Ultrasound simulators in obstetrics and gynecology: state of the art

Simulation-Based Training in Obstetric Sonography Education: An Applied Research Study

OBJECTIVE

To evaluate and compare the effectiveness of traditional teaching methods versus simulation-based learning in clinical ultrasound internships in obstetrics and gynecology.

DESIGN

A randomized controlled study was conducted to compare three teaching methods: simulation-based teaching, traditional + simulation-based teaching, and traditional teaching.

SETTING

The study was conducted at Longgang District Maternity & Child Healthcare Hospital of Shenzhen City (Affiliated Shenzhen Women and Children's Hospital (Longgang) of Shantou University Medical College) from January 2023 to December 2024.

POPULATION OR SAMPLE

A total of 120 clinical interns were selected and randomly divided into 3 groups (40 in each): Experimental Group 1 Simulation Teaching Group; Experimental Group 2 Traditional + Simulation Teaching Group; Control Group Traditional Teaching Group.

METHODS

All groups received theoretical and practical ultrasound training, followed by assessment. Teaching performance was evaluated based on teaching time, daily practice opportunities, content mastery, stress levels, error rates in clinical assessments, and long-term knowledge retention.

MAIN OUTCOME MEASURES

Teaching time, number of daily practice opportunities, stress levels, content mastery, error rates during practical exams, and long-term knowledge retention.

RESULTS

Simulation-based teaching significantly improved teaching efficiency, reduced anxiety, and lowered error rates during clinical operations. Long-term knowledge retention was highest in the traditional + simulation group, and combining both teaching methods enhanced skills and knowledge retention.

CONCLUSIONS

Simulation-based teaching, especially when combined with traditional methods, enhances ultrasound training by improving operational skills, reducing stress, and increasing long-term knowledge retention.

Capacity building in obstetric ultrasound: Impact of simulation based clinical teaching on resident training at a health facility in India

OBJECTIVE

Current postgraduate curriculum in India lacks practical training in ultrasound for residents in obstetrics and gynecology. The objective of this study was to develop and assess impact of a capacity building program utilizing clinical teaching and simulation to enhance knowledge and skills of residents at a healthcare facility in India.

METHODS

A training program comprising of 14 modules on basic obstetric ultrasounds was created over 3 months. These modules, validated by fetal medicine experts, underwent a pilot study for face validity. A total of 18 newly enrolled junior residents without prior ultrasound experience were recruited. A two-day workshop included interactive module sessions and 6 h and 30 min of hands-on training using an obstetric simulator. Pre- and post-tests consisting of 50 multiple-choice questions (MCQs) assessed knowledge. Follow-up assessments were carried out at 1 and 3 months. Skill assessment at the third month was conducted using an objective structured practical examination (OSPE), alongside image submission by residents.

RESULTS

There was significant improvement in marks over time, with a mean pretest score of 24 ± 2.7 out of 50 marks, post-test score of 36.81 ± 2.86 and stable scores (34.6 ± 3.21, 34.4 ± 2.96) during follow-up reviews. OSPE scores at third month averaged at 21.47 ± 2.3 (maximum marks 30); image assessment scores averaged at 83 ± 8.62 (maximum marks 100). Participant feedback indicated a positive response to all program aspects (practicality, content and structured training). Confidence levels in performing clinical ultrasound improved significantly after attending the module (P < 0.0001).

CONCLUSION

Simulation with clinical teaching effectively enhanced knowledge and skills of residents, fostering confidence in performing basic obstetric ultrasounds early on in their residency. Integrating similar capacity building initiatives into residency training programs can improve healthcare delivery by ensuring a well prepared cadre of doctors skilled in obstetric ultrasounds.

Comparative evaluation of two simulation technologies for obstetric ultrasound trainees' assessment

OBJECTIVE

The objective was to evaluate the performance of two different obstetric ultrasound simulators in assessing the practical skills of trainees compared to the standard method of practical assessment conducted on pregnant women volunteers.

METHODS

We performed a prospective observational study. Two simulators were compared: the Simbionix simulator which uses a mannequin and heteroevaluation and the OPUS simulator which uses optical positioning technology with automatic assessment. All trainees who underwent the practical exam of the French national diploma in Ultrasound in Obstetrics and Gynecology in our center were recruited and assessed both on a volunteer pregnant woman and on simulator. We compared the results obtained by the trainees on the simulator with those obtained on pregnant women through correlation analysis of the scores and success rates.

