Ultrasound Simulation Training Research Articles

Long-term evaluation of the Hernia Compact course of the German Hernia School.

Since 2011, the German Hernia Society has developed the German Hernia School (GHS) as a standardized hernia surgery training program for younger surgeons, consisting of the Hernia Compact basic module. It is a standardized three day training program (cadaver workshop, ultrasound simulation training, and hands-on training). After 12years of experience, a survey was conducted to evaluate the long term effect of this training. Using an anonymous online-questionnaire, we contacted from September 2023 to October 2023 the Hernia Compact course participants via the congress organizer "Weitmeer" and the German Hernia Society. This online questionnaire contains 18 multiple choice questions regarding participants' age, gender, professional experience, participation in other modules of the German Hernia School, the effect of the course on their daily practice and their specific interest in hernia and abdominal wall surgery. A total of 146 participants responded to the anonymous online questionnaire. A majority of 132 of 146 participants (90.42%) responded that this course improved the quality of surgical and hernia training (n = 146, no missing data). 141 of 146 individuals (96.58%) recommended the course to surgical colleagues (n = 146, no missing data). There were 89.73% of participants, (n = 146, no missing data) that developed a specific interest in hernia and abdominal wall surgery after the course. For 78.08% (n = 146, no missing data) of participants hernia and abdominal wall surgery was one of the most important activities in their daily surgical practice. The standardized Hernia Compact basic course of the German Hernia School appears to have a huge impact on the quality of hernia surgery training in Germany and Austria. It might also help generate a specific interest in hernia surgery among participants.

Controlled prospective study on ultrasound simulation training in fetal echocardiography: FESIM II.

To analyze the learning curves of ultrasound novices in fetal echocardiography during structured simulation-based ultrasound training (SIM-UT) including a virtual, randomly moving fetus. 11 medical students with minimal (< 10h) prior obstetric ultrasound experience underwent 12h of structured fetal echocardiography SIM-UT in individual hands-on sessions during a 6-week training program. Their learning progress was assessed with standardized tests after 2, 4, and 6weeks of SIM-UT. Participants were asked to obtain 11 fetal echocardiography standard planes (in accordance with ISUOG and AHA guidelines) as quickly as possible. All tests were carried out under real life, examination-like conditions on a healthy, randomly moving fetus. Subsequently, we analyzed the rate of correctly obtained images and the total time to completion (TTC). As reference groups, 10 Ob/Gyn physicians (median of 750 previously performed Ob/Gyn scans) and 10 fetal echocardiography experts (median of 15,000 previously performed Ob/Gyn scans) were examined with the same standardized tests. The students showed a consistent and steady improvement of their ultrasound performance during the training program. After 2weeks, they were able to obtain > 95% of the standard planes correctly. After 6weeks, they were significantly faster than the physician group (p < 0.001) and no longer significantly slower than the expert group (p = 0.944). SIM-UT is highly effective to learn fetal echocardiography. Regarding the acquisition of the AHA/ISUOG fetal echocardiography standard planes, the students were able to reach the same skill level as the expert group within 6 weeks.

Ultrasound simulation training to meet the 2021 Royal College of Radiologists' curriculum for radiology trainees: South East London experience

To enhance ultrasound teaching delivery to radiology trainees using a simulation course matched to the 2021 Royal College of Radiologists (RCR) curriculum. An ultrasound simulation training course was designed for specialty trainees (ST) 1 in radiology, which was based on the 2021 RCR curriculum and covered the top ultrasound training priorities. The course was piloted initially on two occasions in a 1-day format to the August 2021 and the March 2022 ST1 intake trainees. Based on the feedback, a comprehensive 4-day course was developed and delivered between October and December 2022 for the August 2022 ST1 intake, funded by Health Education England. The outcomes measured were subjective trainee feedback using numerical scores and free text. All King's College Hospital NHS Foundation Trust radiology ST1 trainees from the August 2021 to the August 2022 intake participated in ultrasound simulation training. The training matched the RCR curriculum and increased the trainees' confidence and competency in medical ultrasound. Ultrasound simulation training can be successfully delivered to ST1 trainees to match the 2021 RCR curriculum and enhance training in medical ultrasound for radiologists.

Controlled Prospective Study on the Use of Systematic Simulator-Based Training with a Virtual, Moving Fetus for Learning Second-Trimester Scan: FESIM III.

