Simulation Based Training for Focused Abdominal Sonography for Trauma (FAST) Performance

Abstract

Background: The use of focused abdominal sonography for trauma (FAST) allows for rapid bed side diagnosis of intra-abdominal, pleural, or pericardial hemorrhage in trauma casualties. Purpose: To develop and validate a training program for FAST performance for non radiologists using the UltraSim simulator. Methods: The training and evaluation program included – 1. Introductory computer based lecture for self learning of the general principles of ultrasound and FAST. 2. Introduction and hands on session on the simulator. 3. Pre training simulator based evaluation consisting of two scenarios. 4. Six training scenarios. 5. Post training evaluation consisting of two scenarios. Results: 20 physicians (3 radiologists, 5 surgeons experienced in FAST performance, 5 surgeons with moderate experience in Fast performance and 7 novices) participated in the study. During the pre training evaluation, only 14 (70%) participants correctly placed the transducer in all the examination positions, and only 5 (25%) were able to maintain the correct direction of the transducer. During the post training evaluation both parameters were correctly maintained by all participants (p<0.001). The time required for obtaining the image in each of the examination positions was 133±87 seconds prior and 86± 58 seconds following training (p<0/001). The quality of the images obtained, subjectively assessed by a radiology specialist, was 7.2±2.1 prior and 8.4±1.2 following training (scale of 1–10) (p<0.001). Correct diagnosis (positive / negative) was made in 69% and 89% for pre and post evaluations respectively (p<0.001). Construct validity was demonstrated in all the evaluation parameters. Never the less, radiology specialists were still better then other participants in the time required to obtain the images, quality of the images and the incidence of correct diagnosis. Following training participants indicated that the opening presentation taught the principles of FAST, the clinical scenarios represented real clinical situations; and that the simulator system presented a real imaging situation (scores of 5.6±0.4, 5.6±0.8, 4.9±1.0, respectively in a range of 1–6). Participants recommended to use this training modality for all trauma physicians (score of 5.9±0.2). Criticism included low-quality imaging and lack of cardiac or respiratory motion. Conclusion: Although data are preliminary, this study clearly demonstrates the value of simulation based training for FAST performance. Furthermore, face, content and construct validity were achieved. Conflict of Interest: Authors indicated they have nothing to disclose.