title: The effect of a simulation training package on skill acquisition for duplex arterial stenosis detection.
abstract: OBJECTIVE
  In vascular surgery, duplex ultrasonography is a valuable diagnostic tool in patients with peripheral vascular disease, and there is increasing demand for vascular surgeons to be able to perform duplex scanning. This study evaluates the role of a novel simulation training package on vascular ultrasound (US) skill acquisition.
  
  
  METHODS
  A total of 19 novices measured predefined stenosis in a simulated pulsatile vessel using both peak systolic velocity ratio (PSVR) and diameter reduction (DR) methods before and after a short period of training using a simulated training package. The training package consisted of a simulated pulsatile vessel phantom, a set of instructional videos, duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool, and a portable US scanner. Quantitative metrics (procedure time, percentage error using PSVR and DR methods, DUOSAT scores, and global rating scores) before and after training were compared.
  
  
  RESULTS
  Subjects spent a median time of 144 mins (IQR: 60-195) training using the simulation package. Subjects exhibited statistically significant improvements when comparing pretraining and posttraining DUOSAT scores (pretraining = 17 [16-19.3] vs posttraining = 30 [27.8-31.8]; p < 0.01), global rating score (pretraining = 1 [1-2] vs posttraining = 4 [3.8-4]; p < 0.01), percentage error using both the DR (pretraining = 12.6% [9-29.6] vs posttraining = 10.3% [8.9-11.1]; p = 0.03) and PSVR (pretraining = 60% [40-60] vs posttraining = 20% [6.7-20]; p < 0.01) methods.
  
  
  CONCLUSIONS
  In this study, subjects with no previous practical US experience developed the ability to both acquire and interpret arterial duplex images in a pulsatile simulated phantom following a short period of goal direct training using a simulation training package. A simulation training package may be a valuable tool for integration into a vascular training program. However, further work is needed to explore whether these newly attained skills are translated into clinical assessment.
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom. Electronic address: usman.jaffer@doctors.org.uk.
authors.forename: Usman
authors.initials: U
authors.lastname: Jaffer
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
authors.forename: Pasha
authors.initials: P
authors.lastname: Normahani
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
authors.forename: Prashant
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aslam
authors.affiliation: Department of Vascular Surgery, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Standfield
mesh_terms: D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D018794:Problem-Based Learning; D000066908:Simulation Training / Q000379:methods*; D013647:Task Performance and Analysis; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000193:education*
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; duplex; simulation; training; ultrasound; vascular