Citation Information :
Urbina J, Monks SM, Crawford SB. Simulation in Ultrasound Training for Obstetrics and Gynecology: A Literature Review. Donald School J Ultrasound Obstet Gynecol 2021; 15 (4):359-364.
Aim: The purpose of this review is to present the state of the art for simulation-based ultrasound training in obstetrics and gynecology.
Background: Ultrasound (US) is a primary tool used in obstetrics and gynecology and has become indispensable in prenatal assessment and for diagnosing various gynecological pathologies. The core skills for US, however, are highly operator dependent. The American Institute of Ultrasound in Medicine (AIUM) assembled a multisociety task force in 2017 to develop standardized recommendations for curricula and competency assessment tools for the performance of basic OB/GYN ultrasound examinations in residency programs. Due to diminishing opportunities for training during residency programs, the task force encourages the use of US simulation during residency training and expects simulation to be a significant part of the curriculum and competency assessment process.
Methods: A literature search was conducted for the key terms “ultrasound,” “OB/GYN,” “simulation,” and “phantoms,” for works published in English from 2017–2021 with clinically relevant results reviewed.
Results: Based on the reviewed literature, there are three primary approaches for US simulation. These are grouped by their method of image generation: (1) software-based learning that occurs digitally or online through web-based programs or virtual reality (VR) systems, (2) mannequin-based, where a high-fidelity mannequin is paired with actual US images from a dataset, or 3) phantom-based training devices that simulate anatomical features for the practice of diagnostic or procedural skills. Commercially available mannequin-based simulators offer numerous pathologies for the evaluation of first and second-trimester pregnancies as well as normal anatomic features, allowing the learner to perform standard obstetric measurements and calculations in different fetal positions. Alternatively, the creation of custom US simulation trainers by a simulation center is a well-established technique to meet the needs of a specific training program. This may be to provide less expensive alternatives to commercial products, meet unique simulation requirements, or produce consumable simulation components.
Conclusion: Simulation is an important component of resident training in OB/GYN due to the diminishing opportunities during clinical rotations. There are commercially available options for training in US imaging, acquisition, interpretation, and integration into diagnostics, however, the limitations for these are that they may not be customizable and can be rigid in their learning modules and objectives. Thus, self-made models can be constructed using materials that have been characterized for their US properties. Multiple phantom materials can be aggregated to construct functional task trainers that can be used for training in the acquisition of targets along various planes. Additionally, simulators allow for training of US-guided invasive procedures, which many times are low incidence/high-risk tasks.
Clinical significance: With increasing time pressures for procedural and clinical efficiency as well as requirements for improved patient safety, clinical training opportunities are no longer a stand-alone option for resident procedural experience and training requirements. The use of simulation training in external training labs, or as a component of just-in-time training, is being used to meet these needs. Learners can gain required procedural baseline skills to allow focus on patient care delivery in the healthcare environment and less on device interaction, muscle memory training, or image interpretation.
Abuhamad A, Minton KK, Benson CB, et al. Obstetric and gynecologic ultrasound curriculum and competency assessment in residency training programs: consensus report. American J Obstet Gynecol 2018;218(1):29–67. DOI: 10.1002/jum.14519
Tolsgaard MG. Assessment and learning of ultrasound skills in Obstetrics & Gynecology [dissertation]. University of Copenhagen, Faculty of Health and Medical Sciences; 2017.
Benacerraf BR, Minton KK, Benson CB, et al. Proceedings: Beyond Ultrasound First Forum on improving the quality of ultrasound imaging in obstetrics and gynecology. American J Obstet Gynecol 2018;218(1): 19–28. DOI: 10.1016/j.ajog.2017.06.033
ISUOG: update on proposed minimum standards for ultrasound training for residents in Ob/Gyn Ultrasound Obstet Gynecol 1996;8: 363–366. DOI: 10.1046/j.1469-0705.1996.08050363.x
American Board of Obstetrics and Gynecology 2021 [Accessed 14 June 2021] http://www.abog.org/downloads.asp.
