In my years of medical practice, I’ve seen experiential (‘hands-on’) learning increasingly used in medical education. Often referred to as “simulation,” this teaching style allows learners to demonstrate competence in skills without risk to patients. In a simulated setting, students take charge of patient care using patient mannequins, live actors, and other media, mastering procedural and diagnostic skills while educators assess their critical thinking. Simulation helps academic medical centers teach real-world practice, and immersion in low- and high-fidelity simulated environments teaches patient-centered care while preserving patient safety.

For over 15 years, UNC’s Clinical Skills and Patient Simulation Center, a.k.a. the “SIM Lab,” has provided the School of Medicine (SOM) several locations around UNC’s medical campus for procedural and technical instruction followed by self-directed critical thinking to help master what has been learned.  The Department of Radiology initially used the SIM Lab for Diagnostic Radiology resident (GME) teaching, and in 2018, SIM Lab instruction was added to medical student (UME) radiology education in preclinical and clinical years.

We now instruct using radiology simulation regularly and successfully. From monthly Critical Tests and Critical Values labs for medical students held at the PACS monitors each block, to annual contrast reaction simulation training for residents and fellows held in the CT bays, our educational initiatives receive high marks. Simulation rapid fire case interpretation plays an important role in preparing our rising second-year residents for independent call.

Clockwise, TOP: traditional classroom learning (short segments); Far right: “Ms. Cluck” breast Bx demonstration; BOTTOM: FAST (focused abdominal sonography trauma) practice.

Procedural teaching is arguably best initially taught in simulation manner. Drs. Sheila Lee and Sheri Jordan (Breast Imaging) proctor residents and medical students in ultrasound-guided breast biopsy labs each block, and Drs. Ellie Lee and Katrina McGinty (Abdominal Imaging) join Dr. Sheila Lee in hands-on Ultrasound scanning with first-year residents early in residency.

In the introductory UME elective (RADY 401), students are taught to understand radiology’s participatory role in emergency medicine responses to life-or-death scenarios such as tension pneumothoraces and intracranial hemorrhages, discussing critical findings from anonymized cases in lecture format. An empty reading room then provides a simulated setting for student groups to formulate ‘Critical Results’ diagnostic interpretations and present their findings using PACS tools.

On experiential learning, the RADY 401 course director, Dr. Oldan, states: “For a [UME] intro course, we want students to learn and apply fundamentals right away. Traditional lecture- and textbook-based teaching is important in providing a foundation, but simulation lets students discuss a case as a group, make findings, and formulate a diagnosis. They’re more engaged in trying to find the solution, in the ideal non-classroom setting – a reading room.”

Many avenues lie ahead for faculty to facilitate GME and UME experiential learning. In late 2019, the SOM begins work on a new education building to replace venerable Berryhill Hall. Projected to open in 2022, the Med Ed Building will introduce more experiential and immersive learning spaces for UME and GME teaching.

Dr. Jordan brings considerable UME and GME leadership experience to recently joining forces with SIM Lab leadership Dr. Benny Joyner and Director of Assessment Julie Messina to integrate simulation into the Foundation (pre-clinical) and Application and Individualization (clinical) phases of the SOM’s Translational Education at Carolina (TEC) curriculum in advance of the new building’s completion.

Dr. Jordan recently expressed her perspective in a manuscript on millennials and medical education, praising both simulation and apprenticeship as “an enduring path for learning including self-assessment of learning needs, independent identification, analysis and synthesis of relevant information, and appraisal of the credibility of information sources.”

I believe it is imperative to continue growing simulation as an integral part of medical education for UNC’s GME and UME learners. If a new facility will soon provide even more experiential learning settings for them to conduct self-directed clinical care without risk to patient, UNC will continue to produce top-tier graduates who contribute optimal health outcomes in medicine and are top performers in the physician workforce.

 

 

Matthew A. Mauro, MD, FACR, FAHA, FSIR
Ernest H. Wood Distinguished Professor of Radiology
Chair – UNC Department of Radiology