RESULTS

Overall, 207 trainees took the practical exam and were also evaluated on the simulator: 103 on the Simbionix and 104 on the OPUS. The success rates were the following: 84.1 % (174/207) for the practical exam on pregnant woman, 81.2 % (168/207) across both simulators, 79.6 % (82/103) on Simbionix and 82.7 % (86/104) on the OPUS. There was a good correlation between the success rate of the examination using a Simbionix simulator and with pregnant women (ρ = 0.69; p < 0.001), but no correlation was observed between the OPUS simulator and pregnant women (ρ = 0.11; p = 0.23).

CONCLUSION

These data indicate that the Simbionix simulator outperforms the OPUS in assessing trainees. It could serve as a tool for screening trainees during practical assessments.

Current status of ultrasound training in obstetrics and gynecology: a scoping literature review

Introduction

As a widely accessible, cost-effective, and safe imaging tool, obstetric and gynecologic (OB/GYN) ultrasound (ULS) plays a vital role in diagnostics and patient care. With its growing relevance, the demand for comprehensive education in this field increases. The objective of this work was to outline the current state of OB/GYN ULS education.

Methods

A scoping literature search was performed until May 2023 using the medical database PubMed according to PRISMA guidelines. Using specific keywords, relevant publications were filtered. Subsequently, abstracts were independently reviewed by two authors and the inclusion of each publication was assessed against pre-defined key search terms. Full-text versions of the included publications were scrutinized and pertinent information was extracted.

Results

In this review, 126 articles from the literature search matched the inclusion criteria and were investigated. Our findings revealed a diverse range of course concepts and programs, a lot of them not meeting the expectations of trainees and international guidelines. OB/GYN ULS training primarily targets residents, yet opportunities for early exposure and continuing education are underexplored. International organizations, such as the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and the German Society for Ultrasound in Medicine (DEGUM) have proposed guidelines and curricula for standardized training. However, adoption remains varied. There is an emergent need to innovate teaching methods.

Conclusion

There is consensus that standardizing OB/GYN ULS curricula could enhance training quality and streamline the creation of new programs, ultimately improving patient care. Further research is needed to define the most effective strategies for curriculum development and implementation.

Validity evidence for simulator-based obstetric ultrasound competency assessment tool: a multi-center study

PURPOSE

To collect validity evidence for a simulator-based obstetric ultrasound competency assessment tool (OUCAT).

METHODS

89 sonographers from three centers (XY, MC, DT), including novices (n=21), experienced trainees (n=44), and experts (n=24), participated in the competency assessment. Validity evidence of OUCAT was collected according to Standards for Educational and Psychological Testing. Content validity was ensured by reviewing guidelines and reaching expert consensus. The response process was ensured via training raters. Internal structure was explored through internal consistency, inter-rater reliability, and test-retest reliability. Relations to other variables were explored by comparing OUCAT scores of sonographers with different experience. Evidence for consequences was collected by determining the pass/fail level.

RESULTS

OUCAT included 123 items, of which 117 items could effectively distinguish novices from experts (P<0.05). The internal consistency was represented by the Cronbach's α coefficient (0.978). The inter-rater reliability was high, with XY being 0.868, MC being 0.877, and DT being 0.937 (P<0.001). Test-retest reliability was 0.732 (P=0.001). The performance of experts was significantly better than experienced trainees, and the performance of experienced trainees was significantly better than novices (70.3±10.7 vs. 39.8±15.0 vs. 20.5±10.6, P<0.001). The pass/fail level determined by contrast group method was 45 points. The passing rate of novices, experienced trainees and experts was 0% (0/21), 31.8% (14/44), and 100% (24/24), respectively.

CONCLUSION

Simulator-based OUCAT exhibits good reliability and validity in assessing obstetric ultrasound skills.

Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study

BACKGROUND

There is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically.

METHODS

This prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees' knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees' clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees.

RESULTS

Pre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence.

CONCLUSION

This study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Evaluation of antenatal Point-of-Care Ultrasound (PoCUS) training: a systematic review

INTRODUCTION

There is limited access to life-saving antenatal ultrasound in rural and low-resource settings largely due to shortages in skilled staff. Studies have shown healthcare practitioners can be upskilled in PoCUS through focused training, offering a viable solution to this deficit. However, standards for training and competency assessment are unclear and regulation surrounding practice is lacking. We aimed to review published literature examining antenatal PoCUS training programs, comparing teaching approaches and study methodologies.

