Excerpts from material by Beth Anderhub, M.Ed., RT, CNMRT, RDMS, Associate Professor/Program Director of the Diagnostic Medical Sonography Program at St. Louis Community College
The primary advantage of a simulator in the medical profession is on the development of basic skills in a less stressful, controlled environment where the student/resident does not have to be concerned about dealing with real patients and the stress of performing examinations in defined time periods. Mistakes can be corrected without the negative consequences associated with real examinations.
There are limitations related to simulation that the instructor must always recognize. First, simulation does not completely replace clinical experience. The use of the simulator can enhance student learning and his or her rate of gaining clinical competency. The primary goals are to develop and evaluate student scan plane orientation, normal and abnormal pattern recognition, problem solving skills and the ability to perform a complete examination protocol. The clinical portion of the student’s education must reinforce simulator time, and the educator should document skill transfer to the actual clinical examination.
A second limitation of the simulator relates to how closely the simulator mimics the real situation. The UltraSim® emulates standard sonographic equipment. However, there is a finite amount of data in each case. The scanning windows and angles are limited in comparison to a real, clinical examination. The instructor and student may find themselves striving for an even better image, but that “perfect” image is beyond the capabilities of the stored data.
One must also remember that the data is derived from real patients, and therefore, not all of the anatomy will visualize as perfect “textbook” examples. Although this fact may be considered a limitation of the UltraSim®, in a sense this replicates the actual clinical situation, and the students quickly realize how few of their patients resemble the optimal anatomy that they have been taught to look for.
The basic foundations of competency-based education hold true for the use of a simulator. The specific educational theory utilized for the development of the UltraSim® is Robert Gagne’s educational hierarchy. Students must master the required background knowledge before they can be expected to demonstrate related skills on the simulator. Progression of skills should proceed from the most simple to the most complex.
The student/resident can practice the skills under supervision or the student/resident can practice at their own pace with the self-guided simulator until the instructor determines that the student is ready for formal evaluation. After gaining experience with several real examinations, the student can undergo formal evaluation to verify clinical competency.
Most UltraSim® educational module consists of two case classifications – Curriculum and Practice. In each classification there are both normal and abnormal examinations. Each case is organized around a task list used to perform the examination. The task lists are based on standard scanning guidelines and internal anatomic landmarks. The Curriculum cases have complete task lists, and are accompanied by an Instructor’s Manual with lesson plans containing an introduction, learning objectives, task list, demonstration lesson, teaching tips and a didactic curriculum outline. The Practice cases may not contain a complete task lists.
For most cases, the Instructor’s Manual provides information regarding the difficulty level for the range of tasks and the normal and abnormal structures demonstrated in each case. The Instructor’s Manual also contains examples of case progression and integration in a complete educational program.
The instructor can use the Curriculum cases as demonstration lessons during laboratory session covering normal and abnormal sonographic patterns. After the demonstration lesson, the students/residents can spend the remainder of the laboratory time scanning the same case or a related practice case. Students/residents with less clinical experience will take an average of 45 minutes to one hour to complete a multiple-organ task list from one of the Curriculum cases. Initial simulator sessions concentrating on abnormal sonographic patterns may require direct instructor supervision and assistance in recognizing the abnormal patterns. Students/residents may use the reference prints in the Image Library during these practice sessions in order to assist in finding the correct scan plane and recognizing the sonographic patterns.
The instructor should ensure that the student/resident understands that more than one image is acceptable for documentation of a given task. The most important concept is that the entire organ of interest was examined for any evidence of pathology. The task lists are grouped according to organ and standard body plane, and are listed in spatial/anatomic sequence. A standard anatomic sequence encourages the development of spatial skills, as well as an orderly approach to sonographic examination.