Are Live Ultrasound Models Replaceable? Traditional vs. Simulated Education Module for FAST Exam

Abstract

IntroductionThe focused assessment with sonography for trauma (FAST) is a commonly used and life-saving tool in the initial assessment of trauma patients. The recommended emergency medicine (EM) curriculum includes ultrasound and studies show the additional utility of ultrasound training for medical students. EM clerkships vary and often do not contain formal ultrasound instruction. Time constraints for facilitating lectures and hands-on learning of ultrasound are challenging. Limitations on didactics call for development and inclusion of novel educational strategies, such as simulation. The objective of this study was to compare the test, survey, and performance of ultrasound between medical students trained on an ultrasound simulator versus those trained via traditional, hands-on patient format.MethodsThis was a prospective, blinded, controlled educational study focused on EM clerkship medical students. After all received a standardized lecture with pictorial demonstration of image acquisition, students were randomized into two groups: control group receiving traditional training method via practice on a human model and intervention group training via practice on an ultrasound simulator. Participants were tested and surveyed on indications and interpretation of FAST and training and confidence with image interpretation and acquisition before and after this educational activity. Evaluation of FAST skills was performed on a human model to emulate patient care and practical skills were scored via objective structured clinical examination (OSCE) with critical action checklist.ResultsThere was no significant difference between control group (N=54) and intervention group (N=39) on pretest scores, prior ultrasound training/education, or ultrasound comfort level in general or on FAST. All students (N=93) showed significant improvement from pre- to post-test scores and significant improvement in comfort level using ultrasound in general and on FAST (p<0.001). There was no significant difference between groups on OSCE scores of FAST on a live model. Overall, no differences were demonstrated between groups trained on human models versus simulator.DiscussionThere was no difference between groups in knowledge based ultrasound test scores, survey of comfort levels with ultrasound, and students’ abilities to perform and interpret FAST on human models.ConclusionThese findings suggest that an ultrasound simulator is a suitable alternative method for ultrasound education. Additional uses of ultrasound simulation should be explored in the future.

A Scoping Review of Ultrasound Teaching in Undergraduate Medical Education

“…Devices and simulators [104][105][106][107][108][109][110][111][112][113][114][115][116] The primary objective of these papers was to describe or evaluate ultrasound simulators (or 'phantoms') or devices adjunctive to the ultrasound machine itself. Ultrasound simulators are models of human anatomy designed to provide a means of practicing ultrasound skills where practice on a human is impractical, dangerous or unethical.…”

“…Ultrasound simulators are models of human anatomy designed to provide a means of practicing ultrasound skills where practice on a human is impractical, dangerous or unethical. Our search found studies that tested both commercially available simulators [104][105][106][107][108] and institutions that built their own simulators with varying degrees of complexity [109][110][111].…”

“…Three papers in this category used a randomised method in comparing simulators with live patients in the teaching of ultrasonography to medical students. Both Bentley et al [105] and Damewood et al [108] randomly allocated students to be taught the FAST scan using either a human model or a simulator; both groups of students were then evaluated in their ability to perform a FAST scan on a live patient, post-intervention. No significant difference in OSCE scores was found between the two groups in either study.…”

The Use of Ultrasound Simulators to Strengthen Scanning Skills in Medical Students: A Randomized Controlled Trial

“…The results concur with previous studies on the benefits and the noninferiority of ultrasound simulators in the training of novice ultrasound learners. In 2016, Silva et al and Bentley et al found no significant difference in the ultrasound skills and knowledge of students trained using an ultrasound simulator versus students trained using live models. In addition, Tolsgaard et al showed significant improvement in the performance of gynecologic ultrasound examinations by residents when the use of an ultrasound simulator was added to their clinical training.…”

“…Of the 14 studies in the review, only 5 included a control group, and only 2 of those were randomized. Since this publication, multiple controlled randomized trials have reported the potential benefits of ultrasound simulators . In addition, ultrasound simulators allow trainees to practice multiple times the same ultrasound modality without the need of supervisors or models.…”