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Simulación y evaluación basadas en competencias en la educación médica: toma de decisiones clínicas y dosimetría de
Michael Roumeliotis1, Heather Warkentin2, Lesley Buckley3
1Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physics & Astronomy, University of Calgary, Calgary, AB, Canada.
Purpose:
To develop a competency-based simulation program to evaluate medical physics residents in radiation output measurements and clinical decision making.
Methods:
A national working group developed methodology to assess competency of residents performing the measurement of radiation output for photon beams on a linear accelerator. The program included (i) pre- and post-task self-assessment, (ii) qualitative task evaluation, (iii) quantitative task evaluation, (iv) evaluator directed discussion and debrief, and (v) evaluator feedback. Eligible study participants were CAMPEP-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 (GRS) and quantitative measures including a procedural checklist for simulation accuracy and completeness. All statistical evaluations used an alpha of 0.05 to indicate significance.
Results:
Over the study period, 39 residents participated from centers in Canada (n = 9) and the US (n = 2). The median (range) time-to-complete the simulation task for a single photon beam energy is 50 (24 to 139) minutes. In the self-assessment questionnaire with nine questions, the difference in pre- and post-task score was statistically significant (p < 0.001). On multivariable linear regression, residents earliest in their residency program (0 to 6 months) reported the largest improvement in preand post-assessment scores (p = 0.02). In the qualitative evaluation, the average (± standard deviation) 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 GRS score (p < 0.01).
Conclusions:
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.
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