Capítulo 2. LA CIUDAD Y LA POESÍA DEL SIGLO XX EN COLOMBIA
2.3 Cinco poetas en una ciudad del siglo
2.3.2 Rogelio Echavarría: El canto cotidiano de la modernidad
standards
Medical Imaging
After discussion at the consultative meetings, there was agreement that in addition to curricula elements identified in the interviews (Table 6), all other curricula elements outlined in the AIR competency standards for the accredited practitioner [32]could be delivered using simulation. Using the Dreyfus model of skill acquisition [35](Appendix 6), delegates determined that the overall skills level of students when students entered their first clinical placement was at beginner level. Expectations for students were that when graduating from a three year degree they would be at a competent level and when graduating from a four year degree or a professional development year they should be at a proficient level. Table 7 outlines the simulation activities that delegates thought could be integrated into the curricula, and the skills levels that could be reached using simulation in teaching. It was thought that simulation could be used to develop skills to a either a beginner or competent level in all curricula elements, excepting digital radiography skills which could be taken to proficiency.
Most universities were already integrating simulation into their teaching programs, including interactive group work and role play, anatomic models and phantoms, image analysis, PACS systems, digital imaging software, and simulated clinical settings. Simulated clinical settings included using real radiographic equipment and phantoms for routine radiographic training. There is potential for these facilities to be upgraded. There was little simulation teaching occurring for other curricula elements of
radiography training, which also are difficult for students to access in clinical practice (fluoroscopy, operating theatre radiography, emergency radiography, and routine CT imaging). There appear to be no products available to simulate these aspects of the curriculum, but there is potential to develop such tools. Suggestions included using video demonstrations, virtual reality, and remote laboratories. Remote laboratories are a concept supported by ‘Labshare’, a national project backed by Australian
Government's Diversity and Structural Adjustment Fund and initiated by universities amongst the Australian Technology Network. Labshare’s mission is to create a nationally shared network of remote laboratories. This project has promise to effect large
efficiencies in teaching students of professional disciplines such as Radiation Science, who use equipment that has high installation and maintenance costs.
Digital radiography equipment, while becoming more widely used in clinical environments, is also not currently available in undergraduate Medical Imaging programs. Installing such systems to simulate clinical settings has the potential to take students from a novice level to a proficient level.
Image interpretation and Quality assurance are large curricula elements in Australian Medical Imaging programs. A range of digital imaging software is currently being used in universities, but there is capacity to upgrade these facilities to more closely replicate the clinical setting. There is also no comprehensive diagnostic electronic imaging library available. A comprehensive diagnostic imaging electronic library, which could be shared across all universities, and which can be accessed with high quality imaging software would have great benefit to simulate the curricula elements of image interpretation and quality assurance.
Use of Simulated Learning Environments in Radiation Science Curricula 33
The benefits of using virtual worlds such as ‘second life’ and ‘reaction grid’ were also discussed as addressing the curriculum elements of communication, teamwork,
problem solving, critical thinking, care and clinical management. These elements could also be delivered using interactive group work, but virtual worlds had the advantage of being remotely accessible and could be shared across universities.
Radiation Therapy
At the consultative meetings there was agreement that in addition to curricula
elements identified in the interviews (Table 6), all other curricula elements outlined in the AIR competency standards for the accredited practitioner [32] could be delivered using simulation. Using the Dreyfus model of skill acquisition [35](Appendix 6), delegates determined that the overall skills level of students when students entered their first clinical placement was at beginner level. Expectations for students were that when graduating from a three year degree they would be at a competent level and when graduating from a four year degree or a professional development year they should be at a proficient level. Table 8 outlines the simulation activities that delegates thought could be integrated into the curricula, and the skills levels that could be reached using simulation in teaching. It was thought that simulation could be used to develop skills to either a beginner or competent level in all curricula elements, with the exception of treatment planning skills which could be taken to proficiency.
Most universities were currently using planning systems, image analysis, dosimetry, and role play or interactive group work.
Curricula areas which were not well covered using simulation included patient assessment, patient positioning, patient immobilisation, manufacture of ancillary equipment, treatment simulation, treatment Imaging, treatment planning, and
treatment verification. While interactive group work and role play, including live actors as standardised patients were valuable in teaching the curricula elements of patient assessment, professional, ethical and safe work practices, communication, team work, problem solving and critical thinking, the group thought that the most significant simulation in a Radiation Therapy program would be VERTTM . VERTTM was viewed to be the simulation tool that could most closely replicate clinical practice, and would have the greatest impact on teaching the foundation clinical skills (treatment simulation, treatment Imaging, treatment planning, and treatment verification) that could only otherwise be addressed in a clinical setting.
