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The Stethoscope of the Future?

Why You May Want to Include Point-of-Care Ultrasound in Your Simulations

Ultrasound isn’t just used in maternal care practices. Having come a long way since its roots in military and industrial settings, today ultrasound is well-established as a crucial technology across a range of diagnostic and therapeutic applications. The uses vary from determining the size and sex of a fetus to boosting the accuracy of a needle biopsy to treating a soft-tissue injury. Further, bedside point-of-care ultrasound (POCUS) has evolved into a valuable addition to an acute care clinician’s toolbox in settings such as emergency and intensive care medicine. It’s fast, improves diagnostic accuracy and informs treatment plans by condensing the list of viable diagnostic etiologies.1

Herein, we discuss the applications of point-of-care ultrasound as well as why you might want to consider integrating it into your existing simulations.


POCUS: The Need to Know

Acting as one large piece of the diagnostic puzzle, POCUS findings typically indicate the next step in the care pathway.

POCUS can help reinforce core anatomy and physiology concepts, illustrate pathology and disease processes, and facilitate mastery of the physical examination. For these reasons, organizations ranging from the American Academy of Emergency Medicine to the American Institute for Ultrasound in Medicine, have advocated for POCUS as an important element of undergraduate medical education. 2 3

However, there are two caveats. First, POCUS is operator dependent. Confidence and competence in image acquisition and interpretation are essential, as is the ability to incorporate one’s findings into clinical decision-making.4 Developing the necessary operator competence in ultrasound often proves problematic, as it currently consists of a “see one, do one” approach that requires patients, standardized patients, commercial training models or cadavers — all at substantial cost.

Second, today’s ultrasound training typically lacks an emphasis on critical thinking and decision-making components — vital in emergency and intensive care settings.

History Repeats Itself…Even in Simulation

As point-of-care ultrasound becomes an increasingly prevalent imaging modality, medical schools and residency programs are beginning to incorporate more robust ultrasound training into the curricula. Experts can’t help but draw a parallel to the history of anesthesia educators, who turned to simulation in order to train basic skills in a realistic context.

Until the 1990s, anesthesiology residents faced challenges in achieving clinical competency while maintaining patient safety. Many of the technical and non-technical skills required for anesthesia practice — from difficult airway management and lung separation to effective teamwork — are ideally acquired by exercises and experiences rather than traditional lectures.

The emergence of high-fidelity mannequin simulators and simulation-based training effectively addressed these challenges. Anesthesiology residents trained with simulators were found to respond more quickly, perform better and deviate less from accepted procedures.5 Other researchers reported better cardiopulmonary resuscitation performance6, reduction in costs and complications related to central catheter insertion7, higher scores in cardiopulmonary bypass weaning and superior non-technical skills in simulation training groups.

Why is medical simulation training so effective? Experience has shown that simulation…

• Serves as an alternative to a live patient.
• Is experiential learning-based.
• Offers varying levels of fidelity.
• Increases engagement and maximizes retention.
• Allows for debriefing.
• Improves teamwork.

Adding Vitality to Your Ultrasound Training

Simulation training is particularly well-suited for mastering point-of-care ultrasound, which is a required core competency for emergency medicine and other specialties. It is rapid, accurate, repeatable, cost-effective, noninvasive and without the risk of radiation, and may be used in both stable and unstable patients. It may also be performed parallel to physical examination, resuscitation and stabilization, which can add significant value to medical schools and residency programs’ ultrasound training.9

A survey by the Association of American Medical Colleges found that more than 80% of medical schools had incorporated simulation-based instruction within all four years of their curriculum.10 Among nursing schools, 87% have incorporated simulation-based training with high- or medium-fidelity mannequins within the curriculum.11

Many schools have access to simulation equipment — its use simply has yet to reach full capacity when it comes to ultrasound. That means the majority of today’s chief residents and clinical directors did not experience the value of simulation firsthand in their own ultrasound training, and may not recognize the opportunity it presents to optimize the teaching of this clinical skill.

With point-of-care ultrasound fast becoming an extension of the clinical examination, simulation-based education is the vehicle of choice to meet emerging educational needs, as well as ultimately improving patient safety and outcomes.

With team training solutions such as the Laerdal SonoSim Ultrasound Solution now available, programs that currently use Laerdal simulators may find they can be expanded to include POCUS training capabilities. 

1 American Academy of Emergency Medicine. AAEM clinical practice committee statement: Ultrasound should be integrated into undergraduate medical education curriculum. J Emerg Med. 2015; 49(1):89-90. doi: 10.1016/j.jemermed.2014.12.092
2 Goldstein SR. "President's letter: "Contagious enthusiasm" for ultrasound in medical education." American Institute of Ultrasound Medicine. http://www.aium.org/soundwaves/article.aspx?aId=785&iId=20140626. Published June 26, 2014. Accessed September 1, 2017.
3 Parks, et al. Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study. Critical Ultrasound Journal 2013 5:9
4 Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R. Does training on an anaesthesia simulator lead to improvement in performance? Br J Anaesth 1994; 73: 293-7.
5 Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest 2008; 133: 56-61
6 Barsuk JH, McGaghie WC, Cohen ER, O'Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med 2009; 37: 2697-701.
7 Bruppacher HR, Alam SK, LeBlanc VR, Latter D, Naik VN, Savoldelli GL, et al. Simulation-based training improves physicians' performance in patient care in high-stakes clinical setting of cardiac surgery. Anesthesiology 2010; 112: 985-92.
8 Abu-Zidan FM, Zayat I, Sheikh M, Mousa I, Behbehani A. Role of ultrasonography in blunt abdominal trauma: A prospective study. Eur J Surg. 1996;162:361–5.[PubMed: 8781916]
9 Passiment M, Sacks H, Huang G. Medical Simulation in Medical Education: Results of an AAMC Survey. Washington, DC; 2011. https://www.aamc.org/download/259760/data/medicalsimulationinmedicaleducationanaamcsurvey.pdf. Accessed September 1, 2017.
10 Hayden J. Use of simulation in nursing education: national survey results. J Nurs Regul. 2010;1(3):52–57.
11. Lewiss, Resa & Hoffmann, Beatrice & Beaulieu, Yanick & Phelan, Mary Beth. (2014). Point-of-Care Ultrasound Education The Increasing Role of Simulation and Multimedia Resources. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine. Doi 33. 27-32. 10.7863/ultra.33.1.27.
12. Institute of Medicine (US) Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health System. Washington (DC): National Academies Press (US); 2000. 2, Errors in Health Care: A Leading Cause of Death and Injury. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225187