title: The effect of dyad versus individual simulation-based ultrasound training on skills transfer.
abstract: BACKGROUND
  Dyad practice may be as effective as individual practice during clinical skills training, improve students' confidence, and reduce costs of training. However, there is little evidence that dyad training is non-inferior to single-student practice in terms of skills transfer.
  
  
  OBJECTIVE
  This study was conducted to compare the effectiveness of simulation-based ultrasound training in pairs (dyad practice) with that of training alone (single-student practice) on skills transfer.
  
  
  METHODS
  In a non-inferiority trial, 30 ultrasound novices were randomised to dyad (n = 16) or single-student (n = 14) practice. All participants completed a 2-hour training programme on a transvaginal ultrasound simulator. Participants in the dyad group practised together and took turns as the active practitioner, whereas participants in the single group practised alone. Performance improvements were evaluated through pre-, post- and transfer tests. The transfer test involved the assessment of a transvaginal ultrasound scan by one of two clinicians using the Objective Structured Assessment of Ultrasound Skills (OSAUS).
  
  
  RESULTS
  Thirty participants completed the simulation-based training and 24 of these completed the transfer test. Dyad training was found to be non-inferior to single-student training: transfer test OSAUS scores were significantly higher than the pre-specified non-inferiority margin (delta score 7.8%, 95% confidence interval -3.8-19.6%; p = 0.04). More dyad (71.4%) than single (30.0%) trainees achieved OSAUS scores above a pre-established pass/fail level in the transfer test (p = 0.05). There were significant differences in performance scores before and after training in both groups (pre- versus post-test, p < 0.01) with large effect sizes (Cohen's d = 3.85) and no significant interactions between training type and performance (p = 0.59). The dyad group demonstrated higher training efficiency in terms of simulator score per number of attempts compared with the single-student group (p = 0.03).
  
  
  CONCLUSIONS
  Dyad practice improves the efficiency of simulation-based training and is non-inferior to individual practice in terms of skills transfer.
authors.affiliation: Department of Obstetrics, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Education, Capital Region and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Tolsgaard
authors.forename: Mette E
authors.initials: ME
authors.lastname: Madsen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ringsted
authors.forename: Birgitte S
authors.initials: BS
authors.lastname: Oxlund
authors.forename: Anna
authors.initials: A
authors.lastname: Oldenburg
authors.forename: Jette L
authors.initials: JL
authors.lastname: Sorensen
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
authors.forename: Ann
authors.initials: A
authors.lastname: Tabor
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003299:Cooperative Behavior; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006176:Gynecology / Q000193:education / Q000592:standards; D006801:Humans; D007858:Learning; D008297:Male; D017145:Models, Educational; D013337:Students, Medical; D014463:Ultrasonography / Q000379:methods