To analyze the feasibility of structured ultrasound simulation training (SIM-UT) in teaching second-trimester ultrasound screening using a high-end simulator with a randomly moving fetus. This was a prospective, controlled trial. A trial group of 11 medical students with minimal obstetric ultrasound experience underwent 12 hours of structured SIM-UT in individual hands-on sessions within 6 weeks. Learning progress was assessed with standardized tests. Performance after 2, 4, and 6 weeks of SIM-UT was compared with two reference groups ((A) Ob/Gyn residents and consultants, and (B) highly skilled DEGUM experts). Participants were asked to acquire 23 2nd trimester planes according to ISUOG guidelines in a realistic simulation B-mode with a randomly moving fetus as quickly as possible within a 30-minute time frame. All tests were analyzed regarding the rate of appropriately obtained images and the total time to completion (TTC). During the study, novices were able to improve their ultrasound skills significantly, reaching the physician level of the reference group (A) after 8 hours of training. After 12 hours of SIM-UT, the trial group performed significantly faster than the physician group (TTC: 621±189 vs. 1036±389 sec., p=0.011). Novices obtained 20 out of 23 2nd trimester standard planes without a significant time difference when compared to experts. TTC of the DEGUM reference group remained significantly faster (p<0.001) though. SIM-UT on a simulator with a virtual, randomly moving fetus is highly effective. Novices can obtain standard plane acquisition skills close to expert level within 12 hours of self-training.

Simulation-Based Training on Basic Obstetrics and Gynecology Ultrasound Skills During COVID Pandemic.

COVID-19 pandemic led to an alarming rise in sickness absenteeism among the radiologists. Anticipating a continued shortage of experienced radiologists in future COVID waves, it is essential to train the medical professionals in basic skills related to ultrasonography to enable them to perform basic Obstetrics and Gynecology (OG) scans safely in emergencies. Virtual reality simulation training is an alternative to conventional ultrasound training. A cross-sectional study was conducted during 8-day-long workshop to identify the trainees' basic, after training knowledge and skills in OG ultrasound and to document their perceptions of the training. Statistical analysis was done using descriptive statistics (percentages and mean standard deviations) and paired t test for comparisons. A total of 80 health care professionals underwent ultrasound simulation training. It was found that the post-test score in the knowledge domain, instrument handling, basic gynecological skills, and first-trimester antenatal ultrasound skills in the practical domain was significantly higher than the pre-test score (P-value < 0.0001). Out of 80 participants, 45 (56.25%) agreed that ultrasound simulation is an ideal method of teaching and training basic OG skills to the novice. Sixty-six out of 80 (82.5%) felt that the principles of handling a human mannequin are the same as those of real patients. Forty-eight participants out of 80 (60.0%) felt that ultrasound simulation can be used as an ideal tool for self-assessment of health care professionals. The study showed that ultrasound-based simulation can provide a realistic setting for training and assessment of novices in learning basic skills.

PEDIATRIC AND MEDICINE RESIDENTS’ PERCEPTIONS OF ULTRASOUND VASCULAR ACCESS AND RESULTS OF AN INTERSPECIALTY, SIMULATION-BASED ULTRASOUND VASCULAR ACCESS WORKSHOP

PEDIATRIC AND MEDICINE RESIDENTS’ PERCEPTIONS OF ULTRASOUND VASCULAR ACCESS AND RESULTS OF AN INTERSPECIALTY, SIMULATION-BASED ULTRASOUND VASCULAR ACCESS WORKSHOP

Ultrasound Simulation Training for Radiology Residents-Curriculum Design and Implementation.

Medical simulation training can be used to improve clinician performance, teach communication and professionalism skills, and enhance team training. Radiology residents can benefit from simulation training in diagnostic ultrasound, procedural ultrasound, and communication skills prior to direct patient care experiences. This paper details a weeklong ultrasound simulation training curriculum for radiology residents during the PGY-1 clinical internship. The organization of established teaching methods into a dedicated course early in radiology residency training with the benefit of a multi-disciplinary approach makes this method unique. This framework can be adapted to fit learners at different skill levels or with specific procedural needs.

