Impact of High-fidelity Transvaginal Ultrasound
Simulation for Radiology on Residents’ Performance and Satisfaction
AUTHORS:
1- DR RANI AHMAD MD 2- DR AMR A JLAN MD
3- DR GHOFRAN AL HASHIMI MD 4- PROF BASIM AL DEEK MD
I NSTITUTE:KAU
ACADEMIC RADIOLOGY 2014
Background
Transvaginal ultrasound is a difficult task Because of the : -Intimate and uncomfortable nature .
-Inadequate training .
-Restrictions of many hospital policies .
Background
The authors identify these problem and decided to create educational method that overcome
these problem to train the residents and choose
simulation session for that .
Objectives
Evaluate the skill acquisition and satisfaction of junior radiological residents using the newly
introduced simulated session on transvaginal
ultrasound to obtain anatomical landmarks of the female pelvis .
Compare its effectiveness with self-evaluations of the senior residents who have never had any
simulation training.
Methods
Study Design
The study is an experimental study test to evaluate the effectiveness and satisfaction of transvaginal ultrasound simulation sessions for radiology residents.
Two conceptual frameworks were chosen; McGaghie’s
mastery learning conceptual framework for the designing of the sessions .
Kirkpatrick’s four levels of evaluation for the evaluation of their outcomes.
Methods
Study Population
We recruit 55 radiological residents (30 junior and 25 senior residents), all from the western region .
Exclusion criteria : any resident who had any extracurricular special training.
After applying the exclusion criteria, we found 25 junior and 20 senior residents who met the criteria and were included in the study.
Methods
Data Collection
• Self-assessment and satisfaction levels of senior residents.
•Pre- and post-training self-assessment and satisfaction levels of junior residents.
•Pre- and post-training performance study of junior residents, which was performed by an expert.
•Number of calls to supervisors to perform transvaginal ultrasound due to the lack of confidence of a resident.
•Rate of repeated studies due to inappropriate technique before and after the sessions.
Methods
Statistical Analysis of Data
The ordinal data of the assessment tools were converted to a scale format, which was then studied using a parametric paired t-test for the comparison between junior residents’
performance pre- and post-sessions and an independent t- test for comparison between the perceptions of junior and senior residents.
Significance was set at the 95% confidence interval.
RESULTS
compare the self-assessment and satisfaction results of the junior and senior residents.
t P value
Cohen's d Seniors
N= 20 Juniors
N=25 Question
µ ± σ µ ± σ
3.751 .001
0.74 4.72 ± 2.951
7.4 ± 1.353 I am (I become)
familiar with TV probe manipulation
4.651 .001
0.92 4.68 ± 2.996
8 ± 1.214 I can obtain 2 views
of the uterus
3.3 .002
0.65 5.2 ± 3.175
7.7 ± 1.302 I can assess the
endometrium
6.975 .001
1.37 3.28 ± 2.301
7.25 ± 1.209 I can obtain 2 views
of the ovaries/adnexa
5.665 .001
1.1 3.36 ± 2.580
7.05 ± 1.504 I can assess the
cervix
3.027 .004
0.6 5.08 ± 3.040
7.4 ± 1.759 I can look for free
fluid
Comparison between the objective assessment of junior residents'
performance of transvaginal ultrasound before and after the simulation training session.
after simulation Juniors Cohen's d P value T
N=25 Juniors before
simulation N=25 Question
µ ± σ µ ± σ
-3.851 .001
0.6 7.75 ± 2.0488
5.5 ± 3.379 The resident
handles the TV probe correctly inside the vaginal
-3.611 .002
8.0500 ± 1.877 0.65 5.6 ± 3.761
The resident obtains 2 good views of the uterus
-4.359 .001
0.65 7.3 ± 2.904
4.3 ± 3.373 The resident
obtains 2 good views of the ovaries/adnexa
-3.177 .005
7.9 ± 2.573 0.52 5.5 ± 3.954
The resident obtains good views of the endometrium
-3.822 .001
0.74 7.7 ± 2.83
4.05 ± 4.11 The resident obtains
good views of the cervix
-2.517 .021
8.1 ± 2.77 0.45 5.85 ± 4.404
The resident looks for free fluid
RESULTS
Tables , compare the performance, self-assessment and satisfaction of the junior residents’ pre- and post-simulation sessions.
t P value
Cohen's d Juniors
after simulation N=25 Juniors
Before simulation N=25 Question
µ ± σ µ ± σ
-5.872 .001
1 3.7 ± 1.031
1.95 ± 1.190 I am satisfied with
the time needed to perform TVUS
-5.446 .001
3.75 ± .910 1 2.15 ± 1.348
I am confident to perform TVUS on real patients
-4.610 .001
3.85 ± .875 1 2.3 ± 1.418
I am a safe resident obtaining standard
views of female pelvic organs
-5.090 .001
0.9 3.7 ± .923
2.2 ± 1.563 I am satisfied about
the quality of the images that I obtain
-6.054 .001
3.95 ± 1.698 0.8 2.2 ± 1.152
I feel I can perform TVUS as a routine
study
RESULTS
The total number of calls asking supervisors to come to the hospital to perform transvaginal ultrasound decreased from 4 calls/month to 1 call/month. Also, the rate of repeated
examinations due to inappropriate technique was reduced from 8 cases/month to 1 case/month.
limitation
No objective assessment for senior resident .
Possibility of additional training .
Cost effective was not calculated .
CONCLUSION
Transvaginal ultrasound simulation sessions for the residency program improved the perceived performance and confidence levels of the residents .
Improving patient safety.
They created a solution for the ethical problem of using a training program to teach residents.
Integrating simulation sessions will be recommended for different ultrasound examinations, and the effectiveness of this method will require further studies.
