Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial

M G Tolsgaard, C Ringsted, E Dreisler, L N Nørgaard, J H Petersen, M E Madsen, N L C Freiesleben, J L Sørensen, A Tabor, M G Tolsgaard, C Ringsted, E Dreisler, L N Nørgaard, J H Petersen, M E Madsen, N L C Freiesleben, J L Sørensen, A Tabor

Abstract

Objective: To study the effect of initial simulation-based transvaginal sonography (TVS) training compared with clinical training only, on the clinical performance of residents in obstetrics and gynecology (Ob-Gyn), assessed 2 months into their residency.

Methods: In a randomized study, new Ob-Gyn residents (n = 33) with no prior ultrasound experience were recruited from three teaching hospitals. Participants were allocated to either simulation-based training followed by clinical training (intervention group; n = 18) or clinical training only (control group; n = 15). The simulation-based training was performed using a virtual-reality TVS simulator until an expert performance level was attained, and was followed by training on a pelvic mannequin. After 2 months of clinical training, one TVS examination was recorded for assessment of each resident's clinical performance (n = 26). Two ultrasound experts blinded to group allocation rated the scans using the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale.

Results: During the 2 months of clinical training, participants in the intervention and control groups completed an average ± SD of 58 ± 41 and 63 ± 47 scans, respectively (P = 0.67). In the subsequent clinical performance test, the intervention group achieved higher OSAUS scores than did the control group (mean score, 59.1% vs 37.6%, respectively; P < 0.001). A greater proportion of the intervention group passed a pre-established pass/fail level than did controls (85.7% vs 8.3%, respectively; P < 0.001).

Conclusion: Simulation-based ultrasound training leads to substantial improvement in clinical performance that is sustained after 2 months of clinical training. © 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Trial registration: ClinicalTrials.gov NCT01895868.

Keywords: medical education; simulation-based medical education; simulation-based ultrasound training; transvaginal; ultrasound assessment; ultrasound competence.

© 2015 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Figures

Figure 1
Figure 1
Flowchart of the study showing participant enrollment, randomization, allocation of interventions and follow-up.
Figure 2
Figure 2
Learning curve of participants in first four training rounds on virtual-reality transvaginal simulator. Two participants required more than four rounds of training to attain expert level (dotted line). Error bars indicate ± 2 standard errors.
Figure 3
Figure 3
Objective Structured Assessment of Ultrasound Skills (OSAUS) scores of participants who underwent simulation-based ultrasound (US) training followed by clinical training and those who underwent clinical training only, measured after 2 months into residency. , Knowledge of equipment; , image optimization; , systematic examination; , interpretation of images; , documentation of images; , medical decision-making.

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