Use Of Ultrasound Simulators Research Articles

549 Evaluating use of ultrasound simulation to meet recommended obstetric ultrasound goals in residency

In 2018 a consensus report outlining residency curriculum and competency assessment for obstetric/gynecologic ultrasound was created by a multi-society collaboration with SMFM, AIUM, ACOG and others. To date, no studies demonstrate completion of this curriculum within an OBGYN residency. The goals of this study were to evaluate if standard residency training meets the outlined competencies and also to evaluate if use of obstetric ultrasound simulation increased competency. Between 2019-2020, we created a hands-on quiz on the Scantrainer ultrasound simulator (Figure 1) to test if PGY-3 & PGY-4 residents met the year specific competencies in the consensus report. The ultrasound quiz required them to scan, capture and correctly diagnose common fetal and uterine anomalies. In the same time period, the PGY-2 residents completed weekly simulator learning modules on the Scantrainer during their MFM rotation. At the beginning and end of the rotation they underwent a pre-& post-test quiz on the simulator to assess if ultrasound simulation helps increase competency to meet the PGY-2 level curriculum. Only 1 out of 17 PGY3 & PGY4 residents passed (scored >70%) the ultrasound quiz. Most could not accurately identify common cardiac, facial or congenital uterine malformations as outlined in the curriculum. The PGY2 post test scores were significantly higher than the pretest scores when compared using a paired two-tailed t-test (79% vs 43%; p< 0.05) with improvement in accuracy of biometry measurements, placental evaluations, cervical lengths and diagnosis of common abnormalities. Based on scores from our ultrasound quiz, standard ultrasound training at our institution did not meet the proposed expected knowledge of upper level residents by the competency curriculum. This suggests re-evaluation of current ultrasound training as well as review of the competency curriculum. We did find obstetric ultrasound simulation was an effective means to improve ultrasound skills and provides a tool for capturing and assessing resident knowledge.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

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.

Commentary: Integrating Diagnostic Ultrasound into Athletic Training Education Programs

Context: The use of point-of-care ultrasound (POCUS) is increasingly becoming a standard of care for sports medicine and orthopedic physicians. As such, there will be increased demand for athletic trainers to have knowledge and skills in diagnostic ultrasound. Objective: To provide key considerations for integration of diagnostic ultrasound into athletic training education and address challenges and barriers to such integration. Background: Advancements in designing portable, user-friendly ultrasound units have enabled clinicians to perform POCUS as an adjunct to the physical exam, resulting in improved patient care. Increased demands for POCUS across medicine have prompted medical schools to integrate diagnostic ultrasound throughout the curriculum, providing athletic training education programs a framework to consider within their curriculum. Synthesis: Integrating diagnostic ultrasound throughout the curriculum provides focused experiences to prepare, conduct, and link imaging to clinical and physical exam skills. Diagnostic ultrasound has a role in visualizing structures in an anatomy course, as an adjunct to physical exam in medical conditions, orthopedic exam, and diagnosis courses, and as a visual feedback tool in rehabilitation courses, thus enabling it to be integrated throughout existing curriculum. Barriers to diagnostic ultrasound include cost, time, and faculty expertise. Results: Cost sharing or use of ultrasound simulators can overcome cost barriers. Use of online educational modules to deliver content virtually is effective and allows face-to-face time to be spent in hands-on experiential learning. Finally, developing interprofessional partnerships to “teach the teacher” is an effective model in teaching faculty about diagnostic ultrasound. Recommendation(s): Educational programs should consider ways to overcome barriers and integrate diagnostic ultrasound into curriculum equipping future athletic trainers with knowledge and skills for POCUS, thus increasing their effectiveness on a health care team. Conclusion(s): Proactive integration of diagnostic ultrasound into athletic training education will equip graduates to add value to a health care team.

Ultrasound simulation utilization among point of care ultrasound users: Results of a survey.

