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

Abstract

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.

Zusammenfassung

Ziel Ziel dieser systematischen Übersicht und Metaanalyse war es, die Auswirkungen des simulationsbasierten Ultraschalltrainings (SIM-UT) in der Geburtshilfe und Gynäkologie im Vergleich zu Nicht-SIM-UT auf das Lernen der Auszubildenden, die klinische Leistung, den patientenrelevanten Outcome und die Kosten der Ausbildung zu untersuchen.

Methoden Im Juni 2019 wurde eine systematische Suche in PubMed, Embase und Scopus mit Suchbegriffen zum Thema und zur Intervention sowie mit bestimmten MESH-Begriffen durchgeführt. Die Einschlusskriterien wurden gemäß des PICO-Schemas definiert. Eingeschlossen wurden Studien jeglicher Sprache, die SIM-UT in der Geburtshilfe und Gynäkologie beinhalten und dieses mit Nicht-SIM-UT oder keiner Schulung verglichen. Die Ergebnisse umfassten Auswirkungen auf das Lernen und die klinische Leistung von Gesundheitsdienstleistern, den patientenrelevanten Outcome und Schulungskosten. Zwei Autoren bewerteten die Studienqualität mit dem MERSQI-Instrument und dem Oxford Quality Scoring System. Für die eingeschlossenen randomisierten kontrollierten Studien war eine Metaanalyse geplant.

Ergebnisse 15 Studien wurden eingeschlossen, 11 Studien waren für eine Metaanalyse geeignet. SIM-UT war der reinen klinischen Ausbildung und dem theoretischen Unterricht mit mittleren Standarddifferenzen (SMD) von 0,84 (0,08–1,61) bzw. 1,20 (0,37–2,04) signifikant überlegen. Allerdings war SIM-UT der Ausbildung am lebenden Modell nicht überlegen. Die SMD betrug 0,65 (–3,25–4,55). Von allen in die Metaanalyse einbezogenen Studien bevorzugten 91 % SIM-UT gegenüber der reinen klinischen Ausbildung, dem theoretischen Unterricht oder in einigen Fällen gegenüber der Ausbildung am lebenden Modell.

Schlussfolgerung Im Bereich der Geburtshilfe und Gynäkologie verbessert SIM-UT zusätzlich zur klinischen Ausbildung das Lernen der Auszubildenden, die klinische Leistung sowie die vom Patienten wahrgenommene Qualität der Versorgung deutlich.

Key words

gynecology - obstetrics - education - training - quality assurance - simulation-based training - ultrasound

