Rationale and Objectives
Because of the intimate and uncomfortable nature of transvaginal ultrasound, training residents to perform this type of examination is a difficult task. As a consequence, residents may receive inadequate training that leads to a lack of the skills and confidence needed to perform this examination. The aim of the study was to assess the effectiveness of using simulation sessions to teach residents how to perform transvaginal ultrasound, enabling them to diagnose obstetric and gynecologic emergencies and helping them survive on-calls alone while keeping their patients safe.
Materials and Methods
We used an experimental study design to compare the confidence levels of 20 senior residents who received clinical training only to those of 25 junior residents who were enrolled in a simulation-based teaching session. We also compared the junior residents’ levels of performance and confidence using transvaginal ultrasound before and after the sessions.
Results
The performance of transvaginal ultrasound by the junior residents and their confidence levels significantly improved after they attended the simulation sessions. They had higher levels of confidence than the senior residents who did not attend the session. It was also observed that the number of nondiagnostic transvaginal ultrasounds performed by the on-call resident that needed to be repeated the next day had significantly dropped.
Conclusions
Simulation-based teaching sessions are an effective method of education, which improve trainees’ skills and confidence levels and improve patient safety.
With advances in computer technology, hardware, and software, ultrasound has become the modality of choice for many medical specialties, such as obstetrics and gynecology . Transvaginal ultrasound has been found to be the most extensively used imaging examination in this specialty . However, users face many difficulties in learning to use the tool as patients cannot tolerate the examination being extended because of the inexperienced operators. Additionally, training experience is limited due to the restrictions of many hospital policies and the shortage of sonographers . The development of high-fidelity mannequins provides an educational environment that fosters training in pelvic ultrasound simulation .
Simulation is now a well-established educational tool that fosters the learning process of health providers. It can be defined as an artificial replication of sufficient components of the real-world situation to achieve certain goals . It imitates many physical appearances, medical procedures, and clinical scenarios that allow trainees to obtain the necessary knowledge or skills without the need for real patients. Simulation offers the learner opportunities to become engaged in experiential learning . In comparison to learning that is not experiential in nature, simulation is acknowledged to be more effective . Furthermore, in correlation with patient safety, simulation provides new methods of teaching error management and promoting a culture of safety. It also offers ethical benefits, increasing the precision and relevance of training as well as competency assessment . Transvaginal ultrasound simulation has been shown to increase the confidentiality of trainees and has the potential to replace the initial clinical training on real patients .
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Materials and methods
Context
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Study Design
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Table 1
McGaghie Mastery Learning Conceptual Framework
Element Action Performed Baseline or diagnostic testing Presession assessment was performed Clear learning objectives, sequenced as units in increasing difficulty The required psychomotor skill in obtaining the images of the female pelvic landmarks was clearly identified by the expertise Engagement in educational activities (eg, skills practice, data interpretation, reading, and focused on reaching the objectives) Simulation sessions were conducted focusing on the required skills only A set minimum passing standard (eg, test score) for each educational unit Each anatomic landmark is clearly identified Formative testing to gauge unit completion at a preset minimum passing standard for mastery Assessment within the sessions was performed with immediate feedback Advancement to the next educational unit gave a measured achievement at or above the mastery standard The expected common radiologic appearance of common pathology was discussed briefly in the sessions Continued practice or study on an educational unit until the mastery standard is reached Postsession assessment was performed after 2–3 months
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Formulation of the Assessment Tools
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Table 2
Reliability Analysis of the Results of the Assessment Tools
Scale Cronbach Alpha Performance assessment tool before the simulation session 0.940 Performance assessment tool after the simulation session 0.906 Self-assessment tool before the simulation session 0.934 Self-assessment tool after the simulation session 0.950 Satisfaction assessment tool before the session 0.916 Satisfaction assessment tool after the session 0.933
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Study Population
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Formulating the Simulation Sessions
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Data Collection
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Statistical Analysis of Data
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Ethical Approval
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Results
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Table 3
Comparison Between the Junior Residents Who Have Attended the Simulation Training Session and the Senior Residents Who Did Not Attend the Simulation Session, Regarding Their Perception of Their Performance of Transvaginal Ultrasound (Self-assessment)
Question Juniors ( n = 25); μ ± σ Seniors ( n = 20); μ ± σ Cohen d__P Value_t_ I am (I become) familiar with TV probe manipulation 7.4 ± 1.353 4.72 ± 2.951 0.74 .001 3.751 I can obtain two views of the uterus 8 ± 1.214 4.68 ± 2.996 0.92 .001 4.651 I can assess the endometrium 7.7 ± 1.302 5.2 ± 3.175 0.65 .002 3.3 I can obtain two views of the ovaries/adnexa 7.25 ± 1.209 3.28 ± 2.301 1.37 .001 6.975 I can assess the cervix 7.05 ± 1.504 3.36 ± 2.580 1.1 .001 5.665 I can look for free fluid 7.4 ± 1.759 5.08 ± 3.040 0.6 .004 3.027
TV, transvaginal.
