P-039 - Development of a Simulation-Based Intrathecal Drug Delivery Course in a Fellowship/Residency Setting

Abstract Title: Development of a Simulation-Based Intrathecal Drug Delivery Course in a Fellowship/Residency Setting

Background: Intrathecal Drug Delivery Systems (IDDS) represent an important aspect of healthcare delivery across multiple settings, including pain management and physiatry. While this treatment modality is frequently tested on board and training exams, exposure to IDDS is often limiting in many training programs for a variety of reasons.

Recognizing this lack of exposure to residents from various specialties and pain management fellows, a simulation-based training course was developed to allow both ‘hands-on’ and lecture-based training.

Purpose/Objectives: The primary aim of this project is to address the limited exposure to Intrathecal Drug Delivery Systems (IDDS) in medical training programs, particularly in pain management and physiatry. To bridge this gap, we developed a simulation-based training course that combined hands-on practice with lecture-based education to enhance knowledge, clinical competence, and exam preparedness. The objectives included providing in-depth knowledge of IDDS, measuring knowledge gains through pre- and post-course quizzes, improving practical skills and confidence in managing various aspects of IDDS, and demonstrating the effectiveness of simulation-based training. Ultimately, this project sought to ensure that physicians were well-prepared to help manage patients who use IDDS, thereby enhancing healthcare delivery in pain management and physiatry.


Methods: Twelve trainees: two pain management fellows and ten residents (physiatry and family medicine) attended a four-hour training workshop. Before education or simulation regarding IDDS therapy, attendees were given a 25-question quiz covering key topics likely to be tested on upcoming exams and considered important by experienced practitioners. Attendees were also asked to self-rate their confidence level in four areas related to IDDS therapy.

The course consisted of three lectures covering key areas of IDDS therapy, complications, emergency management, and pump refill procedures. Attendees were then allowed to simulate an IDDS pump refill procedure using equipment provided by industry representatives.

After the lecture and simulation, attendees were then given a post-test consisting of the same questions given before the course, as well as were asked to rate their confidence level on the same four areas related to IDDS pump management (patients’ questions, pump interrogation read-out, pump refill procedure, and managing pocket fill).


Results: Exposure to therapy as nuanced as intrathecal drug delivery systems will ideally involve repeated in-person exposure. This is frequently not achievable at many training programs across the country; however, physicians should still be familiar with the therapy not only to counsel patients appropriately but also to be prepared for both board and in-training exams. Simulation courses have been successfully used across post-graduate medical training for exposure to uncommon therapies.

Before the simulation course, attendees rated management of IDDS confidence as 0.27 on a 0-1 scale with 1 being “100% confident.” Post-course confidence increased to 0.68. Similarly, knowledge-based testing demonstrated initial scores averaging 56% with post-test scores increasing to 85% correct.

Course attendees also reported a subjective increase in skill levels related to conducting the pump interrogation read-out, and emptying and refilling the IDDS pump correctly.

Conclusions/Implications for future research and/or clinical care: By incorporating simulation-based training, medical programs can bridge the gap in exposure to Intrathecal Drug Delivery Systems, ensuring that physicians are well-prepared for patient care and examinations. This approach not only enhances clinical competence but also improves overall healthcare delivery in pain management and physiatry.


References: Kivlehan E, Branch D, Reger C, Rojas AM. Simulation-based mastery learning for intrathecal baclofen pump management in physical medicine and rehabilitation: A pilot study. PM R. 2023 Nov 4.

Al-Elq AH. Simulation-based medical teaching and learning. J Family Community Med. 2010 Jan;17(1):35-40.