Nuclear Medicine
At the consultative meetings, there was agreement that in addition to curricula
elements identified in the interviews (Table 6), all other curricula elements outlined in the ANZSNM competency standards [33] could be delivered using simulation. Using the Dreyfus model of skill acquisition [35] (Appendix 6), delegates believed that the overall skills level of students entering clinical practice for the first time was at novice to
beginner level. Expectations for students were that when graduating they would be at a competent level.
Table 9 outlines the simulation activities that delegates thought could be integrated into the curricula, and the skills levels that could be reached using simulation in teaching. It was thought that simulation could be used to develop skills to either a beginner or competent level, excepting ‘analysis of data’, which could be taken to proficiency.
Most universities were using simulation activities using real life scenarios/group work/role play, image and data processing software, venous injections and cannulations and radiopharmacy laboratories.
Curricula elements that were not currently well covered by simulation included data acquisition, data analysis, archiving data, quality assurance, problem solving and critical thinking.
Use of Simulated Learning Environments in Radiation Science Curricula 34
Data acquisition, data analysis and data archiving is a large curricula component in Nuclear Medicine clinical training and can be facilitated by simulation if working gamma cameras or other imaging equipment were available in universities. It was felt that collectively that data processing skills could be facilitated across all universities if nuclear medicine software vendors could contribute to a common educational platform with multiple log in licences. Animal imaging could also integrated into
teaching to simulate functional imaging, which is not possible using innate phantoms, or real patients due to radiation exposure. As Nuclear Medicine imaging equipment is very expensive, there were other suggestions of simulation activities that could be
developed in lieu of a real gamma camera, and ancillary equipment. These included the development of computer assisted tutorials, artificial neural network, virtual reality, video demonstrations, VIRAD (virtual reality injection software) scan image and QA outcome databases, and upgrading of image processing software.
Medical Sonography
From the consultative meetings there was agreement that in addition to curricula elements identified in the interviews (Table 6), all other curricula elements outlined in the ASAR competency standards [34] could be delivered using simulation. Two other
curricula elements were identified in the discussions; transducer manipulation and instrumentation, which are regarded as important foundation skills. Using the Dreyfus model of skill acquisition [35](Appendix 6), delegates believed that the overall skills level of students entering clinical practice for the first time was at novice level, and the skills level of students graduating from program was at competent level.
Table 10 outlines the simulation activities that delegates of consensus meetings thought could be integrated into the curricula, and the skills levels that could be reached using simulation in teaching. It was thought that simulation could be used to develop skills to a novice or beginner level, but not to a competent or proficient level.
Most universities deliver medical sonography programs in external mode/ distance education, therefore minimising opportunities for simulation unless web-based or online simulations are used, or changing the delivery mode of the program.
Most universities reported using live scanning simulation, but students have limited exposure, with most development of skills in performing complete examinations, transducer manipulation, and instrumentation occurring in clinical practice. The group agreed that development of these psychomotor skills could be facilitated by simulation using body part phantoms for lower level skills, and live scanning and standardised patients for higher level skills. Animal scanning was also suggested for limited applications such as scanning the fetal heart.
Image Interpretation is an important curricula element which appeared not to be well covered with simulation. Simulation exercises in this domain can be developed and adapted to suit online delivery. Image Interpretation could be facilitated by access to a comprehensive online image library, which could be made available to all
universities.
Other elements of the curricula that were not well covered using simulation, included image interpretation, understanding the clinical question, professional, ethical and safe work practices, manual handling, communication, teamwork, critical thinking and care and clinical management. These elements could be addressed using simulation with virtual reality or worlds, videos, actors and role play.
