Competency-Based Simulation and Evaluation in Medical Education: Clinical Decision Making and Reference Dosimetry

To develop a competency-based simulation program to evaluate medical physics residents in radiation output measurements and clinical decision making.

A national working group developed a methodology to assess the competency of residents performing the measurement of radiation output for photon beams on a linear accelerator. The program included (1) pre- and posttask self-assessment; (2) qualitative task evaluation; (3) quantitative task evaluation; (4) evaluator-directed discussion and debrief; and (5) evaluator feedback. Eligible study participants were Commission on Accreditation of Medical Physics Education Programs-accredited residents in medical physics. Evaluation was performed by a certified medical physicist directly observing the participant perform the simulation. Study outcomes included time-to-complete as well as qualitative scoring using a 30-point global rating scale and quantitative measures, including a procedural checklist for simulation accuracy and completeness. All statistical evaluations used an α of .05 to indicate significance.

Over the study period, 39 residents participated from centers in Canada (n = 9) and the United States (n = 2). The median (range) time-to-complete the simulation task for a single photon beam energy is 50 (24-139) minutes. In the self-assessment questionnaire with 9 questions, the difference in pre and posttask score was statistically significant (P < .001). On multivariable linear regression, residents earliest in their residency program (0-6 months) reported the largest improvement in pre- and postassessment scores (P = .02). In the qualitative evaluation, the average (±SD) global rating scores for the entire cohort were 26.1 (±2.6). On multivariable linear regression, residents with prior hands-on experience in performing dosimetry measurements yielded a significantly improved global rating scale score (P < .01).

A competency-based simulation program was applied to medical physics residents in a structured, multi-institutional setting. These findings support the role of simulation-based environments in consolidating foundational dosimetry knowledge and clinical reasoning within medical physics residency training.