Rosen Hadar, Windrim Rory, Lee Yee Man, Gotha Lara, Perelman Vsevolod, Ronzoni Stefania
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
J Obstet Gynaecol Can. 2017 Mar;39(3):166-173. doi: 10.1016/j.jogc.2016.10.009.
To compare the use of simulator-based and patient-based obstetric ultrasound training.
This was a prospective, randomized, single-blinded trial. Eighteen consenting obstetric trainees with minimal previous ultrasound exposure were recruited. Enrolled patients were also fully consenting. Mid-trimester fetal brain anatomy in the standard planes (i.e., biparietal diameter and head circumference, cavum septum pellucidum, posterior fossa, and lateral ventricle) was chosen as a surrogate for all fetal anatomy ultrasound training. Trainees were randomized into two groups according to training method: simulator group (n = 9) or patient group (n = 9). All participating trainees went through the following sequence: a didactic session regarding the required planes; a "real" patient 15-minute pretest; a 45-minute training session with a dedicated ultrasound educator, using either a simulator or a "real" patient (according to the randomized group assignment); and a 15-minute post-test to obtain and label the standard four planes on a "real" patient. All images were stored and then scored by two blinded Maternal Fetal Medicine staff, according to 3 set criteria: image quality, landmarks, and measurements. Each criterion was scored 0 to 15 for a total score of 0 to 60.
Pretest competence was similar between the two groups. For each of the two groups there was a significant score improvement following training: real patient (mean score pretest 13.3 vs. post-test 24.6; P < 0.04) and simulator group (mean score pretest 15.9 vs. post-test 28.9; P < 0.05). All trainees demonstrated significant overall score improvements (mean score pretest 14.6 vs. post-test 26.6; P < 0.04) regardless of training method. Trainees were further divided by their initial level of confidence (pretest score ≤5: very unconfident; pretest >5: unconfident). The improvement was similar for both groups, but "very unconfident" trainees' performance improved more in the simulator group (mean pretest vs. post-test score 3.5 to 35) compared with the patient group (mean pretest vs. post-test score 2.3 to 25.6) CONCLUSION: Simulator-based obstetric ultrasound training performed as well as real patient training and was found to be especially beneficial for beginner trainees. Simulator-based ultrasound training has a high rate of acceptance by trainees, does not require investment of patient or clinic resources, and warrants consideration as an educational tool for the safe and effective teaching of obstetric ultrasound.
比较基于模拟器和基于患者的产科超声培训的效果。
这是一项前瞻性、随机、单盲试验。招募了18名先前超声接触极少且同意参与的产科实习生。入选患者也均完全同意。选择孕中期胎儿大脑标准平面（即双顶径和头围、透明隔腔、后颅窝和侧脑室）的解剖结构作为所有胎儿解剖超声培训的替代内容。根据培训方法将实习生随机分为两组：模拟器组（n = 9）或患者组（n = 9）。所有参与的实习生都经历以下流程：关于所需平面的理论课程；对一名“真实”患者进行15分钟的预测试；与一名专门的超声教员进行45分钟的培训课程，使用模拟器或“真实”患者（根据随机分组）；以及对一名“真实”患者进行15分钟的后测试，以获取并标注标准的四个平面。所有图像均被存储，然后由两名不知情的母胎医学工作人员根据3套标准进行评分：图像质量、标志点和测量。每个标准的评分范围为0至15分，总分0至60分。
两组的预测试能力相似。两组在培训后分数均有显著提高：真实患者组（预测试平均分13.3分对后测试24.6分；P < 0.04）和模拟器组（预测试平均分15.9分对后测试28.9分；P < 0.05）。无论培训方法如何，所有实习生的总分均有显著提高（预测试平均分14.6分对后测试26.6分；P < 0.04）。实习生根据其初始信心水平进一步划分（预测试分数≤5：非常不自信；预测试>5：不自信）。两组的提高情况相似，但“非常不自信”的实习生在模拟器组中的表现提升幅度更大（预测试平均分对后测试分数从3.5分至35分），相比患者组（预测试平均分对后测试分数从2.3分至25.6分）。结论：基于模拟器的产科超声培训与基于真实患者的培训效果相当，且对初学者特别有益。基于模拟器的超声培训受到实习生的高度认可，不需要投入患者或诊所资源，值得作为产科超声安全有效教学的教育工具加以考虑。
