Development, implementation, and results of a simulation-based hands-on brachytherapy workshop for medical students

Abstract

Purpose: The new Medical Licensing Regulations 2025 (Ärztliche Approbationsordnung, ÄApprO) require the development of competence-oriented teaching formats. In addition, there is a great need for high-quality teaching in the field of radiation oncology, which manifests itself already during medical school. For this reason, we developed a simulation-based, hands-on medical education format to teach competency in performing accelerated partial breast irradiation (APBI) with interstitial multicatheter brachytherapy for early breast cancer. In addition, we designed realistic breast models suitable for teaching both palpation of the female breast and implantation of brachytherapy catheters.

Methods: From June 2021 to July 2022, 70 medical students took part in the hands-on brachytherapy workshop. After a propaedeutic introduction, the participants simulated the implantation of single-lead catheters under supervision using the silicone-based breast models. Correct catheter placement was subsequently assessed by CT scans. Participants rated their skills before and after the workshop on a six-point Likert scale in a standardized questionnaire.

Results: Participants significantly improved their knowledge-based and practical skills on APBI in all items as assessed by a standardized questionnaire (mean sum score 42.4 before and 16.0 after the course, p < 0.001). The majority of respondents fully agreed that the workshop increased their interest in brachytherapy (mean 1.15, standard deviation [SD] 0.40 on the six-point Likert scale). The silicone-based breast model was found to be suitable for achieving the previously defined learning objectives (1.19, SD 0.47). The learning atmosphere and didactic quality were rated particularly well (mean 1.07, SD 0.26 and 1.13, SD 0.3 on the six-point Likert scale).

Conclusion: The simulation-based medical education course for multicatheter brachytherapy can improve self-assessed technical competence. Residency programs should provide resources for this essential component of radiation oncology. This course is exemplary for the development of innovative practical and competence-based teaching formats to meet the current reforms in medical education.

Keywords: Accelerated partial breast irradiation; Early-stage breast cancer; Medical education; Multicatheter brachytherapy; Simulation-based training.

Fig. 1

Photographic images (a) and CT scans of the breast model in axial (b) and sagittal view (c). The imitation of the tumor bed appears hypointense on CT. The catheter positions (d) within the breast model are visualized by CT scan (e, f)

Fig. 2

Workflow of the multiprofessional training course teaching practical skills in brachytherapy for early-stage breast cancer

Fig. 3

Training course on breast cancer brachytherapy using the newly developed breast cancer model. Following an introductory lecture (a), residents and participants trained the implantation of single-lead catheters into the silicone breast model (b). CT scan evaluated the accuracy of applicator placement and CT-based contouring and treatment planning was demonstrated and trained (c, d)

Fig. 4

Evaluation of the model and workshop. Items on a six-point-Likert scale (totally agreed–disagreed, and completely/very good–poor for overall impression)