School of Graduate Research, Central Queensland University, Cairns, Australia.
Department of Agriculture and Fisheries, Queensland Government, Rockhampton, Australia.
Radiography (Lond). 2021 May;27(2):404-413. doi: 10.1016/j.radi.2020.10.002. Epub 2020 Oct 21.
Traditionally in Australia, sonographer skills are learnt on patients in clinical practice. A four-year undergraduate-postgraduate course introduced ultrasound simulation to prepare novice sonographer students for interaction with patients. Second-year students learnt psychomotor and patient-sonographer communication skills during simulation using commercial ultrasound machines and volunteer year-group peers as standardised patients. This paper reports on the transfer of the ultrasound skills learnt in simulation to clinical practice.
Clinical performance evaluations were completed by 94 supervisors involved in the initial clinical practice of 174 post-simulation second-year students over a two-year period (2015-2016). Student performance of each component skill, and skill category, was analysed by modelling binomial proportions with logistic regression.
Students demonstrated substantial transfer of learnt ultrasound skills to achieve a mean of advanced beginner competence (mean score of equal to or >3/5) in complex psychomotor and patient-sonographer communication skills, as measured one month into clinical practice. Knowledge and skill components, or sub-tasks, varied significantly (P < 0.001) in transferability. Scanning tasks in general, particularly the skill of 'extending the examination', transferred with significantly (P < 0.001) less efficacy than pre-exam, instrumentation, post-exam, and additional tasks. Skill transfer improved significantly (P < 0.001) following increased deliberate practice with tutor feedback.
Preclinical simulation, using standardised patients, clearly stated objectives to manage cognitive load and immediate tutor feedback, facilitated substantial transfer of ultrasound skills to clinical practice. The efficacy of skill transfer varied but improved with increased deliberate practice and feedback quality.
The incorporation of preclinical simulation into the core curriculum of sonographer courses is recommended to improve student performance, reduce the burden on clinical staff and increase patient safety during the early stages of ultrasound education.
在澳大利亚，传统上超声技师的技能是在临床实践中通过患者来学习的。四年制本科-研究生课程引入了超声模拟，以帮助新手超声技师学生为与患者的互动做好准备。第二年的学生在模拟中使用商用超声机和标准化患者（志愿者年级同学）学习运动技能和医患沟通技能。本文报告了模拟中学到的超声技能在临床实践中的转移情况。
在两年（2015-2016 年）的时间里，94 名参与初始临床实践的导师对 174 名模拟后的第二年学生进行了临床绩效评估。使用逻辑回归对每个组件技能和技能类别进行建模，以分析学生的表现。
学生在复杂的运动技能和医患沟通技能方面表现出了大量已学技能的转移，达到了初学者入门水平（平均得分等于或大于 3/5），这是在临床实践一个月后测量的。知识和技能组成部分（或子任务）在可转移性方面差异显著（P<0.001）。一般来说，扫描任务，特别是“扩展检查”技能，转移效果明显（P<0.001）不如检查前、仪器使用、检查后和附加任务。经过增加有针对性的练习和导师反馈，技能转移显著（P<0.001）提高。
使用标准化患者的临床前模拟明确了管理认知负荷和即时导师反馈的目标，这显然促进了超声技能向临床实践的大量转移。技能转移的效果存在差异，但随着有针对性的练习和反馈质量的提高而提高。
建议将临床前模拟纳入超声技师课程的核心课程，以提高学生的表现，减轻临床工作人员的负担，并提高超声教育早期的患者安全性。
