufficient brachytherapy training for radiation oncology trainees in the United States. This study aimed to address these gaps by developing and piloting a simulationbased education (SBE) workshop for MR-guided cervical cancer brachytherapy. METHODS AND MATERIALS: An SBE workshop was developed for graduate medical education (GME) trainees focusing on MR-guided brachytherapy for cervical cancer. Four hands-on stations, simulating aspects of the procedure, were led by a team of gynecological brachytherapy experts. The learners were radiation oncology residents and fellows in a U.S. GME training program. The primary outcome was feasibility, assessed by completion of the workshop within the time constraints of the curriculum. Learners completed preworkshop and postworkshop surveys to provide information on efficacy. RESULTS: The workshop was successfully completed in a 1-h block of GME didactic time. Ten trainees completed all four stations, and all completed preworkshop and postworkshop surveys, which showed improvements in knowledge and technical proficiency. Feedback was positive, and trainees requested additional learning opportunities. CONCLUSIONS: This study showed that GME-focused SBE in MR-guided cervical cancer brachytherapy was feasible. SBE provided a nonclinical environment in which to practice aspects of MR-guided brachytherapy. Ongoing work includes collaboration with other U.S. institutions. Future studies should focus on international adaptation.

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?…”

“…The stations included (1) physical exam and applicator placement on a pelvic model, (2) suturing, (3) MRI contouring, and (4) clinical cases with MR images and applicator selection. The entire workshop was given in a 1 hour timeslot and was reviewed favorably by all 10 trainees 33…”

“…The entire workshop was given in a 1 hour timeslot and was reviewed favorably by all 10 trainees. 33 Computer-based Simulation Virtual reality offers immersive, engaging and time-efficient experiences that often would not be possible, such as observing a brachytherapy case in 3D before stepping into the procedure suite. At the University of Pennsylvania, a virtual reality training video was created that was able to be viewed through YouTube on a commercially available headset (https://www.youtube.com/watch?v=rs42NXRyhkk).…”

Ultrasound-guided Brachytherapy for Cervix Cancer

“…It is acknowledged that 'the manipulations necessary to optimise placement of the intracavitary system in different anatomic situations can only be learned with experience' [13], but this experience can be expedited with ultrasound guidance [14]. Ultrasound is increasingly being incorporated into training and simulation-based education courses to provide realistic and timely exposure of trainees to a range of brachytherapy procedures [15].…”