While ultrasound simulation devices have long been available as adjuncts to ultrasound education, it is unclear how they are used. We conducted a survey to determine the current utilization of emergency point-of-care ultrasound simulation and describe the current trends in the use of ultrasound simulation. A survey was sent to 1270 members of the American College of Emergency Physicians Ultrasound Section via email. The survey listed 23 questions that queried how survey participants used ultrasound simulation devices. One hundred and fifty-one survey responses were collected. The majority of survey respondents (83%) indicated that ultrasound simulation devices are available at their institution, with nearly half (45%) survey participants reporting both high- and low-fidelity ultrasound simulators available, and fewer describing low-fidelity simulators only (33%) or high-fidelity simulators only (5%). Most respondents (84%) with ultrasound simulators use them for training residents, students, fellows, and faculty. Only 20% of survey participants use ultrasound simulators for credentialing purposes. Ultrasound simulation devices are widespread amongst our survey respondents, who represent a small percentage of the ACEP ultrasound section. Ultrasound simulators are used to help ultrasound learners at various levels of training.

The Use of Ultrasound Simulators to Strengthen Scanning Skills in Medical Students: A Randomized Controlled Trial.

This study evaluates the use of ultrasound simulators for retaining and improving ultrasound skills acquired in undergraduate ultrasound training. Fourth-year medical students (n = 19) with prior training in point-of-care sonography for shock assessment were recruited for this study. Students were randomly assigned to a study group (n = 10) that followed an undergraduate ultrasound training curriculum, then used a simulator to complete 2 self-directed practice ultrasound sessions over 4 weeks. The control group (n = 9) followed the same undergraduate ultrasound training curriculum and received no additional access to a simulator or ultrasound training. A blinded assessment of the students was performed before and after the 4-week study period to evaluate their image acquisition skills on standardized patients (practical examination). To evaluate the student's clinical understanding of pathological ultrasound images, students watched short videos of prerecorded ultrasound scans and were asked to complete a 22-point questionnaire to identify their findings (visual examination). All results were adjusted to pretest performance. The students in the study group performed better than those in the control group on the visual examination (80.1% versus 58.9%; P = .003) and on the practical examination (77.7% versus 57.0%; P = .105) after the 4-week study period. The score difference on the postintervention practical examinations was significantly better for the study group compared to the control group (11.6% versus -9.9%; P = .0007). The use of ultrasound simulators may be a useful tool to help previously trained medical students retain and improve point-of-care ultrasound skills and knowledge.

Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: consensus report.

Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multi-Society Task Force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency-assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at or close to 75% for each, and obtaining a set of five ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the Task Force expects that the criteria set forth in this document will evolve with time. The Task Force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency-assessment process. Incorporating this training curriculum and the competency-assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: consensus report

Ultrasound imaging has become integral to the practice of obstetrics and gynecology. With increasing educational demands and limited hours in residency programs, dedicated time for training and achieving competency in ultrasound has diminished substantially. The American Institute of Ultrasound in Medicine assembled a multisociety task force to develop a consensus-based, standardized curriculum and competency assessment tools for obstetric and gynecologic ultrasound training in residency programs. The curriculum and competency assessment tools were developed based on existing national and international guidelines for the performance of obstetric and gynecologic ultrasound examinations and thus are intended to represent the minimum requirement for such training. By expert consensus, the curriculum was developed for each year of training, criteria for each competency assessment image were generated, the pass score was established at, or close to, 75% for each, and obtaining a set of 5 ultrasound images with pass score in each was deemed necessary for attaining each competency. Given the current lack of substantial data on competency assessment in ultrasound training, the task force expects that the criteria set forth in this document will evolve with time. The task force also encourages use of ultrasound simulation in residency training and expects that simulation will play a significant part in the curriculum and the competency assessment process. Incorporating this training curriculum and the competency assessment tools may promote consistency in training and competency assessment, thus enhancing the performance and diagnostic accuracy of ultrasound examination in obstetrics and gynecology.

