Simulation Training in the Management of Adverse Contrast Reactions: A Systematic Review

Abstract

BackgroundSimulation-based training has become increasingly prominent within medical education, but its utility within radiology remains underexplored. ObjectiveTo appraise the evidence for the effectiveness of simulation on the management of adverse reactions to contrast media. MethodsA systematic search of the literature was conducted. Eligible studies recruited radiology residents, provided simulation-based training focused on contrast reaction management, and measured any effectiveness outcome compared with any nonsimulation training or no training. The quality of studies was appraised and outcomes were classified according to Kirkpatrick’s hierarchy and the strength of evidence. ResultsOut of 146 screened results, 15 articles were included that described 17 studies—3 randomized trials and 14 pretest-posttest studies of hands-on or, less commonly, computer-based simulation. In all 16 studies that assessed knowledge before and after intervention, written test scores improved after simulation. Most studies noted improvements in comfort or confidence managing contrast reactions as well. In all three studies that assessed knowledge after simulation and after didactic lecture as a control, posttest scores were not statistically significantly better in the simulation groups than the lecture groups. Common study limitations included single-group designs, measuring only learning outcomes using unvalidated instruments, modest sample sizes, and limited assessment of long-term retention. ConclusionSimulation produces subjective improvements and knowledge gain relevant to contrast reaction management. Further research is required to demonstrate superiority of simulation-based contrast reaction management training over traditional didactic lecture-based instruction.