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Ultrasound is ubiquitous across all disciplines of medicine; it is one of the most commonly used noninvasive, painless diagnostic tools. However, not many are educated and trained well enough in its use. Ultrasound requires not only theoretical knowledge but also extensive practical experience. The simulated setting offers the safest environment for health care professionals to learn and practice using ultrasound.
This study aimed to (1) assess health care professionals’ need for and enthusiasm toward practicing using ultrasound via simulation and (2) gauge their perception and acceptance of simulation as an integral element of ultrasound education in medical curricula.
A day-long intervention was organized at the American University of Beirut Medical Center (AUBMC) to provide a free-of-charge interactive ultrasound simulation workshop—using CAE Vimedix high-fidelity simulator—for health care providers, including physicians, nurses, ultrasound technicians, residents, and medical students. Following the intervention, attendees completed an evaluation, which included 4 demographic questions and 16 close-ended questions based on a Likert scale agree-neutral-disagree. The results presented are based on this evaluation form.
A total of 41 participants attended the workshop (46% [19/41] physicians, 30% [12/41] residents, 19% [8/41] sonographers, and 5% [2/41] medical students), mostly from AUBMC (88%, 36/41), with an average experience of 2.27 (SD 3.45) years and 30 (SD 46) scans per attendee. Moreover, 15 out of 41 (36%) participants were from obstetrics and gynecology, 11 (27%) from internal medicine, 4 (10%) from pediatrics, 4 (10%) from emergency medicine, 2 (5%) from surgery and family medicine, and 5 (12%) were technicians. The majority of participants agreed that ultrasound provided a realistic setting (98%, 40/41) and that it allowed for training and identification of pathologies (88%, 36/41). Furthermore, 100% (41/41) of the participants agreed that it should be part of the curriculum either in medical school or residency, and most of the participants approved it for training (98%, 40/41) and teaching (98%, 40/41).
All attendees were satisfied with the intervention. There was a positive perception toward the use of simulation for training and teaching medical students and residents in using ultrasound, and there was a definite need and enthusiasm for its integration into curricula. Simulation offers an avenue not only for teaching but also for practicing the ultrasound technology by both medical students and health care providers.
Ultrasound is ubiquitous across all disciplines of medicine; it is one of the most commonly used noninvasive, painless diagnostic tools. However, not many are educated and trained well enough in its use. In obstetrics and gynecology (OBGYN), for instance, ultrasound is the primary method of imaging [
Currently, theoretical knowledge of ultrasound technology and application is sometimes insufficient, and practical training has traditionally been patient-dependent, that is, achieved on actual patients or volunteers [
These changes in the context of medical education and training have paved the way for a somewhat new concept of learning, that is, simulation, focused mainly on learners’ needs and patient safety [
Ultrasound simulators are integrated simulators, generally composed of a human mannequin, a mock probe, and a computer. Usually, the mock probe is connected directly to a monitor that displays the ultrasound image depending upon the probe’s position and movements. Most of these simulators use electromagnetic tracking systems to define the probe’s position. The mock probe usually contains a 3-dimensional sensor, capable of acquiring virtual position data instantaneously [
To justify the expenses of adding a costly, albeit proficient and high-fidelity simulator, the authors needed to assess stakeholders’ interest and institutional need for the investment. Therefore, a day-long workshop was organized to provide a free-of-charge interactive ultrasound simulation training—using CAE Vimedix high-fidelity simulator (see
CAE Vimedix high-fidelity simulator.
The study is an experimental intervention, that is, an ultrasound simulation workshop provided at the American University of Beirut Medical Center (AUBMC).
An open invitation to the event was circulated via email; participants included physicians, nurses, ultrasound technicians/sonographers, residents, and medical students.
CAE Vimedix high-fidelity simulator was used for the workshop. This simulator facilitates engaging and intuitive learning in cardiac, pulmonary, abdominal, and OBGYN US—all in 1 common platform. With its state-of-the-art manikin-based system and innovative software tools, CAE Vimedix accelerates the development of essential psychomotor and cognitive skills for ultrasound probe handling, image interpretation, diagnoses, and clinical decision making (CAE Healthcare, Corp, 2019).
The workshop was divided into 4 modules. All modules started with a short didactic presentation of the theoretical basis to ultrasound relating to that specific module (10 min). The first module contained adult cardiology scenarios (pulmonary stenosis, cardiac tamponade, heart failure, and aortic regurgitation). The second module contained emergency medicine topics (pneumonia, acute myocardial infarction, pleural effusion, pneumothorax, and acute abdomen). The third module contained pediatric cardiology topics (Ebstein anomaly, valvular diseases, and single ventricle physiology). The fourth module was tailored for OBGYN and emergency medicine providers, and it contained scenarios on ectopic pregnancy (8 weeks), normal fetus (8 weeks and 12 weeks), and cleft lip (20 weeks). The participants got a 1-hour hands-on practice with direct one-on-one feedback during each module.