Table 4
Comparison Between the Junior Residents Who Have Attended the Simulation Training Session and the Senior Residents Who Did Not Attend the Simulation Session Regarding Their Satisfaction of Their Performance of Transvaginal Ultrasound
Question Juniors ( n = 25); μ ± σ Seniors ( n = 20); μ ± σ Cohen d__P value_t_ I am satisfied about time I need to perform TVUS 3.7 ± 1.031 2.48 ± 1.005 0.8 .001 4 I am confident to perform TVUS on real patients 3.75 ± 0.910 2.48 ± 1.229 0.75 .001 3.85 I am a safe resident obtaining standard views of the female pelvic organs by TVUS 3.85 ± 0.875 2.72 ± 1.308 0.65 .002 3.313 I am satisfied with the quality of the images I obtain 3.7 ± 0.923 2.4 ± 1.118 0.82 .001 4.181 I feel I can perform TVUS as a routine study 3.95 ± 0.759 2.16 ± 1.028 1.72 .001 6.493
TVUS, transvaginal ultrasound.
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Table 5
Comparison Between the Objective Assessment of Junior Residents’ Performance of Transvaginal Ultrasound Before and After the Simulation Training Session
Question Juniors Before Simulation ( n = 25); μ ± σ Juniors After Simulation ( n = 25); μ ± σ Cohen d__P Value_t_ The resident handles the TV probe correctly inside the vaginal 5.5 ± 3.379 7.75 ± 2.0488 0.6 .001 −3.851 The resident obtains two good views of the uterus 5.6 ± 3.761 8.0500 ± 1.877 0.65 .002 −3.611 The resident obtains two good views of the ovaries/adnexa 4.3 ± 3.373 7.3 ± 2.904 0.65 .001 −4.359 The resident obtains good views of the endometrium 5.5 ± 3.954 7.9 ± 2.573 0.52 .005 −3.177 The resident obtains good views of the cervix 4.05 ± 4.11 7.7 ± 2.83 0.74 .001 −3.822 The resident looks for free fluid 5.85 ± 4.404 8.1 ± 2.77 0.45 .021 −2.517 Overall, the study is completed 4.9 ± 3.354 7.6 ± 2.037 0.3 .001 −4.925
TV, transvaginal.
Table 6
Comparison Between the Junior Residents’ Subjective Self-assessment of Their Performance in Transvaginal Ultrasound Before and After the Simulation Training Session
Question Juniors Before Simulation ( n = 25); μ ± σ Juniors After Simulation ( n = 25); μ ± σ Cohen d__P Value_t_ I can introduce TV probe in the correct position 5.15 ± 2.925 7.4 ± 1.875 0.7 .005 −3.167 I am familiar with TV probe manipulation 3.250 ± 7.4 7.4 ± 1.353 0.82 .001 7.625 I can obtain two views of the uterus 3.7 ± 3.262 8 ± 1.214 1.5 .001 −6.015 I can assess the endometrium 4.35 ± 3.117 7.7 ± 1.302 1.2 .001 −5.998 I can obtain two views of the ovaries/adnexa 3.45 ± 2.625 7.25 ± 1.209 1.5 .001 −6.418 I can assess the cervix 2.7 ± 2.536 7.05 ± .336 2.7 .001 −7.257 I can look for free fluid 3.8 ± 3.302 7.4 ± 1.759 1 .001 −6.136
TV, transvaginal.
Table 7
Comparison Between the Junior Residents Regarding Their Satisfaction About Their Performance of Transvaginal Ultrasound Before and After the Simulation Training Session
Question Juniors Before Simulation ( n = 25); μ ± σ Juniors After Simulation ( n = 25); μ ± σ Cohen d__P Value_t_ I am satisfied with the time needed to perform TVUS 1.95 ± 1.190 3.7 ± 1.031 1 .001 −5.872 I am confident to perform TVUS on real patients 2.15 ± 1.348 3.75 ± .910 1 .001 −5.446 I am a safe resident obtaining standard views of female pelvic organs 2.3 ± 1.418 3.85 ± .875 1 .001 −4.610 I am satisfied about the quality of the images that I obtain 2.2 ± 1.563 3.7 ± .923 0.9 .001 −5.090 I feel I can perform TVUS as a routine study 2.2 ± 1.152 3.95 ± 1.698 0.8 .001 −6.054
TVUS, transvaginal ultrasound.
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Discussion
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Limitations
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Conclusion
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Acknowledgments
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