Use of Simulated Learning Environments in Radiation Science Curricula 35
Table 7: Curricula elements of medical imaging that could be delivered with simulation Curricula elements in Medical Imaging
Simulation
activities A B C D E F G H I J K L M N O P Techn-
ical Proced-ural Health and safety Human Elem- ents Achievable skills level with simulation 2 1-3 3- 4 2 3 3 3 3 2 2 3 3 2 2- 3 2 2 2 2 Anatomical models (body parts) Full body phantom Image analysis/ interpretation Interactive group work/role play Live actors PACS Simulated clinical settings Digital imaging software Computer assisted learning program Digital image library (large data and image sets) Virtual reality software Remote lab simulation Video demon- strations
KEY 1: novice; 2: beginner; 3: competent; 4: proficient; A: Patient assessment; B: General radiography; C:Digital radiography; D: Fluoroscopy; E: Operating theatre imaging; F:Emergency imaging; G: Routine CT imaging; H: Image interpretation; I: Peer mentoring; J: Quality Assurance; K: Professional, ethical and safe work practices; L: Communication; M: Team work; N: Problem solving; O: Critical thinking; P: Care and clinical management
Use of Simulated Learning Environments in Radiation Science Curricula 36
Table 8 Curricula elements of Radiation Therapy that could be delivered with simulation
Curricula elements Radiation Therapy Simulation activities A B C D E F G H I J K L M N Positioning for treatment 1-4 2 1-3 1-3 Planning system 2D 2 1-4 1-3 1-3 Planning system 3D 2 1-4 1-3 1-3 Image analysis 3 3 3 Dosimetry 1-4 1-3 1-3 Automatic phantoms 3 Image library 2 2 3 3 1-4 3 Manufacture ancillary equipment 2 2 1-3 1-3 Reproduct- ion of clinical environment 3 1-4 3 Virtual software programs 3 1-3 1-3 VERTTM 3 3 1-4 3 1-3 1-3 Video replay 2 1-3 1-3 1-3 1-3 1-3 Actors with or without video replay 3 1-3 1-3 1-2 1-3 1-3 1-3 Real-life scenarios / role-play /group work 1-2 1-2 1-2 1-3 1-3 1-2 Replicated clinical environment (with suite of equipment) 2 3 1-4 3 Real patients in a university clinic 3 1-3 1-3 1-3 1-3 1-3 Virtual reality 1-2 1-2 1-2 1-3 1-3 1-2 KEY: 1: novice; 2: beginner; 3: competent; 4: proficient; A: patient assessment; B: Patient positioning; C: Patient immobilisation D: Manufacture of ancillary equipment; E: Simulation; F: Treatment Imaging; G: Treatment planning; H: Treatment verification; I: Professional, Ethical and safe work practices; J: communication; K: Team work; L: Problem solving; M: critical thinking; N: care and clinical management
Use of Simulated Learning Environments in Radiation Science Curricula 37
Table 9 Curricula elements of Nuclear Medicine that could be delivered with simulation
Curricula elements in Nuclear Medicine
Simulation Activities A B C D E F G H I J K L M Real-life scenarios/role
play/ group work x X 2-3 2+
Image and data processing software (computer lab) 2 2 Anatomic models/Phantoms 2 2 Live actors 2 X
Radio pharmacy lab(hot
lab/ cold lab or both) 1-3 2 Computer assisted instruction 1-3 2 2-3 2-3 Video/CD simulation (demonstrations) 3-4 1-2 2 Gamma camera 3 3- 4 1-2 Animals 2 2 2 2 2 3-4 2-3 2- 3 Virtual reality 2 X Real clinics 2 2
Image data base/image
Evaluation 3-4 1-2 Artificial intelligence 1-2
KEY: 1:novice; 2: beginner; 3: competent; 4:proficient; x:no skills level determined; A: Preparation of radiopharmaceuticals; B:Administration of radiopharmaceuticals; C: Acquisition of data (parameters + analysis); D:Analysis of data; E:Archiving data; F:Quality assurance; G:advocacy; H:Professional, ethical and safe work practices; I:Communicaion; J:teamwork; K:Problem solving; L:critical thinking; M: care and clinical management
Table 10 Curricula elements of Medical Sonography that could be delivered with simulation
Curriculum elements Medical Sonography
Simulation A B C D E F G H I J K
Body Part Phantom 1 2 2
Online Quizzes 1-2
Live scanning 1-2 2 2
Simulated biometry
measurements 2
Online interactive group
work/computer programs 2 PACS/image library 1-2 Virtual reality 1-2 2 1-2 1-2 1-2 1-2 1-2 1-2 2 2 Videos 2 1-2 1-2 1-2 1-2 1-2 1-2 2 Actors 2 1-2 1-2 1-2 1-2 1-2 1-2 2 2 Standardised patient 1.5 2 Role play 2 1-2 1-2 1-2 1-2 1-2 1-2 Animal 2
KEY 1:novice; 2: beginner; 3: competent; 4= proficient; A: image interpretation; B: understanding the clinical question; C: performing complete examinations; D: Professional, ethical and safe work practices; E: manual handling; F: communication; G: teamwork, H: critical thinking; I: care and clinical management; J: instrumentation; K: transducer manipulation
Use of Simulated Learning Environments in Radiation Science Curricula 38 Interdisciplinary Radiation Science
Common curriculum elements were identified across each of the four radiation science discipline (Table 6). These were:
-Professional, ethical and safe work practice -Communication
-Team work -Problem solving -Critical thinking
-Care and clinical management
From the consultative meeting it was agreed that simulation resources could be
developed and shared across the Radiation Science disciplines (and other allied health and medical disciplines) to meet these common curriculum elements. Examples of simulation activities that could be developed included:
-Comprehensive radiation science image library (available to share across universities)
-Virtual reality programs/virtual worlds (potential for sharing across universities) -Software to develop computer assisted learning programs (potential for sharing across universities)
-Video resources (potential for sharing across universities) -Video playback facilities