High-fidelity Ultrasound Simulator Research Articles

Development and Assessment of Simulation-Based Point-of-Care Ultrasound Curriculum in Undergraduate Medical Education.

Implementation barriers and lack of standardized point-of-care ultrasound (POCUS) curricula make the development of effective POCUS curricula and methods of assessment challenging. The authors aim to develop a longitudinal POCUS curriculum through staged intervention. In the first stage, the authors hypothesized that the use of high-fidelity ultrasound simulation during the Internal Medicine clerkship would improve POCUS confidence and knowledge among medical students, minimizing the need for trained faculty. A quasi-experimental study of third-year students on the Internal Medicine clerkship at a large academic medical center in the United States was performed assessing the efficacy of ultrasound simulation use. The control group consisted of students who received baseline POCUS education during teaching rounds but did not have access to the ultrasound simulator. The experimental group consisted of students who, in addition to baseline POCUS education, had access to a high-fidelity ultrasound simulator throughout the clerkship for a minimum of 1 hour per week. Students in both the control and experimental groups completed a pre- and post-intervention confidence survey and knowledge-based examination. Eighty-two percent (50/61) of students completed pre- and post-tests, with the control group demonstrating no significant difference in POCUS confidence or knowledge. After exposure to the ultrasound simulator, the experimental group demonstrated statistically significant improvement in POCUS confidence and overall POCUS knowledge (p < .01). The use of high-fidelity ultrasound simulation can improve POCUS confidence and knowledge among medical students while addressing common barriers to the implementation of a POCUS curriculum. Despite showing statistically significant improvement in overall knowledge, the results did not appear to hold educational significance. Additional POCUS educational methods are necessary to overcome cognitive bias and potential overconfidence. The next stage of curriculum development will include resident-led POCUS workshops to supplement simulation.

Predictors of Performance on the Arthrobox Arthroscopy Simulator for Medical Students

PurposeThe purpose of this study was to analyze the effects of past participation in athletics, the playing of musical instruments and video games and other variables on medical students’ performance on an arthroscopic simulator task as well as other assessments of visuospatial ability.MethodsWe assessed 50 medical students by using previously validated tests of manual dexterity and spatial reasoning as well as performance on an arthroscopic surgical simulator. Inclusion criteria were to be 18 years of age or older and to be a student studying in the M.D. program at a single public state university. Exclusion criteria were previous use of an arthroscopic surgery training device or active participation in an actual arthroscopic surgery, defined as participating as a surgeon, resident trainee, physician’s assistant, or other similarly credentialed professional. Students were also assessed by the use of a high-fidelity ultrasound simulator as a marker of visuospatial capacity. Students were then surveyed about lifestyle characteristics and personal attributes hypothesized to predict surgical skill, such as playing sports, instruments or video games.ResultsA total of 49 participants were included in this study. High levels of athletic experience were significantly associated with improved performance on the arthroscopic surgical simulator (P = .008). Participants with higher levels of athletic experience were more likely to achieve competence on the arthroscopic surgical simulator (P = .006). Scores on the arthroscopic simulator task were significantly correlated with both ultrasound simulator shape-identification task scores and masked mirror-tracing task scores, as independent measures of visuospatial ability (P = .015 and P = .013, respectively).ConclusionsThis study provides evidence of a statistically significant correlation between increased experience in athletics and single-use test performance on an arthroscopic surgical simulator. Subjects who reported higher levels of experience in athletics were significantly more likely to achieve competence in the arthroscopic surgical simulator task. Finally, statistically significant correlations were found between subjects’ performance scores on tasks assessed by the surgical simulator, masked mirror-trace assessment and ultrasound simulator.Clinical RelevanceSimulator-based training and education allow for the development of arthroscopic skills prior to operating on a live patient in a clinical situation. This is an area of great interest in orthopaedic education. Our study evaluates parameters in a trainee that may relate to a higher performance level in technical skills on an arthroscopic surgical simulator.

A low-cost high-fidelity ultrasound simulator with the inertial tracking of the probe pose

The authors developed a versatile ultrasound simulator. The proposed system achieves the main features of a high-fidelity device exploiting low-cost rapid prototyping hardware. The hand-guided ultrasound simulator probe includes a RFID reader, a 9-DOF inertial sensor unit, consisting of an accelerometer, a magnetometer and a gyroscope, and a microcontroller that performs the real-time data acquisition, the processing and the transmission of the estimated pose information to the visualization system, so that the proper ultrasound view can be generated. Since the probe orientation is the main information involved in the pose reconstruction, this work presents and investigates several tracking methods for the probe orientation, exploiting a sensor fusion technique to filter the noisy measurements coming from inertial sensors. The performances of a Kalman filter, a nonlinear complementary filter and a quaternion-based filter as inertial trackers have been tested by means of a robot manipulator, in terms of readiness, accuracy and stability of the estimated orientation signal. The results show that the nonlinear complementary filter and the quaternion-based filter match all the application requirements (RMSE <3deg, variance <1deg2, and settling time <0.3s), and they involve a lower computational time with respect to the Kalman filter.

The effectiveness of simulation training in the teaching of skills required for sonographic fetal assessment in mid-trimester pregnancy to novices: A pilot study.

