Simulation for competency assessment in vascular and cardiac ultrasound

Abstract

Healthcare providers who use peripheral vascular and cardiac ultrasound require specialized training to develop the technical and interpretive skills necessary to perform accurate diagnostic tests. Assessment of competence is a critical component of training that documents a learner's progress and is a requirement for competency-based medical education (CBME) as well as specialty certification or credentialing. The use of simulation for CBME in diagnostic ultrasound is particularly appealing since it incorporates both the psychomotor and cognitive domains while eliminating dependency on the availability of live patients with a range of pathology. However, successful application of simulation in this setting requires realistic, full-featured simulators and appropriate standardized metrics for competency testing. The principal diagnostic parameter in peripheral vascular ultrasound is measurement of peak systolic velocity (PSV) on Doppler spectral waveforms, and simulation of Doppler flow detection presents unique challenges. The computer-based duplex ultrasound simulator developed at the University of Washington uses computational fluid dynamics modeling and presents real-time color-flow Doppler images and Doppler spectral waveforms along with the corresponding B-mode images. This simulator provides a realistic scanning experience that includes measuring PSV in various arterial segments and applying actual diagnostic criteria. Simulators for echocardiography have been available since the 1990s and are currently more advanced than those for peripheral vascular ultrasound. Echocardiography simulators are now offered for both transesophageal echo and transthoracic echo. These computer-based simulators have 3D graphic displays that provide feedback to the learner and metrics for assessment of technical skill that are based on transducer tracking data. Such metrics provide a motion-based or kinematic analysis of skill in performing cardiac ultrasound. The use of simulation in peripheral vascular and cardiac ultrasound can provide a standardized and readily available method for training and competency assessment.

Analysis of Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas Based on Duplex Ultrasound Simulation

“…This makes it possible to assess the accuracy of the measurements and the skill of the examiner, as well as to identify sources of error. 5 Review of images from the volume flow measurements made by examiner 2 in this study indicated a specific source of error involving scanning technique with improper placement of the Doppler sample volume.…”

“…Simulators are assuming a more prominent role in medical settings for both procedural training and assessment of psychomotor skills. 5,8 Duplex scanners are the primary instrumentation for vascular ultrasound, but simulating the Doppler component of duplex scanning presents unique technical challenges. The duplex ultrasound simulator we developed at the University of Washington uses 3D models of vessel geometry and computational fluid dynamics modeling to provide a realistic representation of arterial flow displayed as Doppler spectral waveforms and color-flow images.…”

“…2,4 Simulation is playing an increasing role in medical training, and ultrasound simulators are available for both cardiac and vascular ultrasound. 5 Most applications of medical ultrasound depend on 2-dimensional (2D) B-mode (gray-scale) imaging alone. However, duplex ultrasound combines B-mode imaging with pulsed Doppler flow detection, and flow characteristics are displayed as spectral waveforms and color-flow images.…”

Ultrasound of dialysis fistulae: Factors influencing Australian practice

“…The survey attracted more respondents from private practices and vascular speciality practices than from the reported national average (Table 1). This is likely due to AVF scanning being considered as complex and requiring a high degree of specialised vascular skill 8,13 …”

Utility of color flow Doppler ultrasound to identify peripheral intravenous catheter position in adult surgical patients

“…Standardization can be obtained by implementation of simulation training sessions. 15 Training is also an important tool to document the patency of venous lines. In a multidisciplinary team care model, relaying information between professional taking care of patients is a powerful tool to reduce adverse outcomes.…”