Long-terms Effects of Simulation-based Ultrasound Training: A Randomized Trial

Ultrasonography has become increasingly used in many medical specialties over the last decades as smaller and less expensive ultrasound equipment has become available. Although ultrasound imaging traditionally is considered safe, its use is highly operator dependent (EFSUMB 2010). The lack of sufficient operator skills can lead to diagnostic errors that eventually compromise patient safety due to unnecessary tests or interventions (Moore & Copel 2011). Clinical ultrasound training is challenged with long learning curves and is therefore both time consuming and requires large teacher resources (Jang et al. 2010). Some trainees may therefore never acquire the basic skills and knowledge needed for independent practice (Tolsgaard et al. 2012). In the search for effective training methods, simulation-based training has proven to be an effective adjunct to clinical training, which has been documented in several studies on interventional procedures (Larsen et al. 2009, Zendejas et al 2011, Barsuk et al. 2009). Most comparative studies on simulation-based training have, however, only examined the initial effects of simulation-based training on the first couple of procedures, it is not known if VR simulation training provides sustained improvements trainee performance throughout their learning curves until they reach clinical proficiency. Large resources are currently being allocated to simulation training in many different specialties but the effects of simulation may easily be over-estimated if only evaluating the immediate effects of simulation training. A small difference in the number of supervised ultrasound examinations needed for proficiency may not justify the financial costs associated with investing in simulation equipment, space for simulation training as well as teacher resources during simulation training. Therefore, the research questions of this study was:

In a group of ultrasound novices, what are the implications of simulation-based training compared to clinical training alone on the technical quality of scans performed after two months of training?

Methods

Study design This study is reported according to the CONSORT statement (www.consort-statement.org). A randomized observer-blind study to compare VR ultrasound training with traditional supervised practice on subsequent patient scans (see Figure 1 for flowchart of study design). Ethical approval was obtained from the Regional Ethical Committee of the Capital Region, Denmark. The Danish Data Protection Agency approved the storing of patient relevant information. This randomized trial is reported to clinicaltrials.gov prior to inclusion of participants.

Setting This study is carried out at the Departments of Gynecology at the Juliane Marie Centre, Copenhagen University Hospital, Denmark, Næstved Hospital, and Hillerød Hospital.