Assessment of a Transvaginal Ultrasound Simulator as an Educational Tool in an MSc Ultrasound Programme

Abstract

The key challenge with transvaginal ultrasound (TVUS) imaging is that its performance is highly operator-dependent, the acquisition of a clear image relying completely on the practitioner’s skill and the amount of training received. The intimate nature of these scans can also cause patients to be reluctant to allow a trainee to perform their scan, lessening practitioners’ opportunities to gain crucial TVUS training within a clinical setting. As a consequence, investment in simulation-based training has increased recently, and virtual reality (VR) simulators (e.g. the ScanTrainer) are becoming more commonly used for TVUS training. However, the existing literature provides limited evidence for the effectiveness of VR simulation as a TVUS learning tool within an educational programme. Therefore, this thesis aims to evaluate VR-TVUS simulation as a learning tool for TVUS skills within the MSc Ultrasound programme. A multi-study project was designed with an overall integration approach to synthesise results from four concurrent studies. The first study was an Irish hospital survey that aimed to investigate the existence of TVUS training protocols in obstetrics and gynaecology (OBGYN) ultrasound departments across the Republic of Ireland. The second study used a pre-test/post-test approach to examine the effect of using VR-simulation on the learning of TVUS skills. The third study employed a convergent mixed-methods approach to evaluate the simulator’s practicality as a learning tool based on practitioners’ perspectives. The fourth study followed a qualitative approach that aimed to explore the difference in TVUS training between simulation and clinical settings based on practitioners’ experiences. The findings of these studies were then integrated and analysed, offering a greater understanding of the effectiveness of VR simulation in learning TVUS skills, the factors that affect this learning and the limitations of the simulator as a learning tool. The hospital survey results indicated a paucity of TVUS training protocols in Irish hospitals and a potential dependency on university programmes’ outcomes. Simulation was found to be effective for learning basic TVUS skills. However, the practitioners’ primary qualification impacted their learning of TVUS skills using the simulator, indicating that different healthcare disciplines may need varied amounts of simulation training. Additionally, the practitioner’s age affected their interest in vii simulation training − the simulator being found to be more appreciated by younger practitioners. The simulator demonstrated several limitations, including a lack of informative feedback, an over-sensitive transvaginal (TV) probe that reduced the realism of the scan and the poor ergonomic setting of the equipment which rendered the scanning process painful for the practitioner. The various outcomes of this thesis can be employed as the basis for guidance for any healthcare educators planning to provide TVUS training based using VR simulation. Offering simulation training with a repetitive practice to novice practitioners can ensure that participants effectively learn basic skills in TVUS. However, reaching Masters performance level on the simulator could require extra simulation training for practitioners, depending on their primary specialty. Further investigation is needed to determine the optimal amount of simulation training required for each healthcare specialty before proceeding to clinical practice. Healthcare educators must also consider ensuring a safe ergonomic setting for the equipment as well as offering informative feedback during simulation training. Furthermore, addressing the simulator’s limitations by encouraging the manufacturer to address further technical developments is necessary to enhance the simulator’s realism.