Can an In-Person Hands-On Applicator-Based Teaching Session Improve Trainee Knowledge and Comfort with Complex Gynecologic Brachytherapy?

Abstract

With the emergence of imaged-based planning and hybrid applicators the complexity of gynecologic brachytherapy has dramatically increased. Despite the advantages associated with brachytherapy, notable national declines in utilization of brachytherapy have been documented. Clearly improved education in the sphere of gynecologic brachytherapy is needed. We hypothesize that a hands-on applicator-based training session would improve trainee comfort with gynecologic brachytherapy. An in-person applicator-based hands-on training session was held with trainees from both radiation and gynecologic oncology programs. During which trainees had an opportunity to practice assembling and handling the applicators with instruction on the clinical scenarios where the various applicators that are used in cervical, endometrial, and vaginal cancer brachytherapy. All participants were administered an objective test of 10 pictorial-based case vignettes to quantify the trainees' ability to select the correct applicator based on their interpretation of T2 weighted MR images; administered both prior to and following the session to quantity objective changes in learning. A subjective survey was administered pre- and post-session to quantify trainees' subjective comfort and experience with gynecologic brachytherapy using Likert-type question formatting. A total of 14 trainees ranging from PGY2-7 (n = 8 radiation oncology, n = 6 gynecologic oncology) participated with 100% response rates pre-session and 57% post-session. Most common case volumes experience was: intracavitary 0-10 in 57%, hybrid 0-10 71%, and interstitial 0-10 71%. The most common answer pre-session to comfort level was not comfortable still learning: 43% intracavitary, 50% hybrid, and 57% interstitial. Most common answer pre-session to largest gap in knowledge was all facets of brachytherapy. Correct test answers rate was 39% on pre-test versus 60% post-test. The most common answer post-session to comfort level was: 63% very comfortable intracavitary, 50% very comfortable hybrid, 50% somewhat comfortable interstitial. All respondents felt their comfort level with brachytherapy improved post-session: 75% some improvement and 25% marked improvement. Most common answer post-session to largest gap in knowledge was applicator/patient selection, with applicator/patient selection the largest area of identified improvement. Repeating the session in future was ranked by 100% to be helpful in future to their training. Hands on training with applicators improves both subjective and objective comfort with gynecologic brachytherapy. With 100% of participants requesting to continue this as a component of resident training, we suggest that national opportunities might exists to expand such educational process to improve utilization of complex gynecologic brachytherapy in practice.