Abstract
BackgroundTransvaginal ultrasound (TVUS) training opportunities are limited due to its intimate nature; however, TVUS is an important component of early pregnancy assessment. Simulation can bridge this learning gap.AimTo describe and measure the effect of a transvaginal ultrasound simulation programme for obstetric registrars.Materials and methodsThe transvaginal ultrasound simulation training (TRUSST) curriculum consisted of supported practice using virtual reality transvaginal simulators (ScanTrainer, Medaphor) and communication skills training to assist obstetric registrars in obtaining required competencies to accurately and holistically care for women with early pregnancy complications.Trainee experience of live transvaginal scanning was evaluated with a questionnaire. Programme evaluation was by pre-post self-reported confidence level and objective pre-post training assessment using Objective Structured Assessment of Ultrasound Skills (OSAUS) and modified Royal Australian and New Zealand College of Obstetrics and Gynaecology assessment scores. Quantitative data was compared using paired t tests.ResultsFifteen obstetric registrars completed the programme. Numbers of performed live transvaginal ultrasound by trainees were low. Participants reported an increase in confidence level in performing a TVUS following training: mean pre score 1.6/5, mean post score 3/5. Objective assessments improved significantly across both OSAUS and RANZCOG scores following training; mean improvement scores 7.6 points (95% CI 6.2–8.9, p < 0.05) and 32.5 (95% CI 26.4–38.6, p < 0.05) respectively. It was noted that scores for a systematic approach and documentation were most improved: 1.9 (95% CI 1.4–2.5, p < 0.05) and 2.1 (95% CI 1.5–2.7, p < 0.05) respectively.ConclusionThe implementation of a simulation-based training curriculum resulted in improved confidence and ability in TVUS scanning, especially with regard to a systematic approach and documentation.
Highlights
Diagnostic delay regarding pregnancy viability is challenging for women and can adversely affect their perception of hospital care
Objective assessments improved significantly across both Objective Structured Assessment of Ultrasound Skills (OSAUS) and RANZCOG scores following training; mean improvement scores 7.6 points and 32.5 respectively
The International Society of Ultrasound in Obstetrics and Gynaecology [15] recommend that a minimum of 100 transvaginal scans are required prior to proficiency, which may not be achievable during RANZCOG
Summary
Diagnostic delay regarding pregnancy viability is challenging for women and can adversely affect their perception of hospital care. The introduction of early pregnancy assessment units provides continuity of care and patient satisfaction [1]. When skilled clinicians are available, point of care TVUS results in a lower rate of admissions from 40.3 to 17.1% and can alter clinical management in 54.1% of patients [2]. Objective, automated measures of performance available on virtual reality (VR) simulators may provide a reproducible assessment of base-level psychomotor competency required prior to live scanning, similar to the role of VR laparoscopic trainers [7]. Transvaginal ultrasound (TVUS) training opportunities are limited due to its intimate nature; TVUS is an important component of early pregnancy assessment.
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