Ultrasound teaching has traditionally relied on access to patients or live model volunteers for the development of trainees' psychomotor skills. With recent developments in technology, simulators are increasingly becoming integrated into formal clinical skills training in medical and allied health education. This study aimed to develop and test the effectiveness of using a high-fidelity ultrasound simulator as the sole training tool to teach mid-trimester obstetric ultrasound skills to novice health and medical professionals who had no previous experience in using ultrasound imaging. This pilot study used a prospective cohort design to recruit and train a small sample (n = 10) of health professionals who had no prior experience in obstetric ultrasound skills. The entire training programme used a high-fidelity simulator as the sole skills trainer across three training sessions. Testing points occurred at each session throughout the 5-week training programme. The final testing point, using live model patients, evaluated how well the skills learned using the simulator could be transferred to a more realistic setting. The skills of trainees improved and the time taken to perform the skills decreased significantly over the training period. These findings are consistent with a broad acceptance that simulated learning advances psychomotor skills. However, at the final simulator testing, trainees did not reach a level of full competency, and this was replicated in the live model testing. Simulated training to develop obstetric sonography skills appears to be useful in alleviating some of the burden of training from the clinical setting.

Skill development of beginner sonography students using high-fidelity simulators: Initial experiences

Background The training of Australian sonographers is shared between accredited course providers and clinical training providers. Scanning skills are mostly developed in a real-life setting environment by the clinical training provider. Sonographer training is burdensome on clinical training providers due to increasing service delivery demands. Accredited course providers should therefore investigate innovative methods of skill training that can be undertaken outside of the clinical environment. Aims This report evaluates four sonographer skill development activities for novice students that used high fidelity ultrasound simulators. Results All students reported positive experiences and outcomes of simulator based learning activities and believed that simulated skills development sessions help them develop scanning skills. Students perceived their skills level after simulation sessions to be at levels where they could scan in a real clinical setting with supervision levels ranging from moderate to no assistance. Supervisor ratings ranged from students being able to scan with large amounts of assistance to being able to scan with minimal assistance. A self-directed learning package was introduced which was well received by students. Conclusions The results of the evaluations of the reported simulated learning activities are promising for a self-directed and student centered learning curriculum to be ‘wrapped’ around the use of high fidelity simulators to develop student skills in the early stages of training.

The effectiveness of the use of high fidelity simulators in obstetric ultrasound training: A systematic review.

Introduction: The benefits of the use of ultrasound technology for point of care obstetric health evaluation have led to increased focus on training programs for physicians wanting to develop skills in this area. Simulation, in a variety of formats, has always played a role in medical and health training, with proven benefits. This systematic review determines the level of evidence available to support the use of high fidelity ultrasound simulators in the training of obstetric ultrasound scanning skills to health professionals. Methods: A systematic review of the literature was performed to define previous investigations into the incorporation of high fidelity ultrasound simulators into obstetric ultrasound training programs. The included studies were reviewed by the authors to evaluate their overall strength and quality. Data surrounding the study participants, simulator types, study design, training program format, outcome measures, and results were extracted. Results and conclusions: While the small body of evidence discovered in this review demonstrates positive results for the use of high fidelity simulators in obstetric ultrasound training, the studies included in this review demonstrate a moderate level of evidence, with some potential of bias throughout. A number of gaps in the literature were identified that could be addressed in further research.

Development and Evaluation of Methodologies for Teaching Focused Cardiac Ultrasound Skills to Medical Students

Handheld ultrasound is emerging as an important tool for point-of-care cardiac assessment. Although cardiac ultrasound skills are traditionally introduced during postgraduate training, the optimal time and methodology to initiate training in focused cardiac ultrasound (FCU) are unknown. The objective of this study was to develop and evaluate a novel curriculum for training medical students in the use of FCU. The study was conducted in two phases. In the first phase, 12 first-year medical students underwent FCU training over an 8-week period. In the second phase, 45 third-year medical students were randomized to one of three educational programs. Program 1 consisted of a lecture-based approach with scan training by a sonographer. Program 2 coupled electronic education modules with sonographer scan training. Program 3 was fully self-directed, combining electronic modules with scan training on a high-fidelity ultrasound simulator. Image interpretation skills and scanning technique were evaluated after each program. First-year medical students were able to modestly improve interpretation ability and acquire limited scanning skills. Third-year medical students exhibited similar improvement in mean examination score for image interpretation whether a lecture-based program or electronic modules was used. Students in the self-directed group using an ultrasound simulator had significantly lower mean quality scores than students taught by sonographers. Third-year medical students were able to acquire FCU image acquisition and interpretation skills after a novel training program. Self-directed electronic modules are effective for teaching introductory FCU interpretation skills, while expert-guided training is important for developing scanning technique.

Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study

BackgroundPoint-of-care ultrasound (PoCUS) is currently not a universal component of curricula for medical undergraduate and postgraduate training. We designed and assessed a simulation-based PoCUS training program for medical learners, incorporating image acquisition and image interpretation for simulated emergency medical pathologies. We wished to see if learners could achieve competency in simulated ultrasound following focused training in a PoCUS protocol.MethodsTwelve learners (clerks and residents) received standardized training consisting of online preparation materials, didactic teaching, and an interactive hands-on workshop using a high-fidelity ultrasound simulator (CAE Vimedix). We used the Abdominal and Cardiothoracic Evaluation by Sonography (ACES) protocol as the curriculum for PoCUS training. Participants were assessed during 72 simulated emergency cardiorespiratory scenarios. Their ability to complete an ACES scan independently was assessed. Data was analyzed using R software.ResultsParticipants independently generated 574 (99.7%) of the 576 expected ultrasound windows during the 72 simulated scenarios and correctly interpreted 67 (93%) of the 72 goal-directed PoCUS scans.ConclusionsFollowing a focused training process using medical simulation, medical learners demonstrated an ability to achieve a degree of competency to both acquire and correctly interpret cardiorespiratory PoCUS findings using a high-fidelity ultrasound simulator.