Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX.
Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX.
Brachytherapy. 2020 Nov-Dec;19(6):738-745. doi: 10.1016/j.brachy.2020.08.009. Epub 2020 Sep 17.
Despite a preponderance of data demonstrating strong clinical outcomes and cost-effectiveness, prostate brachytherapy use and competency continue to decline. Enhanced resident education may help reverse this trend. We therefore developed and implemented a simulation-based medical education course for low-dose-rate prostate brachytherapy (LDR-PB).
A 1-week LDR-PB course comprised four 1-h lectures on clinical outcomes, physics, radiobiology, and anatomy/contouring, followed by a 4.5-h simulation session on ultrasound-guided prostate phantom implantation, was developed for radiation oncology residents at an academic institution. A 10-statement Likert-scale survey and 20-question multiple-choice test were administered 1 week before and 4 weeks after the course.
Precourse and postcourse instruments were completed by 24 and 20 residents, respectively. The median number of prior LDR-PB cases after at least one genitourinary rotation was 10.5 (range 5-20). Overall mean test scores were significantly improved (55% before the course vs 68% after the course; p = 0.010). Mean Likert scores significantly increased on nine of 10 survey statements and were significantly increased overall (2.4 before the course vs 3.3 after the course, p < 0.001). When asked about interest in performing brachytherapy after residency, 37.5% of residents "agreed" or "strongly agreed" before the course vs 50% after the course (p = 0.41). Those with higher postresidency brachytherapy interest (scores of 4-5 vs 1-3) had significantly more LDR-PB cases (11.2 vs 5.3 cases; p = 0.005).
A 1-week simulation-based medical education course for LDR-PB can improve didactic performance and self-reported technical competence/confidence, and may increase overall enthusiasm for brachytherapy. Future studies at our institution will incorporate evaluation of implant quality and assessment of procedural competence into this framework. Residency programs should dedicate resources to this essential component of radiation oncology.
尽管有大量数据表明前列腺近距离放射治疗具有良好的临床效果和成本效益，但该治疗方法的应用和能力仍在持续下降。加强住院医师教育可能有助于扭转这一趋势。因此，我们为学术机构的放射肿瘤学住院医师开发并实施了一种基于模拟的低剂量率前列腺近距离放射治疗（LDR-PB）医学教育课程。
为放射肿瘤学住院医师开发了为期 1 周的 LDR-PB 课程，包括 4 个 1 小时的讲座，分别介绍临床结果、物理学、放射生物学和解剖/轮廓勾画，以及 4.5 小时的超声引导前列腺模型植入模拟课程。在课程开始前 1 周和结束后 4 周，对 24 名和 20 名住院医师进行了 10 项陈述李克特量表调查和 20 道多项选择题测试。
分别有 24 名和 20 名住院医师完成了课前和课后的调查问卷。在至少完成一轮泌尿生殖系统轮转后，每位住院医师进行 LDR-PB 的例数中位数为 10.5（范围 5-20）。总体而言，考试成绩明显提高（课程前为 55%，课程后为 68%；p=0.010）。10 项调查陈述中有 9 项的平均李克特评分显著提高，总体评分也显著提高（课程前为 2.4，课程后为 3.3，p<0.001）。在课程结束后，当被问及对 residency 后进行近距离放射治疗的兴趣时，37.5%的住院医师表示“同意”或“强烈同意”，而课程前这一比例为 50%（p=0.41）。对 residency 后近距离放射治疗兴趣较高（评分 4-5 分比 1-3 分）的住院医师进行 LDR-PB 的例数更多（11.2 例比 5.3 例；p=0.005）。
为期 1 周的基于模拟的 LDR-PB 医学教育课程可以提高理论学习成绩和自我报告的技术能力/信心，并可能增加对近距离放射治疗的整体热情。本机构未来的研究将在这一框架内纳入植入物质量评估和手术能力评估。住院医师培训项目应投入资源来加强这一放射肿瘤学的重要组成部分。
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