title: Simulation in training: one-year experience using an efficiency index to assess interventional radiology fellow training status.
abstract: OBJECTIVE
  To compare objective fellow and expert efficiency indices for an interventional radiology renal artery stenosis skill set with the use of a high-fidelity simulator.
  
  
  METHODS
  The Mentice VIST simulator was used for three different renal artery stenosis simulations of varying difficulty, which were used to grade performance. Fellows' indices at three intervals throughout 1 year were compared to expert baseline performance. Seventy-four simulated procedures were performed, 63 of which were captured as audiovisual recordings. Three levels of fellow experience were analyzed: 1, 6, and 12 months of dedicated interventional radiology fellowship. The recordings were compiled on a computer workstation and analyzed. Distinct measurable events in the procedures were identified with task analysis, and data regarding efficiency were extracted. Total scores were calculated as the product of procedure time, fluoroscopy time, tools, and contrast agent volume. The lowest scores, which reflected efficient use of tools, radiation, and time, were considered to indicate proficiency. Subjective analysis of participants' procedural errors was not included in this analysis.
  
  
  RESULTS
  Fellows' mean scores diminished from 1 month to 12 months (42,960 at 1 month, 18,726 at 6 months, and 9,636 at 12 months). The experts' mean score was 4,660. In addition, the range of variance in score diminished with increasing experience (from a range of 5,940-120,156 at 1 month to 2,436-85,272 at 6 months and 2,160-32,400 at 12 months). Expert scores ranged from 1,450 to 10,800.
  
  
  CONCLUSIONS
  Objective efficiency indices for simulated procedures can demonstrate scores directly comparable to the level of clinical experience.
authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St. Louis, MO 63110, USA. glaibermanc@mir.wustl.edu
authors: Craig B
authors: CB
authors: Glaiberman
authors: Benjamin
authors: B
authors: Jacobs
authors: Mandie
authors: M
authors: Street
authors: James R
authors: JR
authors: Duncan
authors: Mark W
authors: MW
authors: Scerbo
authors: Thomas K
authors: TK
authors: Pilgrim
mesh_terms: D004521:Educational Measurement / Q000379:methods*; D011361:Professional Competence; D015642:Radiology, Interventional / Q000193:education*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013647:Task Performance and Analysis; D014768:Virginia