METHODS

A search of electronic databases EMBASE, MEDLINE and Google Scholar was conducted. Original research articles evaluating antenatal PoCUS training of healthcare professionals worldwide were identified for analysis. Articles with limited detail on the PoCUS training intervention and those describing comprehensive diagnostic training programs were excluded. Evaluations were compared against the Kirkpatrick Evaluation Framework (KEF).

RESULTS

Twenty-seven studies were included from an initial search result of 484 articles. There was considerable heterogeneity between the PoCUS training programs described. Course duration ranged from 3 hours to 2 years, with 11 of the 27 studies delivering obstetric-exclusive content. 44% trained multidisciplinary groups of health professionals. Long-term follow-up training and skills assessments were lacking in over half of the reviewed studies. Study quality and reporting detail varied, but overall beneficial outcomes were reported with 3/4s of the studies reaching upper KEF levels 3 and 4.

CONCLUSION

PoCUS performed by upskilled healthcare professionals offers an attractive solution to the problem of inequitable access to antenatal ultrasound. A review of available literature highlighted a paucity of comparable high-quality studies needed to establish a stronger evidence base for antenatal PoCUS, and a need to standardise training and competency assessment. This review may inform educators, researchers and policy-makers on existing training formats and methodologies to assist in establishing best practice antenatal PoCUS training methods for safe service delivery by remote healthcare professionals.

Optical ultrasound simulation-based training in obstetric sonography

Ultrasound is an imaging modality that is highly operator dependent. This article reviews the challenges in learning how to perform obstetric sonography, as well as the processes necessary to acquire expert performance skills in sonography. Simulation-based education and learning, and the value of medical simulation are also discussed. Ultrasound simulators are an effective means of teaching obstetric sonography, because it provides training, deliberate practice, and performance evaluation/feedback which allows continuous and critical self-evaluation. We review evidence that simulation can improve performance in obstetric ultrasound examination, review current simulators, and discuss the current problems/gaps in ultrasound simulation. Optical positioning ultrasound simulation is a novel high-fidelity simulation learning system, which addresses many of these problems/gaps and is introduced for the first time here.

Competency-Based Assessment Methods in Adult Cardiac Sonography: Students’ Perceptions and Clinical Evaluation

Objective:

This research examined the effects of multiple combined competency-based methods on sonography students’ perceptions of adult echocardiography training components. In addition, clinical preceptor evaluation scores were compared with faculty objective structured clinical examination (OSCE) scores.

Materials and Methods:

A quasi-experimental nonequivalent group research design was used to evaluate students enrolled in an adult cardiac Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited curriculum. Students’ perceptions pre and post multiple competency-based methods (formative assessment, OSCE, & simulation) intervention were recorded via course evaluations. Questions were analyzed individually using descriptive statistics and the Bonferroni correction. Students’ clinical evaluation and OSCE scores were analyzed using Spearman’s rank correlation.

Results:

The majority of students’ perceptions pre- and postintervention of multiple competency-based assessments demonstrated significant differences, or they primarily agreed that their echocardiography knowledge or skill set was enhanced. There was weak correlation between students’ clinical competency evaluation scores and OSCE scores—post implementation of multiple competency-based assessments, rs(37) = −.01, P = .93.

Conclusion:

These results suggest further evaluation of the credentialing process’s clinical assessment to ensure clinical competency.

Fetal biometry in ultrasound: A new approach to assess the long-term impact of simulation on learning patterns

CONTEXT

Simulation-based education (SBE) has demonstrated its acceptability and effectiveness in improving ultrasound training. Because of the high cost of its implementation (investment in equipment and supervision), a pragmatic assessment of the transfer of skills learned in SBE to clinical practice and the identification of its optimal scheduling conditions have been requested to optimize its input.

OBJECTIVES

To quantify the long-term impact of simulation-based education (SBE) on the adequate performance of ultrasound fetal biometry measurements (I). The secondary objective was to identify the temporal patterns that enhanced SBE input in learning (II).

METHODS

Trainees were arbitrarily assigned to a 6-month course in obstetric ultrasound with or without an SBE workshop. In the SBE group, the workshop was implemented 'before' or at an 'early' or a 'late-stage' of the course. Those who did not receive SBE were the control group. The ultrasound skills of all trainees were prospectively collected, evaluated by calculating the delta between OSAUS (Objective Structured Assessment of Ultrasound Skills) scores before and after the course (I). Concomitantly, the accuracy of trainees' measurements was assessed throughout the course by verifying their correlation with the corresponding measurements by their supervisors. The percentage of trainees able to perform five consecutive sets of correct measurements in the control group and in each SBE subgroup were compared (II).

