Simulation of Abdomen Sonography. Evaluation of a New Ultrasound Simulator

Abstract

Aim: We developed and evaluated a simulator for the sonography of the abdomen in order to improve the teaching quality in sonography training. Method: Eleven medicine residents who had received 4 to 12 months full time sonography training performed ultrasound examinations of the right upper quadrant in 5 consecutive patients and in 5 simulator cases. The correctness of their findings and the time required for the examinations were measured. The subjective confidence in their findings and the handling of the ultrasound machines were rated on a visual analogue scale. Results: During patient ultrasound examination 75 % (SEM 9 %) of all pathologic findings were recognized by the residents, whereas 71 % (SEM 8 %) of the pathologies of the simulator cases were found. This minimal difference was not significant in the paired, two sided t-test (p = 0.15). Severe pathologies did not escape detection. The time required for patient examination (10.57 min, SEM 3.25 min) was not significantly different (p = 0.53) to the time required for the simulator cases (9.59 min, SEM 2.98 min). The subjective confidence in the sonographic findings did not differ significantly (p = 0.39) between the real patient situation (68 %, SEM 6 %) and the simulation (64 %, SEM 12 %). Only the handling of the ultrasound machines was judged to be significantly better (p = 0.008) than the simulator (74 %, SEM 7 % vs. 61 %, SEM 12 %). Conclusion: In this first direct cross over comparison between real patient sonography and simulator based scanning we proved that the simulator we developed simulates the real patient examination reliably and reproducibly.

Zusammenfassung

Studienziel: Zur Verbesserung der Ausbildungsqualität in der Sonographie entwickelten und evaluierten wir einen Simulator für die Sonographie des Abdomens. Methode: Elf Assistenzärzte des Zentrums Innere Medizin, die eine 4- bis 12-monatige Sonographieausbildung erhalten hatten, führten bei 5 konsekutiven Patienten und bei 5 Simulatorfällen eine Sonographie des rechten Oberbauches durch. Die Befundkorrektheit und der Zeitbedarf der jeweiligen Untersuchung wurden gemessen. Auf einer visuellen Analogskala beurteilten die Probanden die subjektive Sicherheit in der Befundinterpretation und das Handling des jeweiligen Gerätes. Ergebnisse: Die Assistenzärzte erkannten am Patienten 75 % (Standardfehler SEM 9 %) aller vorhandenen pathologischen Befunde, am Simulator 71 % (SEM 8 %). Der minimale Unterschied erwies sich im gepaarten zweiseitigen t-Test als nicht signifikant (p = 0,15). Schwerwiegende Befunde wurden nicht übersehen. Die Untersuchung beanspruchte beim Patienten 10,57 min (SEM 3,25 min), am Simulator 9,59 min (SEM 2,98 min). Der Unterschied war nicht signifikant (p = 0,53). Auch die subjektive Sicherheit in der Sonographiebefundung war am Sonographiegerät mit 68 % (SEM 6 %) und am Simulator mit 64 % (SEM 12 %) nicht signifikant unterschiedlich (p = 0,39). Lediglich die Beurteilung des Handlings fiel mit 61 % (SEM 12 %) am Simulator signifikant schlechter aus (p = 0,008) als am Sonographiegerät mit 74 % (SEM 7 %). Schlussfolgerung: In der ersten direkten cross over Vergleichsstudie zwischen realer Sonographie am Patienten und am Simulator konnten wir zeigen, dass der von uns entwickelte und evaluierte Simulator die reale Patientenuntersuchung zuverlässig und reproduzierbar simuliert.

Key words

Ultrasound - simulator - training - clinical study - quality management

Schlüsselwörter

Ultraschall - Simulator - Ausbildung - klinische Studie - Qualitätssicherung

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