P025: Optimizing practice for learning emergency department transthoracic echocardiography using an ultrasound simulator

Introduction: Emergency department (ED) transthoracic echocardiography (TTE) is an important application of emergency department bedside ultrasound. Given limited curricular hours and economic constraints, training using ultrasound simulators represents an attractive alternative to using live-human models. Despite increased uptake of ultrasound simulator technology, educators lack evidence informing how best to use this technology. Three educational paradigms will be explored in this study: self-guided theory (learners are able to determine when they have had “enough practice”), desirable difficulties (manipulating practice conditions to create more durable and flexible learning), and the challenge point framework (avoiding cognitive overload). The question we seek to answer is: in novice medical trainees, which practice condition leads to improved learning in a test of retention when assessing the ability to generate and interpret a parasternal long axis (PLAX) and apical four-chamber view (A4CH) of the heart? Methods: Ultrasound-novices will be recruited from rotators in the ED. Participants will be allocated to one of three groups based on a 2x2 orthogonal design: Group A (variable difficulty × self-determined practice); Group B (variable difficulty × fixed practice); Group C (static difficulty × fixed practice). A standardized didactic lecture will be presented to each participant. Practice conditions with respect to difficulty level (easy, medium, hard) and structure of practice (learner-determined or fixed practice) will vary according to assigned groups. All groups will receive standardized feedback. The ability to identify anatomy and pathology will be assessed. At the conclusion of practice, a post-practice skills assessment and survey will be administered. Two to three weeks later, participants will be retested using three case scenarios. Screenshots of the participant-determined “best image” and video of the performance will be taken to be evaluated by two blinded (to group allocation) reviewers. Results: We have currently enrolled 14 participants. We aim to complete enrollment by April 2016. Conclusion: We anticipate that our study will provide evidence to inform the best use of ultrasound simulators for teaching TTE in the ED. It will also provide insight into the ability of three educational theories to predict best learning using a novel educational intervention.

Ultrasound during Critical Care Simulation: A Randomized Crossover Study.

We sought to compare two ultrasound simulation interventions used during critical care simulation. The primary outcome was trainee and instructor preference for either intervention. Secondary outcomes included the identification of strengths and weaknesses of each intervention as well as overall merits of ultrasound simulation during high-fidelity, critical care simulation. The populations of interest included emergency medicine trainees and physicians. This was a randomized crossover study with two ultrasound simulation interventions. 25 trainees and eight emergency physician instructors participated in critical-care simulation sessions. Instructors were involved in session debriefing and feedback. Pre- and post-intervention responses were analyzed for statistically significant differences using t test analyses. Qualitative data underwent thematic analysis and triangulation. Both trainees and instructors deemed ultrasound simulation valuable by allowing trainees to demonstrate knowledge of indications, correct image interpretation, and clinical integration (p<0.05). Trainees described increased motivation to develop and use ultrasound skills. The edus2 was the preferred intervention, as it enabled functional fidelity and the integration of ultrasound into resuscitation choreography. Instructors preferred the edus2, as it facilitated better assessment of trainees' skills, thus influencing feedback. These findings support the use of ultrasound simulation during critical care simulations. The increased functional fidelity associated with edus2 suggests that it is the preferred intervention. Further study of the impact on clinical performance is warranted.

Ultrasound simulation in bone

The manner in which ultrasound interacts with bone is of key interest in therapy and diagnosis alike. These may include applications directly to bone, as, for example, in treatment to accelerate the healing of bone fractures and in assessment of bone density in osteoporosis, or indirectly in diagnostic imaging of soft tissue with interest in assessing exposure levels to nearby bone. Because of the lack of analytic solutions to virtually every "practical problem" encountered clinically, ultrasound simulation has become a widely used technique for evaluating ultrasound interactions in bone. This paper provides an overview of the use of ultrasound simulation in bone. A brief description of the mathematical model used to characterize ultrasound propagation in bone is first provided. A number of simulation examples are then presented that explain how simulation may be utilized in a variety of practical configurations. The focus of this paper in terms of examples presented is on diagnostic applications in bone, and, in particular, for assessment of osteoporosis. However, the use of simulation in other areas of interest can easily be extrapolated from the examples presented. In conclusion, this paper describes the use of ultrasound simulation in bone and demonstrates the power of computational methods for ultrasound research in general and tissue and bone applications in particular.