High-Fidelity Medical Simulation as an Assessment Tool for Radiology Residents' Acute Contrast Reaction Management Skills

Purpose The aims of this study were to use medical simulation as an assessment tool for the evaluation of radiology residents' compliance with contrast reaction treatment protocols and to gauge their perceptions of the simulation experience. Methods A prospective, observational study of postgraduate year 2 and 3 radiology residents' management of simulated life-threatening contrast reactions was designed. After standard didactic teaching on departmental contrast reaction protocols, residents participated individually in high-fidelity medical simulations of acute contrast reactions. Residents' performance of predetermined critical actions was recorded. Presimulation and postsimulation multiple-choice testing evaluated residents' knowledge of departmental protocols. Each resident completed 5-point, Likert-type surveys assessing comfort level while managing contrast reactions and perceptions of the simulation experience. Results Residents performed a mean of 13 of 20 critical actions (range, 10-16). The average presimulation multiple-choice testing score was 56%, whereas the average postsimulation score was 92% ( P = .0003). Subjects' average ratings of comfort level in managing in-hospital contrast reactions before and after study intervention were 3.47 and 4.07, respectively ( P = .03). Average ratings for comfort level in the outpatient setting were 3.08 before and 3.69 after the study ( P = .69). All residents strongly agreed that the simulation was a valuable educational experience, while 85% strongly agreed that it improved their skills in managing acute contrast reactions. Conclusion Standard didactic instruction may provide insufficient training and reinforcement of acute contrast reaction management skills. Medical simulation may provide a valuable means of assessing residents' skills and comfort levels in managing severe contrast reactions.