Summary of the clinical evaluation

Based on the experiment results, we observed that the successful completion time of each task gradually decreased with the training. This provides some level of evidence of the training efficacy of the simulator. Moreover, some of the students confirmed that the training on the simulator facilitated their learning of obstetric ultrasound during the clerkship program. Although the completion time was also influenced by the image quality of the tasks, which varies with image volumes, it does not invalidate such a conclusion. The experimental result also indicates that the scan length was approximately proportion to the completion time.

The survey completed by all 24 students shows that the simulator provided a useful level of ultrasound scan experience, that the quality of the ultrasound images was acceptable and that the simulator had the potential of becoming a valuable supplemental tool for obstetric ultrasound training. Their feedback was consistent with that obtained

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from the experienced sonographers in the preliminary experiment at UMASS Memorial Medical Center. In addition, some students reported that the level of difficulty for the six tasks varied significantly within one image volume. For example, Task 2b and 2c were much easier than the rest. Almost all 24 students agreed that the simulator might be a suitable training tool for medical students, resident doctors, nurses and technicians.

Utilizing the students’ feedback, there are a few improvements that should be implemented in a future version of the simulator to make the training more efficiently and suitable for medical students. These improvements include: 1) providing more task assessment feedback to the learner; 2) providing more training cases (image volumes) that cover more medical conditions; 3) improving the 2D image quality and completeness.

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Chapter 8

The Ultrasound E-training based on the Networked

Simulators

In the past decade, with the evolution of internet technology, distance education has become more widely used. According to a report from the National Center for Education Statistics [112], 22 % of graduates and 11 % of undergraduates enrolled in distance education programs in 2012, and the number of enrollments had been growing over the last ten years. While distance education does require a greater amount of self-discipline, an instructor still plays a significant role. In a typical case, a student can take online classes and quizzes on a flexible basis, according to his or her schedule, but the student must complete these classes and quizzes within a certain time frame. The instructor is also able to request a group learning session and can ask all or a part of students to remotely join the session at a specific time.

Distance education applied to ultrasound training can be divided into two separate categories: E-learning in didactic ultrasound and E-training (remote training) in

ultrasound scan. The didactic ultrasound is focused on basic ultrasound physics, human

anatomy, physiology, pathology, etc., and can be acquired through traditional classroom courses, through self-study or through on-line courses. The E-learning material is mainly delivered in the form of texts, audios, animations, streaming videos via internet, CDs and DVDs, eliminating the need for classrooms and making the training more affordable and flexible. In most of cases, the courses are delivered through pre-recorded videos or text- based reading materials. In contrast, the ultrasound hands-on training is focused on the

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learning of ultrasound scan skills on actual subjects by observing the instructor’s demonstration and practicing the skills under the instructor’s guidance.

The E-learning in didactic ultrasound has been reported in a few published papers [21,113,114] and all of them have reached a similar conclusion that the E-learning can efficiently deliver the didactic ultrasound training. However, current E-learning systems for didactic ultrasound cannot provide scan training, or ultrasound E-training, which requires that all participating students can learn and practice ultrasound scan under the guidance of an instructor at different locations.

As of now, only a few attempts of delivering ultrasound E-training have been reported. VSee Telemedicine [115] has developed hardware that can be integrated to a regular ultrasound machine. With this hardware, a doctor can observe ultrasound scan remotely performed by another doctor. Through a video stream, doctors in rural areas can remotely receive instructions, such as how to appropriately use the probe. However, one noticeable problem of this system for ultrasound training is that video plus voice transmission may not be feasible in regions only having limited speed networks. In addition, this system must be installed on an existing ultrasound system and not suitable for multiple learners. In another recent study, Cenydd [116] built a remote ultrasound training mentor system based on the Wii technology. Although the system is not expensive, their simulator has a few limitations, such as 1) the 2D images are generated based on CT-based images; 2) the simulator provides non-realistic ultrasound scan; 3) the system serves as only a monitor rather than a training system.

This chapter describes an inexpensive, compact ultrasound E-training system utilizing the ultrasound obstetric simulator, described in the previous chapters. The E-training system consists of a dedicated server and multiple network-connected simulators (one simulator for each user) that can be located at multiple sites. The system provides synchronous and asynchronous training modes. The synchronous (or group-learning) mode allows all training participants to observe the scan ability of a chosen learner, or a demonstration by the instructor, in real-time with a low transmission bit rate. This is achieved by directly transmitting position and orientation data from the sham transducer, rather than 2D ultrasound images, and resulting in a system performance independent of

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network bandwidth. The asynchronous mode was actually implemented with the training approach described in Chapter 6.