Nayahangan LJ, Konge L, Møller-Skuldbøl IM, et al. A nationwide needs assessment to identify and prioritize technical procedures for simulation in obstetrics and gynaecology: a Delphi study. J Obstet Gynaecol Can 2020;42(4):409–419. DOI: 10.1016/j.jogc.2019.08.043
Accreditation Council for Graduate Medical Education (ACGME). Obstetrics and gynecology case logs: national data report. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramResources/OBGYNCaseLogInfo.pdf?ver=2021-05-03-161144-103. pdf. Accessed June 22, 2021.
American Institute of Ultrasound in Medicine. AIUM ultrasound practice accreditation. Available at: http://www.aium.org/accreditation/accreditation.aspx. Accessed June 22, 2021.
Arya S, Dwivedi A, Mulla ZD, et al. Effectiveness of ultrasound simulation in obstetrics and gynecology education: a state-of-the-Art review. Donald Sch J Ultrasound Obstet Gynecol 2017;11:115–125. DOI: 10.5005/jp-journals-10009-1512
Dromey BP, Peebles DM, Stoyanov DV. A systematic review and meta-analysis of the use of high-Fidelity simulation in obstetric ultrasound. Simul Healthc 2021;16(1):52. DOI: 10.1097/SIH.0000000000000485
Arya S, Mulla ZD, Kupesic Plavsic S. Role of pelvic ultrasound simulation. Clin Teach 2018;15(6):457–461. DOI: 10.1111/tct.12714
Taksøe-Vester C, Dyre L, Schroll J, et al. Simulation-based ultrasound training in obstetrics and gynecology: a systematic review and meta-analysis. Ultraschall Med 2020. DOI: 10.1055/a-1300-1680
Mahesh RMD, Menon A, Sherif L, et al. Evaluation of the Role of Simulation Training in Nuchal Translucency Measurement. Int J Contemp Med Surg Radiol 2019;4(2):B47-B50. DOI: 10.21276/ijcmsr.2019.4.2.11
The easiest way to learn ultrasonography® [Internet]. SonoSim. [cited 2021 Jun 01]. Available from: http://www.sonosim.com/
Simulation based Medical Education Solutions: Cae Healthcare [Internet]. CAE Healthcare - Medical Simulation Training Solutions. [cited 2021 Jun 01]. Available from: https://www.caehealthcare.com/.
Simulators [Internet]. Simbionix. 2020 [cited 2021 Jun 01]. Available from: https://simbionix.com/.
OBGYN [Internet]. Intelligent Ultrasound. 2021 [cited 2021 Jun 01]. Available from: https://www.intelligentultrasound.com/
See how blue phantom improves patient safety [Internet]. Blue Phantom Ultrasound Training Medical Models and Ultrasound Simulators. [cited 2021 Jun 01]. Available from: https://www.bluephantom.com/
Fetal Ultrasound Biometrics Phantom [Internet]. CIRS. [cited 2021 Jun 01]. Available from: https://www.cirsinc.com/product-category/ultrasound/
Collins MK, Chuang M, Deering S, et al. Basic gynecologic encounters and procedures. Comprehensive Healthcare Simulation: Obstetrics and Gynecology 2019; pp. 171–176. Springer, Cham. DOI: 10.1007/978-3-319-98995-2_16
Crawford SB, Baily LW, Monks SM. Comprehensive Healthcare Simulation: Operations, Technology, and Innovative practice 2019. Springer International Publishing. ISBN-13: 978-3030153779; ISBN-10: 3030153770
Caldwell J, Mooney JJ. Analysis of soft tissue materials for simulation development. Simul Healthc 2019;14(5):312-317. DOI: 10.1097/SIH.0000000000000382
Mooney JJ, Sarwani N, Coleman ML, et al. Evaluation of 3D printed materials for simulation by computed tomography and ultrasound imaging. Simul Healthc 2017;12(3):182–188. DOI: 10.1097/SIH.0000000000000217
Sultan SF, Shorten G, Iohom G. Simulators for training in ultrasound guided procedures. Med Ultrason 2013;15(2):125–131. DOI: 10.11152/mu.2013.2066.152.sfs1gs2
