Use of a simulator to teach focused cardiac ultrasound

We enrolled 22 individuals, internal medicine residents, hospitalists, emergency medicine physicians at a community teaching hospital, to participate in a study to assess improvement in focused cardiac ultrasound (FoCUS)... [ view full abstract ]

We enrolled 22 individuals, internal medicine residents, hospitalists, emergency medicine physicians at a community teaching hospital, to participate in a study to assess improvement in focused cardiac ultrasound (FoCUS) technique with an advanced ECHO simulator. The simulator gave the operator the ability to view cardiac windows in real time with real pathology. Each participant underwent a pre-test and practice section for parasternal long and short axis, apical 4-chamber and 2-chamber views, and subxyphoid view. This was followed by a test section that assessed for improvement. During the practice session the participants could view the ideal plane for each view on the simulator program, however this option was removed during the test. The data from 14 of the participants was ultimately usable for data analysis as these were the only ones to complete all of the simulations.

Our data shows that during the pre-test phase the average angle degree of deviation was 60.8 degress. This improved to 23.5 degrees during the practice phase when participants were able to see the ideal plane. During the testing section this increased accuracy was nearly maintained with an average deviation of 32.9 degrees (p<0.005).

Participants were also tested on their ability to interpret their images, which were based off of real pathological ECHO images. The average score during the pre-test was 43% (SD +/- 23%), which improved to 72% (SD +/-14%) during the testing section (p<0.00005).

There we no correlations with age, gender, level of training, or interestingly prior extensive video game experience (defined as peak of 10-20+ hours per week). There was some suggestion that more formal training had a tendency towards better initial degree deviation, though this was not significant.

This study will continue over the next year with the same participants repeating the testing section at 4, 8, and 12 months to see if simulator based training can show sustained technique and interpretation skills. Based upon the initial results the expectation is favorable that the skills will be retained and honed at the interval assessments. As ultrasound, especially at the bedside, becomes more prevalent, positive results from our study could point to a great way to achieve training.