Publication History

Received: 30 January 2020

Accepted: 20 October 2020

Article published online:
21 December 2020

• References

• 1 Tolsgaard MG, Ringsted C, Dreisler E. et al Sustained effect of simulation-based ultrasound training on clinical performance: a randomized trial. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2015; 46: 312-318 DOI: 10.1002/uog.14780.
• 2 [Anonym]. Minimum training requirements for the practice of Medical Ultrasound in Europe. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 2010; 31: 426-427 DOI: 10.1055/s-0030-1263214.
• 3 [Anonym]. ISUOG Education Committee recommendations for basic training in obstetric and gynecological ultrasound. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2014; 43: 113-116 DOI: 10.1002/uog.13208.
• 4 [Anonym]. Minimum training recommendations for the practice of medical ultrasound. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 2006; 27: 79-105 DOI: 10.1055/s-2006-933605.
• 5 Tolsgaard MG, Ringsted C, Rosthoj S. et al The Effects of Simulation-based Transvaginal Ultrasound Training on Quality and Efficiency of Care: A Multicenter Single-blind Randomized Trial. Annals of surgery 2017; 265: 630-637 DOI: 10.1097/sla.0000000000001656.
• 6 Tolsgaard M, Veluppillai C, Gueneuc A. et al When Are Trainees Ready to Perform Transvaginal Ultrasound? An Observational Study. Ultraschall in der Medizin (Stuttgart, Germany: 1980) 2018; DOI: 10.1055/a-0753-0259.
• 7 Cook DA, Hatala R, Brydges R. et al Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. Jama 2011; 306: 978-988 DOI: 10.1001/jama.2011.1234.
• 8 Reed DA, Cook DA, Beckman TJ. et al Association between funding and quality of published medical education research. Jama 2007; 298: 1002-1009 DOI: 10.1001/jama.298.9.1002.
• 9 Jadad AR, Moore RA, Carroll D. et al Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled clinical trials 1996; 17: 1-12
• 10 Borenstein M. Effect sizes for continuous data. In The handbook of research synthesis and meta-analysis, 2nd ed.. New York, NY, US: Russell Sage Foundation; 2009: 221-235
• 11 Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological methods 2002; 7: 105-125
• 12 Hunter JE, Schmidt FL. Methods of meta-analysis: Correcting error and bias in research findings. Thousand Oaks, CA, US: Sage Publications, Inc; 1990
• 13 Zendejas B, Brydges R, Wang AT. et al Patient outcomes in simulation-based medical education: a systematic review. Journal of general internal medicine 2013; 28: 1078-1089 DOI: 10.1007/s11606-012-2264-5.
• 14 Kirkpatrick D. Evaluating training programs: the four levels. 3rd. Aufl.. San Fransico: 2005
• 15 Akoma UN, Shumard KM, Street L. et al Impact of an Inexpensive Anatomy-Based Fetal Pig Simulator on Obstetric Ultrasound Training. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 2015; 34: 1793-1799 DOI: 10.7863/ultra.15.14.12004.
• 16 Chalouhi GE, Quibel T, Lamourdedieu C. et al [Obstetrical ultrasound simulator as a tool for improving teaching strategies for beginners: Pilot study and review of the literature]. Journal de gynecologie, obstetrique et biologie de la reproduction 2016; 45: 1107-1114 DOI: 10.1016/j.jgyn.2015.12.011.
• 17 Chao C, Chalouhi GE, Bouhanna P. et al Randomized Clinical Trial of Virtual Reality Simulation Training for Transvaginal Gynecologic Ultrasound Skills. Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 2015; 34: 1663-1667 DOI: 10.7863/ultra.15.14.09063.
• 18 Girzadas Jr DV, Antonis MS, Zerth H. et al Hybrid simulation combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine 2009; 16: 429-435 DOI: 10.1111/j.1553-2712.2009.00399.x.
• 19 Moak JH, Larese SR, Riordan JP. et al Training in transvaginal sonography using pelvic ultrasound simulators versus live models: a randomized controlled trial. Academic medicine: journal of the Association of American Medical Colleges 2014; 89: 1063-1068 DOI: 10.1097/acm.0000000000000294.
• 20 Rosen H, Windrim R, Lee YM. et al Simulator Based Obstetric Ultrasound Training: A Prospective, Randomized Single-Blinded Study. Journal of obstetrics and gynaecology Canada: JOGC = Journal d’obstetrique et gynecologie du Canada: JOGC 2017; 39: 166-173 DOI: 10.1016/j.jogc.2016.10.009.
• 21 Williams CJ, Edie JC, Mulloy B. et al Transvaginal ultrasound simulation and its effect on trainee confidence levels: A replacement for initial clinical training?. Ultrasound (Leeds, England) 2013; 21: 50-56 DOI: 10.1177/1742271X13481215.
• 22 Tolsgaard MG, Tabor A, Madsen ME. et al Linking quality of care and training costs: cost-effectiveness in health professions education. Medical education 2015; 49: 1263-1271 DOI: 10.1111/medu.12882.
• 23 Andreasen LA, Tabor A, Norgaard LN. et al Is simulation training only for inexperienced trainees? A multicenter randomized trial exploring the effects of simulation-based ultrasound training on obstetricians’ diagnostic accuracy. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2019; DOI: 10.1002/uog.20362.
• 24 Wüstemann M, Scharf A, Maul H. et al New ultrasound simulation system: An effective training method to improve the examiner’s experience for the first trimester screening for chromosomal abnormalities using sonography. Geburtshilfe und Frauenheilkunde 2002; 62: 1183-1187 DOI: 10.1055/s-2002-36369.
• 25 Ahmad R, Alhashmi G, Ajlan A. et al Impact of high-fidelity transvaginal ultrasound simulation for radiology on residents’ performance and satisfaction. Academic radiology 2015; 22: 234-239 DOI: 10.1016/j.acra.2014.09.006.
• 26 Le Lous M, De Chanaud N, Bourret A. et al Improving the quality of transvaginal ultrasound scan by simulation training for general practice residents. Advances in simulation (London, England) 2017; 2: 24 DOI: 10.1186/s41077-017-0056-z.
• 27 Carolan-Rees G, Ray AF. The ScanTrainer obstetrics and gynaecology ultrasound virtual reality training simulator: A cost model to determine the cost viability of replacing clinical training with simulation training. Ultrasound (Leeds, England) 2015; 23: 110-115 DOI: 10.1177/1742271x14567498.
• 28 Bly S, Van den Hof MC. Obstetric ultrasound biological effects and safety. Journal of obstetrics and gynaecology Canada: JOGC = Journal d’obstetrique et gynecologie du Canada: JOGC 2005; 27: 572-580 DOI: 10.1016/s1701-2163(16)30716-2.
• 29 Ziv A, Wolpe PR, Small SD. et al Simulation-based medical education: an ethical imperative. Academic medicine: journal of the Association of American Medical Colleges 2003; 78: 783-788
• 30 Tolsgaard MG. A multiple-perspective approach for the assessment and learning of ultrasound skills. Perspectives on medical education 2018; 7: 211-213 DOI: 10.1007/s40037-018-0419-8.
• 31 Schwartz LD, Bransford DJ, Sears D. Efficiency and innovation in transfer. 2005
• 32 Arya S, Dwivedi A, Mulla ZD. et al Effectiveness of ultrasound simulation in obstetrics and gynecology education: A state-of-the-Art review. Donald School Journal of Ultrasound in Obstetrics and Gynecology 2017; 11: 115-125 DOI: 10.5005/jp-journals-10009-1512.
• 33 Burden C, Preshaw J, White P. et al Usability of virtual-reality simulation training in obstetric ultrasonography: a prospective cohort study. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2013; 42: 213-217 DOI: 10.1002/uog.12394.