Radiation Oncology History/Education/Social Media
PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): Treatment plan evaluation is a core competency for radiation oncology (RO) and medical physics (MP) residents. Gaps in teaching and assessing plan evaluation have been identified in residency training. The purpose of this project was to create and implement an interactive plan evaluation case bank for RO and MP residents to improve competency.
Materials/Methods: A needs assessment was performed to inform case selection, case bank development and accompanying software. Current and former residents were asked to assess their confidence in various aspects of plan evaluation using a 10-point Likert scale (1=least confident, 10=most confident). In parallel, a list of clinically unacceptable plans (with corresponding acceptable plans) from January 2011-June 2013 was compiled and categorized by clinical site, reason for rejection, detectability and relevance. Cases were reviewed for consensus by two ROs and two MPs. An interactive web-based DICOM-RT tool was used to query and interact with the case bank database. A companion software tool, acting as an interactive simulation platform, was created to allow user interaction with the database.
Results: Thirty participants (68%) responded to the needs assessment: 13 current RO (6 junior, 7 senior), 10 former RO, 3 current MP and 4 former MP residents. Opportunities for improving plan evaluation were identified with the following mean confidence scores: assessment of target coverage (6.6±2.5), doses to OARs (6.2±2.4), conformity (5.7±2.5), overall plan acceptability (5.5±2.3) and ability to suggest improvements (4.9±2.1). Extracted themes for case bank development included incorporating diverse clinical sites, common cases, target coverage and OAR assessment, DVHs, conformity and provision of immediate feedback. Of the 218 clinically unacceptable plans, 50 were included in the case bank. These cases were categorized, anonymized and imported into the case bank database. Additional acceptable and unacceptable plans were generated to augment the case bank where required. The companion simulation software platform was implemented and tested to ensure proper functionality. The simulation platform describes each clinical scenario and allows residents to enter their assessment, error classification and suggested corrective action (if applicable). The simulation platform then provides immediate feedback, including error description, correction strategy and link to the corrected plan.
Conclusion: An innovative, interdisciplinary plan evaluation case bank has been created to address an identified learning gap in RO and MP training. The format improves fidelity of the simulation by allowing interaction with the images and plan in 3D, incorporation of feedback to residents and visualization of the corresponding clinically acceptable plan. This case bank can be leveraged as a teaching and assessment tool in competency based medical education. Future work will evaluate the case bank as a learning tool.
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