Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
Department of Radiation Oncology, Oregon Health & Sciences University, Portland, Oregon, USA.
Int J Gynecol Cancer. 2022 Mar;32(3):407-413. doi: 10.1136/ijgc-2021-002516.
Brachytherapy is an essential component in the curative treatment of many gynecological malignancies. In the past decade, advances in magnetic resonance imaging and the ability to adapt and customize treatment with hybrid interstitial applicators have led to improved clinical outcomes with decreased toxicity. Unfortunately, there has been a shift in clinical practice away from the use of brachytherapy in the United States. The decline in brachytherapy is multifactorial, but includes both a lack of exposure to clinical cases and an absence of standardized brachytherapy training for residents. In other medical specialties, a clear relationship has been established between clinical case volumes and patient outcomes, especially for procedural-based medicine. In surgical residencies, simulation-based medical education (SBME) is a required component of the program to allow for some autonomy before operating on a patient. Within radiation oncology, there is limited but growing experience with SBME for training residents and faculty in gynecological brachytherapy. This review includes single institutional, multi-institutional and national initiatives using creative strategies to teach the components of gynecological brachytherapy. These efforts have measured success in various forms; the majority serve to improve the confidence of the learners, and many have also demonstrated improved competence from the training as well. The American Brachytherapy Society launched the 300 in 10 initiative in 2020 with a plan of training 30 competent brachytherapists per year over a 10 year period and has made great strides with a formal mentorship program as well as externships available to senior residents interested in starting brachytherapy programs. Moving forward, these curricula could be expanded to provide standardized brachytherapy training for all residents. SBME could also play a role in initial certification and maintenance of certification. Given the burden of disease, it would be valuable to develop similar training for providers in low and middle income countries.
近距离放射治疗是许多妇科恶性肿瘤治愈性治疗的重要组成部分。在过去的十年中，磁共振成像技术的进步以及使用混合间质施源器进行治疗的适应性和定制能力的提高，改善了临床结果，同时降低了毒性。不幸的是，近距离放射治疗在美国的临床应用已经减少。近距离放射治疗的减少是多方面的，包括缺乏对临床病例的接触以及缺乏对住院医师的标准化近距离放射治疗培训。在其他医学专业中，已经明确建立了临床病例量与患者结果之间的关系，尤其是对于基于程序的医学。在外科住院医师培训中，基于模拟的医学教育（SBME）是该计划的一个必要组成部分，以使住院医师在对患者进行手术前能够获得一定的自主权。在放射肿瘤学中，基于 SBME 的培训住院医师和教师进行妇科近距离放射治疗的经验有限但在不断增加。本综述包括使用创造性策略教授妇科近距离放射治疗各个组成部分的单一机构、多机构和国家计划。这些努力以各种形式取得了成功；大多数旨在提高学习者的信心，而且许多计划也证明了培训带来的能力提高。美国近距离放射治疗学会于 2020 年发起了“300 人在 10 年内”计划，计划在 10 年内每年培训 30 名有能力的近距离放射治疗师，并通过正式的指导计划以及对有兴趣开展近距离放射治疗计划的高级住院医师提供的实习机会取得了巨大进展。展望未来，这些课程可以扩展为所有住院医师提供标准化的近距离放射治疗培训。SBME 也可以在初始认证和维持认证中发挥作用。考虑到疾病负担，为中低收入国家的提供者开发类似的培训将是有价值的。
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