Simulation As More Than a Treatment Planning Tool: A Systematic Review of the Radiation Oncology Simulation-Based Medical Education Literature

Abstract

Simulation-based medical education (SBME) is gaining prominence with the increased focus on ACGME-mandated competency-based assessment. SBME exists in radiation oncology, although studies to date are infrequently framed in the context of SBME. The goal of this study is to complete the first systematic literature review of radiation oncology SBME. The review focused on radiation oncology-specific SBME literature. Inclusion criteria were according to the PICOS (Population, Intervention, Comparison, Outcome and Setting) framework. The population included undergraduate, graduate, and continuing medical education learners. Simulation was defined as screen-based, virtual reality, part-task trainers, simulated patients or environments, and hybrid. Studies could be single arm or comparative and outcomes could be quantitative or qualitative. Any medical education environment was included. Additionally, studies were limited to English, published after 1/1/1990, and in peer-review manuscript form. PubMed, MedEdPORTAL and in-press articles at prominent radiation oncology and cancer education journals were searched. The PubMed search was conducted using pre-defined search terms. Studies were selected based on independent review by two reviewers (FZ and DWG). References and similar articles of the selected article were also examined. MeSH terms in selected articles were reviewed to ensure that all MeSH terms were included. The two independent sets of studies were reviewed by the entire study team to ensure that they meet the inclusion criteria. Results: 54 SBME publications met the inclusion criteria representing 45 unique SBME interventions. Only 5 studies identified themselves as SBME. The vast majority of SBME was designed to include physicians (40/45), followed by therapists (8/45), physicists (7/45), patients (3/45), others (3/45), dosimetrists (3/45), and nurses (1/45). The SBME classification was mostly screen-based (30/45) with 22/30 providing simulated contouring. Additional SBME types included simulated environments (7/45), virtual reality (5/45) including one haptic, part-task trainers (3/45), and simulated patients (2/45). Overall, this systematic review of the literature provides historical context for further SBME development. More importantly, it provides structure and guidance to future SBME researchers in radiation oncology. Few papers describe their educational methods as SBME. Appropriately framing SBME in radiation oncology as such will allow improved development, implementation, and evaluation of novel SBME interventions. It would also be beneficial to centralize teaching resources resulting from these experiences.