Simulation-Based Abdominal Ultrasound Training – A Systematic Review

Abstract

Purpose: The aim is to provide a complete overview of the different simulation-based training options for abdominal ultrasound and to explore the evidence of their effect.

Materials and Methods: This systematic review was performed according to the PRISMA guidelines and Medline, Embase, Web of Science, and the Cochrane Library was searched. Articles were divided into three categories based on study design (randomized controlled trials, before-and-after studies and descriptive studies) and assessed for level of evidence using the Oxford Centre for Evidence Based Medicine (OCEBM) system and for bias using the Cochrane Collaboration risk of bias assessment tool.

Results: Seventeen studies were included in the analysis: four randomized controlled trials, eight before-and-after studies with pre- and post-test evaluations, and five descriptive studies. No studies scored the highest level of evidence, and 14 had the lowest level. Bias was high for 11 studies, low for four, and unclear for two. No studies used a test with established evidence of validity or examined the correlation between obtained skills on the simulators and real-life clinical skills. Only one study used blinded assessors.

Conclusion: The included studies were heterogeneous in the choice of simulator, study design, participants, and outcome measures, and the level of evidence for effect was inadequate. In all studies simulation training was equally or more beneficial than other instructions or no instructions. Study designs had significant built-in bias and confounding issues; therefore, further research should be based on randomized controlled trials using tests with validity evidence and blinded assessors.

Zusammenfassung

Ziel: Das Ziel war es, einen vollständigen Überblick über die verschiedenen Möglichkeiten des Simulatortrainings in der Sonografie des Abdomens zu geben und dessen Leistungsfähigkeit zu untersuchen.

Material und Methoden: Dieser systematische Review wurde nach PRISMA-Leitlinien durchgeführt und sowohl Medline, Embase, „Web of Science“ und die Cochrane Bibliothek wurden hierfür durchsucht. Die Arbeiten wurden nach der Art der Studie in drei Kategorien eingeteilt (randomisierte kontrollierte Studien; Interventionsstudien und Beobachtungsstudien). Der Evidenzgrad wurde nach dem System des Centre for Evidence-based Medicine in Oxford (OCEBM) und die systematischen Fehler (Bias) wurden nach der Methode zur Bewertung des Bias-Risikos der Cochrane Collaboration bewertet.

Ergebnisse: Siebzehn Studien wurden in die Analyse eingeschlossen: Vier randomisierte kontrollierte Studien, acht Interventionsstudien mit Bewertung vor und nach der Intervention und fünf Beobachtungsstudien. Keine der Studien erreichte den höchsten Evidenzgrad, 14 hatten den niedrigsten Grad. Ein hoher Bias ergab sich für 11 Studien, vier hatten einen niedrigen Bias und zwei Studien hatten einen fraglichen Bias. Keine der Studien benutzte eine Methode mit etablierter Validität oder untersuchte, ob die an den Simulatoren erreichten Qualifikationen den klinischen Fähigkeiten in der Realität entsprachen. Nur eine Studie setzte verblindete Bewerter ein.

Schlussfolgerung: Die eingeschlossenen Studien waren heterogen bezüglich der Auswahl des Simulators, dem Studiendesign, den Teilnehmern und den Zielvorgaben; ebenso war der Evidenzgrad des Ergebnisses nicht ausreichend. In allen Studien war das Simulationstraining gleich oder etwas vorteilhafter als ein anderer Unterricht oder fehlende Anleitung. Die Studiendesigns hatten signifikante eingebaute systematische Fehler und Störfaktoren; deshalb sollte die weitere Forschung auf randomisierte kontrollierte Studien basieren unter Einsatz von Methoden mit Beweiskraft und verblindeten Bewertern.

Key words

ultrasound - education - abdomen - simulation

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