Developing an Ultrasonography Simulator Training Tool

Introduction

Old Dominion University’s Virginia Modeling, Analysis, and Simulation Center (VMASC) research faculty, with direction from physicians at medical teaching hospitals, are developing an ultrasonography simulator training tool bottom-up: from integrating the hardware and software components to crafting the editing capability for uploading teaching modules and testing assessments.¹ This research and development is significant as there is a solid endorsement for using modeling and simulation (M&S) for medical education and training—the sheer need for a larger body of health-care professionals who are educated in an effective manner leads that discussion.² Specifically, medical teaching faculty expert in the use of ultrasonography have called upon the developer community (VMASC) to develop a tool that meets their needs for training and assessment in ultrasonography in a form they prefer. The following discussion details the developer’s experience in designing the tool vis-à-vis these unique requirements. As such, this discussion does not compare and/or contrast other techniques and methodologies in medical simulation tool development, nor does it relate how this effort stands up to that process. Rather, it straightforwardly presents the development and design approach taken by this team. Ultrasonography (US) is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures to include tendons, muscles, joints, vessels and internal organs for possible pathology or lesions.³ As such, portable ultrasound devices are utilized across all sub-fields of medicine. Experts in the use of and education in US recognize this point-of-care medicine is defining the future of patient-physician interaction with pathologies assessed upon examination. US is user-dependent; thus ensuring clinician capability and appropriate usage with US devices is necessary. To fully exploit the technology, medical practitioners must have sufficient pathology-specific training to facilitate cognitive and mechanical proficiency. According to experts in this field, the curriculum and training for US is lacking because it does not accommodate the dual nature of US expertise – cognitive and mechanical skills-sets (Levitov, 2009).⁴ Medical students today do not always recognize pathology when they see it, and/or they understand pathology with cognitive skills, but not with the ultrasound image they have captured. There are also cases whereby students are lacking the dexterity and mechanical skills needed for the capture of images. Most curriculums require cognitive examinations wherein the image is provided and the student must simply associate the name of the pathology with the supplied image. Technically, students are given instruction and hands-on training for image capture, but they do not always recognize the pathology they have retrieve via the captured ultrasound image due to the fact that he does not have the cognitive skill to do so or because the image is not well-retrieved or a combination of both these handicaps (Levitov, 2009). In the United States the standard of 20-30 most common pathologies must be obtained and recognized by the student. A gold standard of 150 procedures / images exists, but even then the student may be incompetent (Levitov, 2011). Moreover, current assessments are one-sided examinations of cognitive skills (e.g., students view a pre-supplied image and associate the pathology with the image).