The use of joints of meat as phantoms for ultrasound-guided needling skills: a prospective blinded study

BackgroundNeedle visualisation during ultrasound-guided procedures is a skill that can be difficult to practise, with commercially available phantoms being expensive and often unrealistic. Our aim was to find an inexpensive, reproducible model that could be used to assist in developing this skill.MethodsPork shoulder, beef brisket, and lamb shoulder joints were compared to a standard blue ultrasound phantom. Five ‘chunky’ yarn pieces were twisted together and threaded through each joint to simulate hyperechoic nerves. Participants were instructed to ultrasound each specimen and insert a needle close to a nerve like structure. Using a visual analogue scale, specimens were scored based on realism of appearances of ultrasound images and ‘feel’ of needling.Results38 people participated. All specimens of meat scored significantly higher than the blue phantom (p = 0.01). There was no significant difference between the different types of meat.ConclusionsPork, beef and lamb joints are an effective model to use for simulation training for needling skills. They have limited lifespan, but due to its relatively low cost, it is feasible to discard the meat after each training workshop. We hope the use of inexpensive meat products will make ultrasound simulation training simpler to organise and more effective.

VP19.02: High‐end ultrasound simulation training in fetal echocardiography FESIM II: a prospective six‐week trial with a virtual, randomly moving fetus

VP19.02: High‐end ultrasound simulation training in fetal echocardiography FESIM II: a prospective six‐week trial with a virtual, randomly moving fetus

Implementing the transvaginal ultrasound simulation training (TRUSST) programme for obstetric registrars

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.

Quantitating skill acquisition with optical ultrasound simulation.

ObjectiveTo investigate and compare the effect of simulator training on quantitative scores for ultrasound‐related skills for trainees with novice level ultrasound experience and expert ultrasound operators.MethodsThree novice (comprising of 11, 32, 23 participants) and one expert (10 participants) subgroups undertook an ultrasound simulation training session. Pre‐ and post‐training test scores were collected for each subgroup. Outcome measures were as follows: mean accuracy score for obtaining the correct anatomical plane, percentage of correctly acquired target planes, mean number of movements, time to achieve image, distance travelled by probe and accumulated angling of the probe.ResultsThe novices showed improvement in image acquisition after completion of the simulation training session with an improvement in the rate of correctly acquired target planes from 28–57% to 39–83%. This was not replicated in the experts. The novice’s individual ratios based on pre‐ vs. post‐training metrics improved between 1.7‐ and 4.3‐fold for number of movements, 1.9‐ and 6.7‐fold for distance, 2.0‐ and 5.2‐fold for time taken and 1.8‐ and 7.3‐fold for accumulated angling. Among the experts, there was no relationship between pre‐training simulator metrics and years of ultrasound experience.ConclusionsThe individual simulation metrics suggest the sessions were delivered at an appropriate level for basic training as novice trainees were able to show demonstrable improvements in both efficiency and accuracy on the simulator. Experts did not improve after the simulation modules, and the novice scores post‐training were similar to those of experts, suggesting the exercises were valid in testing ultrasound skills at novice but not expert level.

Simulation-based clinical learning for the third year medical student: Effectiveness of transabdominal and transvaginal ultrasound for elucidation of OB/GYN scenarios.

Point-of-care ultrasound (POCUS) is gaining recognition as a teaching modality that acts as an integrative learning tool during medical student transition to clinical rotations. This study aimed to determine if the use of ultrasound simulation enhances understanding of Obstetrical and Gynecological (Ob/Gyn) anatomy and pathology in third-year medical students (M3), and if M3 students found the simulator useful. M3 students taking the OB/Gyn clerkship were invited to participate. Baseline knowledge of pelvic ultrasound anatomy and pathology was assessed with a multiple-choice question test. Participants received a one-hour OB/Gyn ultrasound simulation training session. A post-test assessed knowledge after the intervention. Survey data was collected regarding learning styles and learner satisfaction. Following simulator-based training, the median correct number of responses to the knowledge questions increased from 11 of 18 to 14 of 18 correct (P < .001). Statistically significant increases were also observed in comfort level with OB/GYN ultrasound (P < .001). All 68 students answered that the ultrasound simulator was helpful and enjoyed using the simulator. This study suggests that ultrasound simulators are useful for improvement in knowledge, comfort level, and ability to identify pathology in Ob/Gyn scenarios in M3 students.

Can You Teach Yourself Point-of-care Ultrasound to a Level of Clinical Competency? Evaluation of a Self-directed Simulation-based Training Program.

