title: Hybrid simulation combining a high fidelity scenario with a pelvic ultrasound task trainer enhances the training and evaluation of endovaginal ultrasound skills.
abstract: OBJECTIVE
  In this study, an endovaginal ultrasound (US) task trainer was combined with a high-fidelity US mannequin to create a hybrid simulation model. In a scenario depicting a patient with ectopic pregnancy and hemorrhagic shock, this model was compared with a standard high-fidelity simulation during training sessions with emergency medicine (EM) residents. The authors hypothesized that use of the hybrid model would increase both the residents' self-reported educational experience and the faculty's self-reported ability to evaluate the residents' skills.
  
  
  METHODS
  A total of 45 EM residents at two institutions were randomized into two groups. Each group was assigned to one of two formats involving an ectopic pregnancy scenario. One format incorporated the new hybrid model, in which residents had to manipulate an endovaginal US probe in a task trainer; the other used the standard high-fidelity simulation mannequin together with static photo images. After finishing the scenario, residents self-rated their overall learning experience and how well the scenario evaluated their ability to interpret endovaginal US images. Faculty members reviewed video recordings of the other institution's residents and rated their own ability to evaluate residents' skills in interpreting endovaginal US images and diagnosing and managing the case scenario. Visual analog scales (VAS) were used for the self-ratings.
  
  
  RESULTS
  Compared to the residents assigned to the standard simulation scenario, residents assigned to the hybrid model reported an increase in their overall educational experience (Delta VAS = 10, 95% confidence interval [CI] = 4 to 18) and felt the hybrid model was a better measure of their ability to interpret endovaginal US images (Delta VAS = 17, 95% CI = 7 to 28). Faculty members found the hybrid model to be better than the standard simulation for evaluating residents' skills in interpreting endovaginal US images (Delta VAS = 13, 95% CI = 6 to 20) and diagnosing and managing the case (Delta VAS = 10, 95% CI = 2 to 18). Time to reach a diagnosis was similar in both groups (p = 0.053).
  
  
  CONCLUSIONS
  Use of a hybrid simulation model combining a high-fidelity simulation with an endovaginal US task trainer improved residents' educational experience and improved faculty's ability to evaluate residents' endovaginal US and clinical skills. This novel hybrid tool should be considered for future education and evaluation of EM residents.
authors.affiliation: Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA. dgirzadasjr@comcast.net
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Girzadas
authors.forename: Michael S
authors.initials: MS
authors.lastname: Antonis
authors.forename: Herb
authors.initials: H
authors.lastname: Zerth
authors.forename: Michael
authors.initials: M
authors.lastname: Lambert
authors.forename: Lamont
authors.initials: L
authors.lastname: Clay
authors.forename: Sudip
authors.initials: S
authors.lastname: Bose
authors.forename: Robert
authors.initials: R
authors.lastname: Harwood
mesh_terms: D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008348:Manikins; D009774:Obstetrics / Q000193:education; D016544:Patient Simulation; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D013663:Teaching / Q000379:methods; D013997:Time Factors; D014463:Ultrasonography