Self-Directed Learning for Pulmonary Ultrasound Education

"Scaling Up Ultrasound Education Without Scaling Up Tutors: A Randomized Controlled Equivalence Trial of Self-Directed Learning for Pulmonary Pathology Recognition"

This study compared two ways of teaching medical students how to recognize lung conditions using ultrasound images.

All participants were third-year medical students taking part in a structured ultrasound training session at the University of Turin. Students were randomly assigned to one of two groups. One group learned lung ultrasound pathology recognition with direct guidance from a tutor. The other group used a self-directed digital learning tool called MEDQUIZ, which allowed students to review clinical cases and ultrasound videos independently.

The main goal of the study was to determine whether self-directed learning was equivalent to tutor-guided instruction for recognizing pulmonary ultrasound findings. Students completed ultrasound image-based assessments before and after the training. The assessments evaluated their ability to recognize anatomical structures, distinguish normal from abnormal findings, and identify specific lung conditions such as pneumonia, pleural effusion, interstitial syndrome, and pneumothorax.

The study also evaluated student satisfaction with the learning experience.

Study Overview

• Status: Completed
• Conditions: Ultrasound Training; Pulmonary Ultrasound Education
• Intervention / Treatment: Behavioral: Tutor-Guided Learning; Behavioral: Self-Directed Learning

Detailed Description

This was a single-center, randomized, controlled equivalence trial conducted at the SimTO Advanced Medical Simulation Center, University of Turin, Italy. The study included third-year medical students enrolled in the curricular "Approach to Ultrasound" internship.

Before the in-person training session, all students completed online instructional materials on thoracic and abdominal ultrasound. During the internship, students participated in a structured two-hour ultrasound training session composed of four 30-minute stations. The stations included hands-on scanning of healthy volunteers and case-based pathology recognition activities.

At the thoracic pathology station, students were randomly assigned to either tutor-guided learning or self-directed learning. In the tutor-guided group, students worked through pulmonary ultrasound cases with direct supervision, clinical reasoning guidance, and feedback from a tutor. In the self-directed learning group, students used MEDQUIZ, a purpose-built digital learning tool that presented clinical cases, patient information, and lung ultrasound video clips in an interactive format.

The primary outcomes were based on pre-training and post-training assessments using ultrasound video cases. Students were assessed on three levels of competency: recognition of the anatomical structure shown in the ultrasound clip, classification of the finding as physiological or pathological, and identification of the specific pulmonary condition when a pathological finding was present. An overall case resolution score was also calculated.

Secondary outcomes included student satisfaction with the simulation-based learning experience, assessed at the end of the internship.

• Study Type: Interventional
• Enrollment (Actual): 385
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Italy
    • Turin, Italy, Italy, 10126
      • Advanced Medical Simulation Center- SimTO, School of Medicine, Turin, Italy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Third-year medical students enrolled in the "Approach to Ultrasound" curricular internship at the University of Turin
• Limited or no prior ultrasound experience
• No previous formal specialized ultrasound training
• Provision of informed consent for data collection

Exclusion Criteria:

• Inability to attend the complete ultrasound training session and both assessment sessions
• Physical or medical conditions limiting participation in hands-on ultrasound practice
• Refusal to provide informed consent for data collection

