Abstract

     Ultrasound is an imaging modality that is highly operator dependent. This article reviews the challenges in learning how to perform obstetric sonography, as well as the processes necessary to acquire expert performance skills in sonography. Simulation-based education and learning, and the value of medical simulation are also discussed. Ultrasound simulators are an effective means of teaching obstetric sonography, because it provides training, deliberate practice, and performance evaluation/feedback which allows continuous and critical self-evaluation. We review evidence that simulation can improve performance in obstetric ultrasound examination, review current simulators, and discuss the current problems/gaps in ultrasound simulation. Optical positioning ultrasound simulation is a novel high-fidelity simulation learning system, which addresses many of these problems/gaps and is introduced for the first time here.

Introduction

     Ultrasound imaging is integral to the practice of obstetrics, as it allows comprehensive anatomic and physiologic evaluation of the fetus and maternal pelvic organs [1]. Therefore, ultrasound examinations are recommended for all pregnant women [2–۴]. Over the years, there has been an overall increase in the utilization of obstetric ultrasound in the U.S., with women receiving on average 4–۵ sonographic examinations per pregnancy [5]. Yet, there is substantial variability in the sensitivity of routine sonography to detect fetal anomalies [6–۸]. In a review of 36 studies that included more than 900,000 fetuses, an overall sensitivity of only approximately 40% for detecting fetal anomalies was noted [9]. Although the sensitivity of obstetric sonography depends upon gestational age at screening, type of congenital anomaly, selection of pregnant women, etc. the level of training and expertise of the sonologist is crucial to examination performance [10].

Conclusions

     Ultrasound examinations are recommended for all pregnant women. Yet, sonography is a highly operator-dependent modality that is challenging to master. Simulator training is a reliable tool to assess learners, and improves healthcare education and practice, as well as patient safety. There is broad consensus on the value of integrating simulation into ultrasound education and training programs. Ultrasound simulators are an innovative and effective means of teaching obstetric sonography, because it provides training, deliberate practice, and performance evaluation/feedback which allows continuous and critical self-evaluation. Moreover, teaching occurs in a controlled and safe environment, where skills can be practiced repetitively, and without patient anxiety and medicolegal concerns. Simulation-based training also allows trainees to practice a systematic approach to ultrasonography before the start of clinical training. Optical positioning ultrasound simulation is a high-fidelity simulation learning system which can address many of the current problems/gaps in ultrasound simulation, due to its unique characteristics.