Proficiency-Based Cervical Cancer Brachytherapy Training: An Effort to Combat Recent Trends in Radiation Oncology That Result in Worse Outcomes for an Underserved Population through Resident Education
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Radiation therapy is the mainstay of treatment for women with cervical cancer with disease outside of the uterine cervix. To deliver the high doses needed for cure, brachytherapy (BT) is necessary to avoid toxicity to normal tissues (1). Technique is of utmost importance for outcomes of BT, but due to a lack of training during residency, the use of BT is declining nationwide (2, 3). The effectiveness of procedural simulation training, especially proficiency-based training, has been well established in other medical specialties, but there is no simulation training for cervical cancer brachytherapy used anywhere else in the country at this time (4-8). To combat this problem, we developed and implemented a structured proficiency-based BT simulation curriculum that will be able to be modified and replicated at training programs across the country and will be particularly practical for programs with less exposure to gynecologic brachytherapy. Residents who participated in the simulation training had measurable improvements in the time to perform the procedure, applicator placement quality and confidence, which translate to fewer complications and better tumor control for patients.
To determine if simulation-based proficiency training on a pelvic model will improve the quality of tandem and ovoid placement, improve resident confidence with the procedure, and decrease the time needed to complete the procedure (less anesthesia time for the patient).
1. Training in the placement of tandem and ovoid applicators using a pelvic model will improve the quality of implantation which will facilitate the optimization of dosimetry.
2. Simulation training will increase resident confidence and long-term competence with intracavitary cervical brachytherapy.
3. Simulation training will decrease overall procedural time.
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