虚拟超声模型对超声初学者测量一致性评估

Consistency of ultrasonic measurements by trainee doctors using an ultrasound simulator

目的探讨采用虚拟超声模型对超声初学者进行超声测量一致性评估的效果。方法选取2017年4月在北京协和医院超声医学科参加住院医师规范化培训的第一年住院医师17人,在培训6个月后,采用虚拟超声模型对甲状腺结节上下径、左右径、前后径,乳腺结节长径、短径,最大羊水深度,胎盘厚度等13个参数进行盲法测量,每个参数测2遍,与超声专家的测值进行比较。采用Bland-Altman图进行定量资料的一致性评价,采用单样本t检验及配对t检验比较超声初学者与专家的测量结果有无差异。同时填写教学情况调查问卷,采用Likert式5项评分,对虚拟超声模型教学进行评价。结果超声初学者的测量和专家的差异在-2.175~0.540 cm之间,差异有统计学意义(t=-4.532,P<0.001)。对于羊水深度、胎盘厚度、肾脏长径等参数初学者与专家的测值,差异均有统计学意义(t=-3.395、2.418、-4.043,P均<0.05);而甲状腺右叶结节上下径、横径、前后径及乳腺实性结节长径、短径等参数的测值比较,差异均无统计学意义(P均>0.05)。编号11、14初学者的测值与专家测值差异有统计学意义(t=-2.212、2.320,P均<0.05)。检查结束后70.6%初学者(12/17)同意或强烈同意虚拟超声培训能改善扫查技巧的学习,94.2%(16/17)同意或强烈同意使用虚拟模型进行练习会更放松,94.2%(16/17)期待或强烈期待进行虚拟超声检查相关培训。结论采用虚拟超声模型可对超声初学者测量的一致性进行评价并指导培训,可作为一种有效的超声医学质量控制手段。

Objective To investigate the consistency of ultrasonic measurements by ultrasound beginners using an ultrasound simulator.Methods In April 2017,17 first-year residents at the Department of Ultrasound in Peking Union Medical College Hospital who had undergone standardized resident training for six months were included.Thirteen parameters,including the long diameter,transverse diameter,and anteroposterior diameter of thyroid nodules,the long diameter and short diameter of breast nodules,the maximum amniotic fluid depth,and placental thickness,were measured blindly using a virtual ultrasound model.Each parameter was measured twice and compared with those measured by ultrasound experts.Single sample t-test and paired t-test were used to compare the results of beginners with those of experts.A teaching questionnaire was completed,and five Likert scores were used to evaluate the use of virtual ultrasound model in ultrasound training.Results The difference between the measurements by ultrasound beginners and those by experts was-2.175-0.54 cm,with statistical significance(t=4.532,P<0.001).For amniotic fluid depth,placental thickness,and kidney length,the measurement differences were statistically significant between beginners and experts(t=-3.395,2.418,-4.043,all P<0.05).But for the long diameter,transverse diameter,and anteroposterior diameter of thyroid nodules in the right lobe and the long diameter and short diameter of breast solid nodules,there was no significant difference(P>0.05).There was a significant difference between the measurements by No.11 and No.14 beginners and those by experts(t=-2.212,2.320,all P<0.05).After the examination,70.6%of the beginners(12/17)agreed or strongly agreed that virtual ultrasound training could improve the learning of scanning skills,94.2%(16/17)agreed or strongly agreed that virtual model training would be more relaxing,and 94.2%(16/17)looked forward to or strongly looked forward to virtual ultrasound training.Conclusion The ultrasound simulator can be used to evaluate the consistency of measurements between ultrasonic beginners and experts.It can be used as an effective means of quality control in ultrasound medicine and guide further training.