Following the intervention, the attendees were asked to complete an evaluation, which included 4 demographic questions and 16 close-ended questions based on a Likert scale (agree-neutral-disagree).
Novel training strategies should ideally create a chain of impact at several levels. The most widely used training evaluation methodology is the Kirkpatrick and Phillips model [
The evaluation of ultrasound simulation has until now remained mainly at levels 1 and 2. Most studies have evaluated reaction, satisfaction [
Data collected from the evaluations were entered, coded, and analyzed via the Statistical Package for Social Sciences version 24 (IBM Corp). Descriptive analyses were performed using the number and percentage for categorical variables or mean and SD for continuous ones. To avoid redundancy, the 5-point Likert scale was collapsed into 3 points: strongly agree and agree were combined under “agree,” and similarly, strongly disagree and disagree were combined under “disagree;” therefore, analyses were performed on the scale agree-neither agree nor disagree-disagree.
A total of 41 participants attended the workshop (46% [19/41] physicians, 30% [12/41] residents, 19% [8/41] sonographers, and 5% [2/41] medical students), mostly from AUBMC (88%, 36/41), with an average experience of 2.27 (SD 3.45) years and 30 (SD 46) scans per attendee. Moreover, 36% (15/41) of participants were from OBGYN, 27% (11/41) from internal medicine, 10% (4/41) from pediatrics, 10% (4/41) from emergency medicine, 5% (2/41) from surgery and family medicine, and 12% (5/41) were technicians.
Overall, Twenty participants had been previously exposed to simulation in general. The majority of participants agreed that ultrasound simulation provided a realistic setting (98%, 40/41) and that it allowed for training and identification of pathologies (88%, 36/41). In addition, 100% (41/41) of the participants agreed that it should be part of the curriculum either in medical school or residency, and most of the participants agreed that it was useful for training (98%, 40/41) and teaching (98%, 40/41;
Results of the evaluation forms (N=41).
Evaluation questions | Agree, n (%) | Neither, n (%) | Disagree, n (%) |
In terms of complexity...pathologies on the simulator seemed significantly less complex | 39 (95) | 1 (2) | 1 (2) |
Simulation-based assessment of USa skills is an acceptable method for evaluation | 39 (95) | 1 (2) | 1 (2) |
The US simulation gives realistic images, and the pathologies are represented realistically | 38 (93) | 2 (5) | 2 (5) |
The US simulation gives a realistic sensation of probe manipulation | 38 (93) | 2 (5) | 1 (2) |
The US simulation should be introduced as part of the US training in the medical school curriculum | 41 (100) | —b | — |
The US simulation is a good tool for training | 40 (98) | 1 (2) | — |
The US simulation is a good tool for teaching | 40 (98) | 1 (2) | — |
The US simulation allows training and identification of complex or /rare pathologies | 36 (88) | 3 (7) | 2 (5) |
On the basis of this session, I do not see any added value of the US simulation, and there is no justification for its use in medical school environments | 9 (22) | 1 (3) | 31 (75) |
The US simulation allows for good auto-evaluation of health care professionals | 39 (95) | 2 (5) | — |
Handling of the US session on the simulation requires the same level of care and meticulousness as the process with a real patient | 25 (62) | 8 (20) | 7 (17) |
Handling a case on the US simulation is as stressful as real-life patients | 11 (27) | 4 (10) | 26 (63) |
Simulation-Based Assessments should be used for future licensing exams | 35 (85) | 6 (15) | — |
An US simulation allows exposure of students/professionals to a wider range of pathologies | 39 (95) | 1 (2) | 1 (2) |
This session was satisfactory | 39 (95) | 1 (2) | 1 (2) |
Participation in future simulation initiatives | 40 (98) | 1 (2) | — |
aUS: ultrasound.
bCells with 0 responses. For example, when 100% of participants responded with “agree” and none with “neither” or “disagree.”
Our findings showed that participants unanimously supported the introduction of ultrasound via simulation in medical school curricula and residency programs. The importance of hands-on repeat-training and deliberate practice [
There is broad consensus on the utility of integrating virtual reality into ultrasound education and into training programs [
There are a number of commercially available ultrasound simulators, but they remain expensive and require maintenance and adequate training for their use. These factors may limit the widespread adoption of the technology. Some practitioners believe that acquisition of simulators can be economically beneficial by allowing trainees to improve their performance without monopolizing ultrasound machines required in the clinical setting [
We acknowledge that the study has limitations, including the fact that it is an analysis of 1 workshop. The heterogeneity among participants in terms of disciplines, experience, and specialty lead us to consider our findings relatively sound in external validity. More importantly, future interventions and assessments need to be conducted to measure the long-term effects of such exercises on participants’ knowledge and skill retention.
American University of Beirut Medical Center
obstetrics and gynecology
return on investment
ultrasound
None declared.