Evaluation of Simulation-Based Virtual Patient Encounters for Learning Oncologic Emergency Management

Abstract

<h3>Purpose/Objective(s)</h3> Managing oncologic emergencies is a fundamental competency for radiation oncology trainees and is evaluated through an entrustable professional activity (EPA) in the competency-by-design curriculum. Simulation-based learning has been extensively studied in medical education as an effective learning strategy to support achieving specific clinical skill goals. This study aims to evaluate the effectiveness of virtual cases in improving trainee knowledge and readiness to assess oncologic emergencies. <h3>Materials/Methods</h3> Three virtual patient modules simulating common oncologic emergencies encountered throughout residency training in radiation oncology were developed using a simulation-based online learning platform. These modules include spinal cord compression, superior vena cava syndrome, and tumor-induced hemorrhage. Clinical vignettes were designed to mimic the clinical presentation and evolution of a patient exhibiting signs and symptoms of these common oncologic emergencies. Each module consisted of pre- and post-module questions compared to assess immediate knowledge acquisition. Questions focused on physical examination, imaging interpretation, staging, anatomy, epidemiology, differential diagnosis, prognostication, radiation planning, communication skills, and pertinent literature. We recruited radiation oncology residents from across Canada to participate over a 6-month period from June to December 2021. <h3>Results</h3> A total of 13 radiation oncology trainees across Canada (PGY2-6) completed 32 virtual patient scenarios. The modules were completed by junior residents (PGY2-3) 24 times and by senior residents (PGY4-6) 8 times. For all residents, the mean pre-module completion score was 66% (range 60-71%). Mean pre-module completion scores were 65% (range 63-68%) and 69% (range 50-80%) for junior and senior residents, respectively. Mean post-module completion scores were higher, at 92% (range 89-95%) for all residents, 92% (range 90-94%) and 91% (range 88-95%) for junior and senior residents, respectively. Pre-module completion scores were lowest for the tumor-induced hemorrhage scenario, identifying a potential knowledge gap. Resident feedback was unanimously positive, and residents reported that these online modules were useful for their learning. <h3>Conclusion</h3> Online virtual patient modules can be used as complementary learning and assessment tools in the management of different oncologic emergencies. There is a significant improvement in knowledge acquisition after completion of each module, and this improvement is seen across all years of residency. Overall, residents find this learning method useful.