IntroductionSelf-directed learning in medical professions is established as an effective method of training in certain modalities. Furthermore, simulation technology is becoming widely used and accepted as a valid method of training for various medical skills, with ultrasound being one of the best studied. The use of point-of-care ultrasound (PoCUS) in the practice of emergency medicine is well established, and PoCUS is a core competency of the Royal College of Physicians and Surgeons of Canada emergency medicine standards. The primary goal of our study was to assess the effectiveness of a self-directed simulation-based training program for medical students, in terms of achieving competency in basic PoCUS scans.MethodsFourteen second-year medical students with no prior ultrasound experience were provided access to online study modules created by SonoSim ultrasound training solutions (SonoSim, Santa Monica, CA, US), covering ultrasound theory and methodology, and attended a two-hour introductory session where they were introduced to the study protocol, simulation equipment, and software. Participants then undertook self-directed ultrasound simulation training throughout the year, using the CAE Vimedix PoCUS simulator (CAE Healthcare, Sarasota, FL, US) and the SonoSim ultrasound training solution system. Upon reaching 10 (and 25) scans in each of the four categories (cardiac, abdomen, aorta, and pelvic), a triggered assessment was arranged in which participants scanned a live volunteer under the direct supervision of PoCUS-certified physicians. The physicians scored the participant attempts in terms of image acquisition, interpretation, and clinical understanding. No feedback was provided to the participants. Following the study, participants submitted feedback regarding the design of the study and were asked to rank their preferred training program protocols out of a provided list of five different options.ResultsAt the first triggered assessment (after completing only 10 scans in each category), four out of 14 participants were scored as competent in the aorta scan, two out of 14 participants were competent in the pelvic scan, and none of the participants were competent in both the cardiac and abdominal scans. Only nine out of 14 participants completed the second triggered assessment (after completing 25 scans in each category). At the second assessment, only three participants were scored as competent in the aorta scan, two participants were competent in the cardiac scan, and one participant was competent in the pelvic scan. None of the 14 learners completed the final phase of the training and assessment protocol. Feedback following the termination of the study showed that none of the participants supported continuing the study protocol as designed originally, and the preferred study design consisted of a full-day introductory course with live models and simulation, followed by self-directed learning with simulation and live models until 50 scans in each category were achieved.ConclusionWe were unable to demonstrate the achievement of competence in PoCUS in medical learners engaged in our combined self-directed simulation-based training program. This is in contrast to the considerable literature supporting self-directed learning and simulation-based learning for other skills. Feedback from faculty, curriculum integration, and alignment with clinical experience may be beneficial.

Role of pelvic ultrasound simulation

Pelvic ultrasound is a critical diagnostic imaging tool in obstetrics and gynaecology. Training opportunities in transvaginal ultrasound have not kept pace with the demand among learners because of the increased complexity of modern ultrasound technology and duty-hour restrictions. Ultrasound simulation training has the potential to overcome this gap. Training opportunities in transvaginal ultrasound have not kept pace with the demand OBJECTIVE: Our study aimed to determine the usefulness, applicability and attitudes toward pelvic ultrasound simulation training among residents, sonographers and practising doctors. Pelvic ultrasound simulation activity using high-fidelity virtual reality ultrasound simulators lasted 4hours and consisted of three modules: abnormal uterine bleeding, adnexal masses and bleeding in pregnancy. All learners completed a pre- and post-encounter quiz, and an anonymous post-simulation survey on the relevance of ultrasound simulation to clinical learning, and its usefulness to improve scanning performance and interpretation skills. Thirty-one participants attended the workshop, and 28 (90.3%) of them responded to the survey. Five respondents agreed and 23 strongly agreed that pelvic ultrasound simulation applies to their clinical ultrasound practice, and seven of them agreed and 21 strongly agreed that their performance of ultrasound and interpretation skills will be improved following their simulation training. The average post-activity knowledge score for all three topics significantly increased (paired Student's t-test, p<0.0001). All 28 respondents believe that ultrasound simulation is a useful complement to learning with real patients, with the potential to improve their pelvic ultrasound performance, interpretation skills and clinical reasoning.

