Training residents using simulation technology: Experience with ultrasoundfor trauma

Background: The need for surgeons to become proficient in pel forming and i nterpreting ultrasound examinations has been well recognized in recent Sear s, but providing standardized training remains a significant challenge. The UltraSim (Med-Sim, Ft. Lauderdale, Fla) ultrasound simulator is a modified ultrasound machine that stores patient data in three-dimensional images. B y scanning on the UltraSim mannequin, the student can reconstruct these ima ges in real-time, eliminating the need for finding normal and abnormal mode ls, while providing an objective method of both teaching and testing. The o bjective of this study was to compare the posttest results between resident s trained on a real-time ultrasound simulator versus those trained in a tra ditional hands-on patient format. We hypothesized that both methods of teac hing would yield similar results as judged by performance on the interpreti ve portion of a standardized posttest. It is designed as a prospective, coh ort study from two university trauma centers involving residents at the beg inning of their first or second postgraduate year of training. The main out come measure was performance on a standardized posttest, which included int erpretation of ultrasound cases recorded on videotape. Methods: Students first took a written pretest to evaluate their baseline k nowledge of ultrasound physics as web as their ability to interpret basic u ltrasound images. The didactic portion of the course used the same teaching materials for all residents and included lectures on ultrasound physics, u ltrasound use in trauma/critical care, and a series of instructional videos . This didactic session was followed by 1 hour for each student of hands-on training on medical models/medical patients (group I) or by training on th e ultrasound simulator (group II). The pretest was repeated at the completi on of the course (posttest). Data were stratified by postgraduate year, i.e ., PG1 or PG2. Results: A total of 74 residents were trained and tested in this study (PG1 = 38, PG2 = 26), All residents showed significant improvement in their pre test and posttest scores (p = 0.00) in both their knowledge of ultrasound p hysics and in their interpretation of ultrasound images. Importantly, me co uld not demonstrate any significant difference between groups trained on mo dels/patients (group I) versus those trained on the simulator (group II) wh en comparing their posttest interpretation of ultrasound images presented o n videotapes (PG1, group I mean score 6.9 +/- 1.4 vs. PG1, group II mean sc ore 6.5 +/- 1.6, p = 0.32; PG2, group I mean score 7.7 +/- 1.4 vs. PG2, gro up IT mean score 7.9 +- 1.2, p = 0.70). Conclusion: The use of a simulator is a convenient and objective method of introducing ultrasound to surgery residents and compares favorably with the experience gained with traditional hands-on patient models.