Multicenter randomized trial exploring effects of simulation‐based ultrasound training on obstetricians' diagnostic accuracy: value for experienced operators

Abstract

Objective To explore the effects of simulation‐based ultrasound training on the accuracy of fetal weight estimation in the third trimester among obstetricians with different levels of clinical experience. Methods This was a multicenter, randomized pre–post‐test practical trial conducted between March 2016 and January 2018. Obstetricians with different levels of clinical experience were randomized to either simulation‐based ultrasound training focusing on fetal weight scans or no intervention. Participants completed two scans in pregnant women at term to establish baseline accuracy of fetal weight estimation. Another two scans were performed at follow‐up. Accuracy was defined by the percentage difference between estimated fetal weight and actual birth weight. Ultrasound image quality was rated by two expert raters. Results Seventy participants with different levels of clinical experience completed the study. Adjusting for clinical experience, the intervention group demonstrated an improvement in measurement accuracy of 31.9% (95% CI, 6.9–50.1%) (P = 0.02), whereas the control group did not improve (relative difference, 13.1% (95% CI, −17.9 to 55.9%); P = 0.45). The change in accuracy was significantly different between the groups (P = 0.02) and independent of clinical experience (P = 0.54). Image‐quality scores improved by a mean of 1.2 (95% CI, 0.4–2.1) (P < 0.01) in the intervention group, with no change in the control group (mean difference, 0.1 (95% CI, −0.8 to 1.0); P = 0.78). There was a strong negative correlation between time spent using the simulator and clinical experience (r = −0.70, P = 0.0001). Conclusion Simulation‐based ultrasound training improved accuracy and image quality when performing fetal weight estimation in women at term, independent of obstetricians' clinical experience. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Determining if simulation is effective for training in ultrasound: A narrative review

“…Additionally, this review has demonstrated that ultrasound simulation is superior to theoretical learning alone and shows comparable learning outcomes when trialled against live models. A recent trial has tested simulation among experienced obstetric consultants with ultrasound experience and trainees in obstetrics . It was found that simulation was effective in improving ultrasound skills independent of the user's skill set .…”

“…A recent trial has tested simulation among experienced obstetric consultants with ultrasound experience and trainees in obstetrics. 27 It was found that simulation was effective in improving ultrasound skills independent of the user's skill set. 27 Simulation could therefore be an alternate method of ultrasound education for sonography students or used as a technique to expand ultrasound proficiency, even in experienced clinicians.…”

Simulation-Based Ultrasound Training in Obstetrics and Gynecology: A Systematic Review and Meta-Analysis

“…The studies originated in Europe (n = 10), the United States (n = 3), Canada (n = 1), and Saudi Arabia (n = 1). Of the 15 included studies, 11 were randomized trials [1,5,[15][16][17][18][19][20][21][22][23] and three were observational two group studies [24][25][26]. One study was a cost effectiveness study involving a questionnaire [27].…”

“…The forest plot on SIM-UT in addition to clinical training vs. clinical training only, involving five studies, showed a pooled effect size of 0.84 (0.08-1.61) Z = 2.17 (P = 0.03) with an I 2 = 77 %, favoring SIM-UT. The outcomes involved 1) skills in the simulated setting [21] measured as posttest scores on the simulator, 2) skills demonstrated in the clinical setting [1,5] measured as scan time and post-test score, and 3) patient-relevant outcomes [22,23] measured as time to discharge and diagnostic accuracy. The final forest plot on SIM-UT vs. theoretical teaching involving two studies showed a pooled effect size of 1.20 (0.37-2.04) Z = 2.82 (P = 0.005) with an I 2 = 66 %, significantly favoring SIM-UT.…”

“…Hence, initial simulation-based ultrasound training may act as preparation for future learning in the clinical setting as suggested by interaction effects between initial simulation-based training and subsequent clinical training in some studies [31]. In addition to the beneficial outcomes described for novices, SIM-UT also seems to improve the diagnostic accuracy of experienced doctors, even though the experienced obstetricians subjectively rated the usability of simulation training significantly lower than inexperienced trainees [23]. The continued increases in computational power combined with increased accessibility to ultrasound cases may drive a continued expansion of simulation-based ultrasound education for advanced learners in the future.…”