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Tutor-Guided Learning; Participants assigned to this arm completed the thoracic pathology recognition station with direct tutor guidance. During the session, students reviewed pulmonary ultrasound cases through structured case-based learning, received real-time clinical reasoning guidance, and were provided with immediate corrective feedback by a trained tutor. All other components of the ultrasound internship were identical to those completed by the self-directed learning group.	Behavioral: Tutor-Guided Learning; Participants completed the thoracic pathology recognition station with direct tutor guidance. During the 30-minute station, students reviewed pulmonary ultrasound cases through structured case-based learning, received real-time clinical reasoning guidance, and were provided with immediate corrective feedback by a trained tutor.
Experimental: Self-Directed Learning; Participants assigned to this arm completed the thoracic pathology recognition station using MEDQUIZ, a purpose-built self-directed digital learning tool. Students independently reviewed clinical cases, patient information, and pulmonary ultrasound video clips without structured tutor guidance. The tool included learning materials that remained available during the session. All other components of the ultrasound internship were identical to those completed by the tutor-guided learning group.	Behavioral: Self-Directed Learning; Participants used MEDQUIZ, a purpose-built digital learning tool, to complete the thoracic pathology recognition station independently. The tool presented clinical cases, patient information, learning materials, and pulmonary ultrasound video clips. Students reviewed the cases and answered independently without structured tutor guidance during the 30-minute station.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anatomical Structure Recognition Accuracy	Percentage of pulmonary ultrasound cases in which participants correctly identified the anatomical structure shown in the ultrasound video clip.	Immediately before and immediately after the 3-hour ultrasound training session
Physiological Versus Pathological Discrimination Accuracy	Percentage of pulmonary ultrasound cases in which participants correctly classified the ultrasound finding as physiological or pathological.	Immediately before and immediately after the 3-hour ultrasound training session
Pulmonary Pathology Identification Accuracy	Percentage of pathological pulmonary ultrasound cases in which participants correctly identified the specific pulmonary condition shown in the ultrasound video clip, including pneumonia or consolidation, interstitial syndrome, pleural effusion, or pneumothorax.	Immediately before and immediately after the 3-hour ultrasound training session
Overall Pulmonary Ultrasound Case Resolution Score	Percentage of pulmonary ultrasound cases correctly resolved with the maximum score. A case was considered correctly resolved when the participant correctly identified the anatomical structure, correctly classified the finding as physiological or pathological, and, where applicable, correctly identified the specific pulmonary pathology.	Immediately before and immediately after the 3-hour ultrasound training session

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Student Satisfaction With the Simulation Experience	Student satisfaction with the ultrasound training experience will be assessed after the session using the Italian version of the Satisfaction with Simulation Experience scale. This scale includes 18 items rated on a 5-point Likert scale, from 1 to 5. The total score ranges from 18 to 90, with higher scores indicating greater satisfaction with the simulation-based learning experience. Three subscale scores will also be calculated: Debriefing and Reflection, ranging from 9 to 45; Clinical Reasoning, ranging from 5 to 25; and Clinical Learning, ranging from 4 to 20. For all subscales, higher scores indicate a better outcome, corresponding to greater satisfaction in the specific domain.	Immediately after the 3-hour ultrasound training session

Collaborators and Investigators

• Sponsor: University of Turin, Italy
• Investigators: Study Director: Alberto Milan, PhD, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy

Publications and helpful links

General Publications

• Agostino S, Daga MA, Novello F, Daga FA, Papotti G, Veglio F, Milan A. Evaluating the efficacy of a cost-effective PC-based tool as an equivalent alternative to traditional ultrasound simulators in medical education. Anat Sci Educ. 2025 Nov;18(11):1203-1214. doi: 10.1002/ase.70115. Epub 2025 Aug 29.

Study record dates

Study Major Dates

• Study Start (Actual): March 3, 2026
• Primary Completion (Actual): April 30, 2026
• Study Completion (Actual): April 30, 2026

Study Registration Dates

• First Submitted: June 23, 2026
• First Submitted That Met QC Criteria: June 29, 2026
• First Posted (Actual): July 1, 2026

Study Record Updates

• Last Update Posted (Actual): July 1, 2026
• Last Update Submitted That Met QC Criteria: June 29, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Randomized Controlled Trial; Medical Education; Point-of-Care Ultrasound; Lung Ultrasound; Equivalence Trial; Simulation-Based Education
• Other Study ID Numbers: 219865

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be made publicly available. Access to de-identified data may be considered only in the context of a formal scientific collaboration and after approval by the relevant institutional and ethics committee authorities, in accordance with applicable regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No