Simulation-based ultrasound training improved quality of care and reduced the need for repeated patient examination and trainee supervision.

This study found that validity evidence for the assessment of mastery learning in simulation-based ultrasound training can be demonstrated and that ultrasound novices can attain mastery learning levels with less than 5 hours of training. Only one-third of the standard simulator metrics discriminated between different levels of competence.

ObjectiveTo provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. (CLM), as compared with obstetricians.MethodsThe model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio (ICER) and (iv) estimating cost‐effectiveness probability for different willingness to pay (WTP) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to CLM training (midwife‐performed CLMs) or no training (initial management by midwife, and CLM performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model.ResultsIntervention‐group participants needed a mean 268.2 (95% confidence interval [CI], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95% CI, 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group (n = 65; mean difference, 36.6 [95% CI 7.3‒65.8] minutes; p = 0.008), which corresponded to an ICER of 0.45 EUR minute−1. For WTP values less than EUR 0.26 minute−1, obstetrician‐performed CLM was the most cost‐effective strategy, whereas midwife‐performed CLM was cost‐effective for WTP values above EUR 0.73 minute−1.ConclusionCost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable.

The provision of error management instructions during simulation-based training improves the transfer of learning to the clinical setting compared with error avoidance instructions. Rather than teaching to avoid errors, the use of errors for learning should be explored further in medical education theory and practice.

Novices can attain mastery learning levels using simulation-based ultrasound training with less than, on average, 2 h of practice. However, we found large variations in the amount of training needed, which raises questions about the adequacy of current volume-based models for determining ultrasound competency.

Objective The purpose of this systematic review and meta-analysis was to examine the effects of simulation-based ultrasound training (SIM-UT) in obstetrics and gynecology compared to non-SIM-UT on trainee learning, clinical performance, patient-relevant outcomes, and cost of training. Methods A systematic search was performed in June 2019 in PubMed, Embase, and Scopus using search terms for the topic and the intervention as well as certain MESH terms. Inclusion criteria were defined in accordance with the PICO question. Studies published in any language involving SIM-UT in obstetrics and gynecology compared to non-SIM-UT or no training were included. The outcomes included effects on health care provider learning and clinical performance, patient-relevant outcomes, and cost of training. Two authors evaluated the study quality with the MERSQI instrument and the Oxford Quality Scoring System. A meta-analysis was planned for the included randomized controlled trials. Results 15 studies were included, and 11 studies were eligible for meta-analysis. SIM-UT was significantly superior to clinical training only and theoretical teaching with standard mean differences (SMD) of 0.84 (0.08–1.61) and 1.20 (0.37–2.04), respectively. However, SIM-UT was not superior to live model training; SMD of 0.65 (–3.25–4.55). Of all studies included in the meta-analysis, 91 % favored SIM-UT over clinical training alone, theoretical teaching, or in some cases live model training. Conclusion In the field of obstetrics and gynecology, SIM-UT in addition to clinical training markedly improves trainee learning, clinical performance, as well as patient-perceived quality of care.

Context The knowledge of normal variation of reproductive hormones, internal genitalia imaging and the prevalence of gynecological disorders in adolescent girls is limited. Objective The study aimed to describe reproductive parameters in post-menarcheal girls from the general population including the frequency of oligomenorrhea, PCOS and use of hormonal contraception. Design The Copenhagen Mother-Child Cohort is a population-based longitudinal birth cohort of 1210 girls born 1997-2002. Setting University Hospital. Participants 317 girls were included with a median age of 16.1 years and time since menarche of 2.9 years. Main Outcome Measure(s) Tanner stage, height, weight, age at menarche, menstrual cycle length and regularity, ovarian / uterine volume and number of follicles were recorded. Serum concentrations of FSH, LH, AMH, inhibin B, estradiol, testosterone, SHBG, androstenedione, DHEAS, 17-OH-progesterone and IGF-1 were measured. Results Twenty girls (6.3%) had oligomenorrhea and differed significantly in serum androgens and AMH, age at and time since menarche from girls with regular cycles. 27 girls were classified with PCOS (8.5%) and had significantly higher 17-OH-progesterone, estradiol, AMH, LH and age at menarche than the reference group. Girls on oral contraception had significantly higher serum SHBG concentrations and lower serum concentrations of all hormones except AMH and IGF-1. Ovarian follicles 2–29.9 mm correlated positively with serum AMH (p < 0.0001). Conclusions Most 16-year old girls had regular menstrual cycles, normal reproductive hormones and uterine and ovarian ultrasound. Serum AMH reflected ovarian follicle count and may be a useful biomarker of ovarian reserve.

The performance of FAST examinations can be assessed in a simulated setting using defensible performance standards, which have both good reliability and validity.