Ultraschall Med 2003; 24(4): 239-244
DOI: 10.1055/s-2003-41713
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Simulation of Abdomen Sonography. Evaluation of a New Ultrasound Simulator

Simulation der Sonographie des Abdomens. Evaluierung eines neuen Ultraschall SimulatorsC.  Terkamp1 , G.  Kirchner1 , J.  Wedemeyer1 , A.  Dettmer1 , J.  Kielstein1 , H.  Reindell2 , J.  Bleck1 , M.  Manns1 , M.  Gebel1
  • 1Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal Medicine, Hannover Medical School, Hannover
  • 2Sonofit GmbH, Stadecken-Elsheim
Further Information

Publication History

eingereicht: 8. Mai 2003

angenommen: 14. Juli 2003

Publication Date:
26 August 2003 (online)

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.

References

  • 1 Meuwly J W, Felley C, Vuilleumier H, Schnyder P, Hewig U. Ultrasound examination of non-traumatic acute abdomen.  Ultraschall in Med. 2002;  23 13 - 21
  • 2 Carrico C W, Fenton L Z, Taylor G A, DiFiore J W, Soprano J V. Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults.  Am J Roentgenol. 1999;  172 513-516
  • 3 Dhillon S, Halligan S, Goh V, Matravers P, Chambers A, Remedios D. The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms.  Clin Radiol. 2002;  57 268-271
  • 4 Uebel P, Weiss H, Trimborn C P, Fiedler L, Bersch W. Ultrasound diagnosis of acute appendicitis - possibilities and limits of the method - results of prospective and retrospective clinical studies.  Ultraschall Med. 1996;  17 100-105
  • 5 Pohl D, Golub R, Schwartz G E, Stein H D. Appendiceal ultrasonography performed by nonradiologists: Does it help in the diagnostic process?.  Ultrasound Med. 1998;  17 217-221
  • 6 Kratzer W, Pfeiffer M, Adler G. Medical education and continuing education of physicians in abdominal sonography at German universities. State of the art.  Internist. 2000;  41 37-40
  • 7 Gracias V H, Frankel H, Gupta R, Malecynski J, Gandhi R, Collazzo L, Nisenbaum H, Schwab C W. Defining the learning curve for the focused abdominal sonogram for trauma (FAST) examination: Implications for credentialing.  Am Surg. 2001;  67 364-368
  • 8 Hertzberg B S, Kliewer M A, Bowie J D, Carroll B A, DeLong D H, Gray L, Nelson R C. Physician training requirements in sonography: How many cases are needed for competency?.  Am J Roentgenol. 2000;  174 1221-1227
  • 9 Gracias V H, Frankel H, Gupta R, Reilly P M, Gracias F, Klein W, Nisenbaum H, Schwab C W. The role of positive examinations in training for the focused assessment sonogram in trauma (FAST) examination.  Am Surg. 2002;  68 1008-1011
  • 10 Jäger K. Levels of training in diagnostic ultrasound.  Ultraschall in Med. 2002;  23 299-300
  • 11 Counselman F L, Sander A, Slovis C M, Danzl D, Binder L S, Perina D G. The status of bedside ultrasonography training in emergency medicine programs.  Acad Emerg Med. 2003;  10 37-42
  • 12 Kasales C J, Coulson C C, Mauger D, Chertoff J D, Matthews A. Training in obstetric sonography for radiology residents and fellows in the United States.  Am J Roentgenol. 2001;  177 763-767
  • 13 Hofer M, Mey N, Metten J, Hartwig H G, Mödder U. Quality control of sonography courses in advanced training of physicians: Analysis of present status and potential for improvement.  Ultraschall in Med. 2002;  23 189-197
  • 14 WHO Study Group .Training in diagnostic ultrasound: Essentials, principles and standards. Report of WHO Study Group. WHO technical report series. 1998: 875
  • 15 Irving H. Training and accreditation: A report from the EFSUMB education and professional standards committee.  EFSUMB Newsletter. 2000;  14 20
  • 16 Baier P, Scharf A, Sohn C. New ultrasound simulation system: A method for training and improved quality management in ultrasound examination.  Z Geburtshilfe Neonatol. 2001;  205 213-217
  • 17 Ziv A, Small S D, Wolpe P R. Patient safety and simulation-based medical education.  Medical Teacher. 2000;  22 489-495
  • 18 Hardman J G, Bedforth N M, Ahmed A B, Mahajan R P, Aitkenhead A R. A physiology simulator: Validation of its respiratory components and its ability to predict the patient's response to changes in mechanical ventilation.  Br J Anaesth. 1998;  81 327-332
  • 19 Gardi T, Christensen U C, Jacobsen J, Jensen P F, Ording H. How do anaesthesiologists treat malignant hyperthermia in a full-scale anaesthesia simulator?.  Acta Anaesthesiol Scand. 2001;  45 1032-1035
  • 20 Cotin S, Dawson S L, Meglan D, Shaffer D W, Ferrell M A, Bardsley R S, Morgan F M, Nagano T, Nikom J, Sherman P, Walterman M T, Wendlandt J. ICTS, an interventional cardiology training system.  Stud Health Technol Inform. 2000;  70 59-65
  • 21 Ferlitsch A, Glauninger P, Gupper A, Schillinger M, Haefner M, Gangl A, Schoefl R. Evaluation of a virtual endoscopy simulator for training in gastrointestinal endoscopy.  Endoscopy. 2002;  34 698-702
  • 22 Neumann M, Mayer G, Ell C, Felzmann T, Reingruber B, Horbach T, Hohenberger W. The Erlangen Endo-Trainer: Life-like simulation for diagnostic and interventional endoscopic retrograde cholangiography.  Endoscopy. 2000;  32 906-910
  • 23 Leedom D K, Simon R. Improving team coordination: A case for behaviour based training.  Military Psychology. 1995;  7 109-122
  • 24 Salen P, O'Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M. Fast education: a comparison of teaching models for trauma sonography.  J Emerg Med. 2001;  20 421-425
  • 25 Knudson M M, Sisley A C. Training residents using simulation technology: Experience with ultrasound for trauma.  J Trauma. 2000;  48 659-665
  • 26 Monsky W L, Levine D, Mehta T S, Kane R A, Ziv A, Kennedy B, Nisenbaum H. Using a sonographic simulator to assess residents before overnight call.  Am J Roentgenol. 2002;  178 35-39

Dr. med. C. Terkamp

Division of Gastroenterology, Hepatology and Endocrinology · Department of Internal Medicine

Hannover Medical School · Carl-Neuberg-Straße 1 · 30623 Hannover ·

Phone: +49-511-532 3415

Fax: +49-511-532 4896

Email: terkamp.christoph@mh-hannover.de