Rationale and Objectives
The American Institute of Ultrasound in Medicine (AIUM) recommends that all providers performing ultrasound-guided invasive procedures be competent in a core set of guidance skills common to all ultrasound-guided procedures, including in-plane and out-of-plane needle guidance and needle imaging optimization techniques such as probe translation, rotation, and heel-toe standoff. To allow for the practice and assessment of these core skills, we have created a novel task trainer and set of targeting tasks, and sought to obtain validity evidence in the content and response process domains for this training and assessment system according to the Standards for Educational and Psychological Testing.
Materials and Methods
We have constructed an ultrasound-guided invasive procedure training system and five targeting tasks that focused on the needle guidance skills outlined by the AIUM. All tasks were performed by obstetrics and gynecology or maternal-fetal medicine physicians with and without experience in ultrasound-guided invasive procedures during a series of simulation workshops. All participants completed a survey regarding the trainer’s and the tasks’ usefulness in the training of inexperienced physicians.
Results
The physicians who completed the tasks had favorable views of task trainer and curriculum. The targeting curriculum was felt to allow practice of all of the core guidance skills outlined by the AIUM. The average response provided for all of the tasks was 4.0 or greater, with half of the items having an average response of 4.5 or higher.
Conclusions
We have constructed a task trainer that incorporates all of the core skills outlined by the AIUM. All five tasks received very favorable reviews from both experienced and inexperienced providers. Taken together, our findings suggest they have strong content and response process validity evidence.
Introduction
With the dramatic improvements in ultrasound technology seen in recent years, many invasive procedures in a variety of medical fields that were performed blindly are now being performed with the aid of ultrasound guidance. Examples include paracentesis, central line placement, and amniocentesis, among numerous others. With the introduction of resident duty hour restrictions and the replacement of invasive procedures with noninvasive tests, it is now difficult for trainees to gain enough real-life experience during residency or fellowship to independently perform these procedures after graduation. The classic “see one, do one, teach one” training paradigm has become unsustainable.
As an example, in obstetrics and gynecology (OB/GYN), studies have demonstrated that between 50 and 100 procedures are required before a provider can become competent in amniocentesis . In chorionic villus sampling (CVS), a single study demonstrated that 100 procedures were required to obtain competence . These numbers of procedures are virtually impossible to obtain in a 4-year OB/GYN residency and remain difficult to achieve with an additional 3-year maternal-fetal medicine (MFM) fellowship. The same difficulties are encountered in interventional radiology. In 2013, the Society of Interventional Radiology outlined the minimum number of procedures required for graduation , including (1) 100 percutaneous vascular punctures, (2) 200 selective vascular catheterizations, (3) 50 vascular angioplasties, (4) 25 vascular stent placements, (5) 50 embolization procedures, and (6) 50 image-guided nonvascular procedures. These are very ambitious numbers for the combined 4 years of residency and 1 year of fellowship required for certification in interventional radiology.
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Methods
Task Trainer Construction
Ballistic Gelatin Simulated Body Walls
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Container
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Dowel Targeting Model
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Straw Targeting Model
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Ball Targeting Model
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Heel-toe Targeting Model
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Targeting Tasks
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In-plane Dowel Task
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Out-of-plane Dowel Task
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Straw Task
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Ball Task
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Heel-toe Task
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Assessment of Trainer Response Process
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TABLE 1
Provider Survey Results
Survey Item Inexperienced Experienced 1. The in-plane dowel task simulated a technical challenge encountered in clinical practice. 4.4 ± 0.6 4.4 ± 0.6 Strongly Disagree (1) Disagree (2) Neutral (3) Agree (4) Strongly Agree (5) 2. The straw task simulated a technical challenge encountered in clinical practice. 4.5 ± 0.7 4.5 ± 0.6 3. The ball task simulated a technical challenge encountered in clinical practice. 4.4 ± 0.7 4.3 ± 0.5 4. The heel-toe task simulated a technical challenge encountered in clinical practice. 4.6 ± 0.5 4.4 ± 0.7 5. The out-of-plane dowel task simulated a technical challenge encountered in clinical practice. 4.1 ± 0.7 4.9 ± 0.4 6. Although the model does not attempt to simulate true anatomic structures, the haptic feel of the training model approximates that of an actual clinical ultrasound-guided invasive procedure. 4.4 ± 0.6 4.3 ± 0.5 7. Repetitive use of the training model will improve a fellow’s hand-eye coordination with ultrasound needle guidance. 4.8 ± 0.4 4.8 ± 0.4 8. Repetitive use of the training model will improve a fellow’s clinical skill with ultrasound-guided invasive procedures. 4.8 ± 0.4 4.6 ± 0.6 9. Repetitive use of the training model will be useful in fellow training in ultrasound-guided invasive procedures. 4.8 ± 0.4 4.8 ± 0.4 10. If available, I would use the training model in the training of the Maternal-Fetal Medicine fellows I supervise. n/a 4.4 ± 065 11. I recommend that other Maternal-Fetal Medicine fellowship programs use the training model in the training of their fellows. n/a 4.7 ± 0.6 12. Repetitive use of the training model will improve an inexperienced provider’s hand-eye coordination with ultrasound needle guidance. n/a 4.5 ± 0.6 13. Repetitive use of the training model will improve an experienced provider’s clinical skill with ultrasound-guided invasive procedures. n/a 4.5 ± 0.7
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Results
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Discussion
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Supplementary Data
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Video 1
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Video 2
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Video 3
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Video 4
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Video 5
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References
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