1. Emergent/Critical Care Imaging Simulation Resident Assessment and Training Tool
Linda Lanier, MD
Associate Professor and Associate Chairman, Department of Radiology
Chris Sistrom, MD, MPH, PhD
Anthony A. Mancuso, MD
Professor and Chairman, Department of Radiology

2. Emergent/Critical Care Imaging Simulation

3. What are we trying to Simulate?

4. What are we trying to Simulate?
ALL of the skills necessary for service as a radiologist performing
Emergent and Critical Care Imaging

5. Observational skills Full DICOM image set ( 1-3000 images)
Image manipulation, optimal viewing
All Modalities:
CR, CT, CTA, US, MRI, MRA, NucMed, Fluoro
All Systems:
Body (Chest/Abdomen/Pelvis/GI/GU), Neuro/ENT, Pediatric, MSK, Vascular

6. Confident Determination of Normal
Observational skills
Confident Determination of Normal
Downside of Overcall
Comprehensive Search Pattern

7. Confident Determination of Normal Identification of Key Findings
Observational skills
Confident Determination of Normal
Identification of Key Findings
Critical/Important/Incidental Findings
Clinical Context (WITH or WITHOUT History)
Prioritize Findings

8. Observational skills
Confident Determination of Normal
Identification of Key Findings
Recognition of Acuity

9. Confident Determination of Normal Identification of Key Findings
Observational skills
Confident Determination of Normal
Identification of Key Findings
Recognition of Acuity
Communication of Results - Actual Practice
Phone/In person
Report Clarity

10. Confident Determination of Normal Identification of Key Findings
Observational skills
Confident Determination of Normal
Identification of Key Findings
Recognition of Acuity
Communication of Results - Simulation
Response is Free Text Entry
No multiple choice
No cueing or ability to “game” responses
No True/False

11. Observational skills
Confident Determination of Normal
Identification of Key Findings
Recognition of Acuity
Communication of Results
Initiate Appropriate action

12. Observational skills
Confident Determination of Normal
Identification of Key Findings
Recognition of Acuity
Communication of Results
Initiate Appropriate action
Stamina

13. Building the Case Library
Core Curriculum ( Topics)
Collect and vet cases (10-20 cases per topic)
Enter Case data into RCMS
Grading key
Reports

15. Building Simulations

16. The HOT SEAT

17. Pick a case from the workflow …

21. Free text response ….

22. Select acuity level ….

23. Submit case ….

24. Oooops … need addendum ?

25. Select a new case from workflow list …..

27. The “Front End” PACS Workstation 8 Hour Shift 65 Cases
Typical Work Flow Style

28. The “Front End” PACS Workstation 8 Hour Shift 65 Cases
Typical Work Flow Style
(Minus the phone calls, interruptions …..)

29. The “Back End”

30. The “Back End”
Tracking Capability

31. Tracking Capability

32. The “Back End”
Tracking Capability Grading

33. Grading Tool

34. Results to Program Director

35. Results to Program Director

36. Results to Individual Residents

37. Video Review of Cases Residents

38. Emergent/Critical Care Imaging Simulation 2011-2014
YEAR
SIMULATION
Total # Residents
R LEVELS
INSTITUTIONS
2011
SIM 1 22
R1-12
R2-10 UF
2012 36
R1-20
R2-16
UF,
UF-J,
Mt. Sinai
2013
SIM1 66
R1-25
R2-24
R3-11
R4 -6
U Mississippi
2014
SIM 2
103
R1-63
R2-31
R3-6
R4-3
UF, UF-J, Mt Sinai
SUNY, Creighton,
Baylor-Dallas,
Geisinger,
U Kentucky

39. Emergent/Critical Care Imaging Simulation 2015
YEAR
SIMULATION
Total # Residents
R LEVELS
INSTITUTIONS
2015
SIM 3
Taken
127
R1 94
R2 33
Albert Einstein
Dartmouth
Geisinger
Hahnemann
Mount Sinai Miami
Stony Brook
SUNY- Brooklyn
University of Florida
University of Florida-Jax
University of Kansas
University of Kentucky
University of Louisville
University of Mississippi
University of Pennsylvania
University of Vermont
University of West Virginia
Registered
(not yet taken) 19
R1 19
Army
Air Force
SIM Monmouth 2
R1 1
R2 1
Monmouth Medical Center

40. Averages and Ranges YEAR SIMULATION R LEVEL (N) AVG SCORE RANGE
SIM 1
R1 (57)
R2 (50)
R3 (11)
R4 (6)
61%
74%
73%
78%
42%-74%
65%-85%
60%-85%
73%-81%
2014
SIM 2
R1 (63)
R2 (31)
R3 (6)
R4 (3)
58%
70%
66%
68%
39%-78%
48%-81%
54%-72%
59%-79%
2015
SIM 3
R1 (94)
R2 (33)
59%
67%
47%-68%
63%-74%

41. Simulation – A Self Discovery Process
Identifies the Educational Tasks
Identifies the Knowledge Gaps
Individuals
Programs
Across institutions
Identifies Areas of Uncertainty
Trains Toward Competency

42. Future SIM - Tiered Options SIM - Scoring by key Findings
SIM - Natural Language Processing (NLP)
SIM – Adaptive testing?
Curriculum – “Emergent/Critical Care Imaging” Interactive
Non synchronous
Case based
Educational Video Clips/Flicks

43. Other uses of Imaging Simulation Platform
Training for Other specified Groups ED
Stroke Team
Med students
Night Hawk
Practice Hires
Hospital safety

44. Pathway to Competency

45. Emergent/Critical Care Imaging Simulation

48. Content SIM 1

49. Content SIM 2

50. Content SIM 3