Esterer B, Hollensteiner M, Schrempf A, et al. Characterization of tissue properties in epidural needle insertion on human specimen and synthetic materials. J Mech Behav Biomed Mater 2020;110:103946. DOI: 10.1016/j.jmbbm.2020.103946
Bude RO, Adler RS. An easily made, low-cost, tissue-like ultrasound phantom material. J Clin Ultrasound 1995;23(4):271-273. DOI: 10.1002/jcu.1870230413
Althoff S, Sudhir A, Woods WA. A study of the surface characteristics of homemade ultrasound phantoms. Crit Ultrasound J 2010;2(2): 53– 57. DOI: 10.1007/s13089-010-0042-3
Gerstenmaier JF, McCarthy CJ, Brophy DP, et al. Evaluation of the particulate concentration in a gelatin-based phantom for sonographically guided lesion biopsy. J Ultrasound Med 2013;32(8): 1471–1475. DOI: 10.7863/ultra.32.8.1471
Earle M, De Portu G, DeVos E. Agar ultrasound phantoms for low-cost training without refrigeration. Afr J Emerg Med 2016;6(1):18–23. DOI: 10.1016/j.afjem.2015.09.003
Elshamy T, Jayaprakasan K. Sonographic assessment of polycystic ovaries. Gynaecological Ultrasound Scanning. 2020;87–99. DOI: 10.1017/9781108149877.007
Amini R, Kartchner JZ, Stolz LA, et al. A novel and inexpensive ballistic gel phantom for ultrasound training. World J Emerg Med 2015;6(3): 225. DOI: 10.5847/wjem.j.1920-8642.2015.03.012
Augenstein JA, Yoshida H, Lo MD, et al. A readily available, inexpensive, and reusable simulation model for teaching ultrasound-guided abscess identification and drainage. J Emerg Med 2016;50(3): 462–465. DOI: 10.1016/j.jemermed.2015.12.020
O'Reilly M, Hoffmann S, Hess L, et al.. Low-tech, high-fidelity models for a robust ultrasound curriculum. Council on Resident Education in Obstetrics and Gynecology (CREOG) and the Association of Professors of Gynecology and Obstetrics (APGO) Annual Meeting. Orlando 2017.
Rosen H, Windrim R, Lee YM, et al. Simulator based obstetric ultrasound training: a prospective, randomized single-blinded study. J Obstet Gynaecol Can 2017;39(3):166–173. DOI: 10.1016/j.jogc.2016.10.009
Tolsgaard MG. A multiple-perspective approach for the assessment and learning of ultrasound skills. Perspect Med Educ 2018;7(3): 211–213. DOI: 10.1007/s40037-018-0419-8
Le Lous M, De Chanaud N, Bourret A, et al. Improving the quality of transvaginal ultrasound scan by simulation training for general practice residents. Adv Simul 2017;2(1):1–5. DOI: 10.1186/s41077-017-0056-z
Oropeza N, Radtke S. Amniocentesis simulator. Southwest Region Simulation Educator and Operations Conference at Texas Tech University Health Sciences Center El Paso. Poster presentation 2020.
Maher JE, Kleinman GE, Lile W, et al. The construction and utility of an amniocentesis trainer. Am J Obstet Gynecol 1998;179(5):1225–1227. DOI: 10.1016/s0002-9378(98)70136-x
Nitsche JF, Shumard KM, Brost BC. Development and assessment of a novel task trainer and targeting tasks for ultrasound-guided invasive procedures. Acad Radiol 2017;24(6):700–708. DOI: 10.1016/j.acra.2016.10.008
Maul H, Scharf A, Baier P, et al. Ultrasound simulators: experience with the SonoTrainer and comparative review of other training systems. Ultrasound Obstet Gynecol 2004;24(5):581–585. DOI: 10.1002/uog.1119
Chalouhi GE, Bernardi V, Gueneuc A, et al. Evaluation of trainees’ ability to perform obstetrical ultrasound using simulation: challenges and opportunities. Am J Obstet Gynecol 2016;214(4): 525.e1–525.e8. DOI: 10.1016/j.ajog.2015.10.932