title: High-Fidelity Contrast Reaction Simulation Training: Performance Comparison of Faculty, Fellows, and Residents.
abstract: OBJECTIVE
  Reactions to contrast material are uncommon in diagnostic radiology, and vary in clinical presentation from urticaria to life-threatening anaphylaxis. Prior studies have demonstrated a high error rate in contrast reaction management, with smaller studies using simulation demonstrating variable data on effectiveness. We sought to assess the effectiveness of high-fidelity simulation in teaching contrast reaction management for residents, fellows, and attendings.
  
  
  METHODS
  A 20-question multiple-choice test assessing contrast reaction knowledge, with Likert-scale questions assessing subjective comfort levels of management of contrast reactions, was created. Three simulation scenarios that represented a moderate reaction, a severe reaction, and a contrast reaction mimic were completed in a one-hour period in a simulation laboratory. All participants completed a pretest and a posttest at one month. A six-month delayed posttest was given, but was optional for all participants.
  
  
  RESULTS
  A total of 150 radiologists participated (residents = 52; fellows = 24; faculty = 74) in the pretest and posttest; and 105 participants completed the delayed posttest (residents = 31; fellows = 17; faculty = 57). A statistically significant increase was found in the one-month posttest (P < .00001) and the six-month posttest scores (P < .00001) and Likert scores (P < .001) assessing comfort level in managing all contrast reactions, compared with the pretest. Test scores and comfort level for moderate and severe reactions significantly decreased at six months, compared with the one-month posttest (P < .05).
  
  
  CONCLUSIONS
  High-fidelity simulation is an effective learning tool, allowing practice of "high-acuity" situation management in a nonthreatening environment; the simulation training resulted in significant improvement in test scores, as well as an increase in subjective comfort in management of reactions, across all levels of training. A six-month refresher course is suggested, to maintain knowledge and comfort level in contrast reaction management.
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut. Electronic address: kyle.pfeifer@yale.edu.
authors.forename: Kyle
authors.initials: K
authors.lastname: Pfeifer
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Staib
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Arango
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: John
authors.initials: J
authors.lastname: Kirsch
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Mel
authors.initials: M
authors.lastname: Arici
authors.affiliation: Simulation Department, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Liana
authors.initials: L
authors.lastname: Kappus
authors.affiliation: Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut.
authors.forename: Jay
authors.initials: J
authors.lastname: Pahade
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003287:Contrast Media / Q000009:adverse effects*; D003479:Curriculum; D004521:Educational Measurement; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011871:Radiology / Q000193:education*; D000066908:Simulation Training; D011795:Surveys and Questionnaires
chemical_list: D003287:Contrast Media
keywords: Contrast reaction; contrast; education; high-fidelity; simulation; team training