Improving students’ ability to perform a standardized foetal biometry plane using ultrasound simulators

ObjectiveThe objective of this study is to assess progress made in the ultrasound (US) measurement of femur length (FL) by students after one hour of training on US obstetric simulators. Materials and methodsMedical residents and midwives registered for the 2016 French national foetal US diploma were invited to a 1-hour US training course with simulators. The time to acquire the FL plane with changing foetal presentation was prospectively measured before and after the training. Every image was recorded, and quality criteria were assessed. ResultsThirty new learners trained in foetal US were evaluated. The time needed to measure the FL was significantly shorter in the post-test versus the pre-test (86s versus 125, P=0.015). The quality criteria were statistically similar before and after training regarding the angle to horizontal (10.0° versus 9.6°, P=0.84) and FL (31.3mm versus 32.0mm, P=0.15). ConclusionThe time needed to obtain the FL plane was reduced by 30% after a 1-hour US simulation training session.

Ultrasound Simulation Training in Pre- and Postgraduate Education

Ultrasound Simulation Training in Pre- and Postgraduate Education

Randomized study of effectiveness of computerized ultrasound simulators for an introductory course for residents in Brazil.

Purpose:This study aimed to assess the impact of ultrasound simulation (SonoSim) on educational outcomes of an introductory point-of-care ultrasound course compared to hands-on training with live models alone.Methods:Fifty-three internal medicine residents without ultrasound experience were randomly assigned to control or experimental groups. They participated in an introductory point-of-care ultrasound course covering eight topics in eight sessions from June 23, 2014 until July 18, 2014. Both participated in lecture and hands-on training, but experimental group received an hour of computerized simulator training instead of a second hour of hands-on training. We assessed clinical knowledge and image acquisition with written multiple-choice and practical exams, respectively. Of the 53 enrolled, 40 participants (75.5%) completed the course and all testing.Results:For the 30-item written exam, mean score of the experimental group was 23.1±3.4 (n=21) vs. 21.8±4.8 (n=19), (P>0 .05). For the practical exam, mean score for both groups was 8.7 out of 16 (P>0 .05).Conclusion:The substitution of eight hours of ultrasound simulation training for live model scanning in a 24 hour training course did not enhance performance on written and image acquisition tests in an introductory ultrasound course for residents. This result suggests that ultrasound simulation technology used as a substitute for live model training on an hour-for-hour basis, did not improve learning outcomes. Further investigation into simulation as a total replacement for live model training will provide a clearer picture of the efficacy of ultrasound simulators in medical education.

Focused simulation training: emergency department nurses' confidence and comfort level in performing ultrasound-guided vascular access.

The objective of this study is to assess Emergency Department (ED) nurses' confidence, comfort level, and competency in performing ultrasound-guided vascular access after a focused ultrasound simulation training session. A cross-sectional study at an academic medical center. A simulation-based ultrasound training module was used to train ED nurses in ultrasound-guided intravenous (IV) access. The training module consisted of didactics followed by hands-on practice on human models and Blue Phantom ultrasound training block model. All subjects completed a questionnaire after completing the training module. A total of 40 nurses were enrolled. All subjects successfully demonstrated competency during the training session by identifying upper extremity sonographic vascular anatomy on a human model and performing real-time ultrasound-guided IV access on Blue Phantom ultrasound training block model. On a scale of 1-10, the average confidence level in performing the ultrasound-guided vascular access was 6.9 [95% confidence interval (95% CI) 6.3-7.46], with 98% (95% CI, 92-102%) reporting no difficulty in recognizing upper limb vascular anatomy on ultrasound. Ninety-two percent (95% CI, 84-100%) agreed that focused training in ultrasound-guided IV access was adequate to learn the procedure. After a focused simulation training session, ED nurses had a high level of comfort using ultrasound for vascular access. Despite having a moderate degree of confidence, ED nurses were accurate in identifying vascular anatomy and performing ultrasound-guided vascular access.

Pelvic Ultrasound Simulation Training Models and Case Scenarios

ABSTRACT Pelvic ultrasound simulation training using high-fidelity mannequins can provide a safe and controlled learning environment to foster the ultrasound education of medical students, residents and faculty. The instruction can be tailored to the specific needs of the learners. Topics for instruction range from teaching basic anatomy and ultrasound scanning techniques to common and advanced obstetrics and gynecology disease presentations and pathological processes. Simulation can closely approximate patient encounters using case based scenarios which will aid in developing knowledge and skills that can be transferred to the clinical environment. The goal of simulation is to help the learners to become more confident and competent to care for their patients. How to cite this article Sarmiento J, Stewart K, Aguila J, Bagherpour A, Kupesic Plavsic S. Pelvic Ultrasound Simulation Training Models and Case Scenarios. Donald School J Ultrasound Obstet Gynecol 2014;8(1):22-30.