RESULTS

The study included 61 trainees (39 SBE and 22 controls). Comparisons between groups showed no significant difference in the quantitative assessment of skill enhancement (difference in the pre- and post-internship OSAUS score: 1.09 ± 0.87 in the SBE group and 0.72 ± 0.98 in the control group) (I). Conversely, the predefined acceptable skill level was reached by a significantly higher proportion of trainees in the 'early' SBE subgroup (74%, compared with 30% in the control group, P<0.01)(II).

CONCLUSIONS

The quantitative assessment does not support the existence of long-term benefits from SBE training, although the qualitative assessment confirmed SBE helped to raise the minimal level within a group when embedded in an 'early' stage of a practical course.

Usefulness of an Intrapartum Ultrasound Simulator (IUSim™) for Midwife Training: Results from an RCT

INTRODUCTION

We conducted a randomized study to determine whether a training session on a dedicated simulator (IUSim™) would facilitate the midwives in learning the technique of transperineal intrapartum ultrasound.

METHODS

Following a 30-min multimedia presentation including images and videos on how to obtain and measure the angle of progression (AoP) and the head-perineum distance (HPD), 6 midwives with no prior experience in intrapartum ultrasound were randomly split into 2 groups: 3 of them were assigned to the "training group" and 3 to the "control group." The midwives belonging to the former group were taught to measure the 2 sonographic parameters during a 3-h practical session conducted on IUSim™ under the supervision of an expert obstetrician. In the following 3 months, all the 6 midwives were asked to independently perform transperineal ultrasound during their clinical practice and to measure on the acquired images either the AoP or the HPD. The sonographic images were examined in blind by the teaching obstetrician who assigned a 0-3 score to the image quality (IQS) and to the measurement quality (MQS).

RESULTS

A total of 48 ultrasound images (24 patients) from 5 midwives were acquired and included in the study analysis. A midwife of the "training group" declined participation after the practical session. Independently from the randomization group, the image quality score (IQS + MQS) was significantly higher for the HPD compared with the AoP (2.5 ± 0.66 vs. 1.79 ± 1.14; p = 0.01). In the training group, the MQS of either AoP (2.66 ± 0.5 vs.1.46 ± 1.45. p = 0.038) and the HPD (2.9 ± 0.33 vs. 1.87 ± 0.83 p = 0.002) was significantly higher in comparison with the control group, while the IQS of both measurements was comparable between the 2 groups (1.91 ± 1.24 vs. 2.25 ± 0.865; p = 0.28).

CONCLUSION

The use of a dedicated simulator may facilitate the midwives in learning how to measure the AoP and the HPD on transperineal ultrasound images.

Simulation-based clinical learning for the third year medical student: Effectiveness of transabdominal and transvaginal ultrasound for elucidation of OB/GYN scenarios

PURPOSE

Point-of-care ultrasound (POCUS) is gaining recognition as a teaching modality that acts as an integrative learning tool during medical student transition to clinical rotations. This study aimed to determine if the use of ultrasound simulation enhances understanding of Obstetrical and Gynecological (Ob/Gyn) anatomy and pathology in third-year medical students (M3), and if M3 students found the simulator useful.

METHODS

M3 students taking the OB/Gyn clerkship were invited to participate. Baseline knowledge of pelvic ultrasound anatomy and pathology was assessed with a multiple-choice question test. Participants received a one-hour OB/Gyn ultrasound simulation training session. A post-test assessed knowledge after the intervention. Survey data was collected regarding learning styles and learner satisfaction.

RESULTS

Following simulator-based training, the median correct number of responses to the knowledge questions increased from 11 of 18 to 14 of 18 correct (P < .001). Statistically significant increases were also observed in comfort level with OB/GYN ultrasound (P < .001). All 68 students answered that the ultrasound simulator was helpful and enjoyed using the simulator.

CONCLUSIONS

This study suggests that ultrasound simulators are useful for improvement in knowledge, comfort level, and ability to identify pathology in Ob/Gyn scenarios in M3 students.

Obstetric ultrasound: where are we and where are we going?

Diagnostic ultrasound (DUS) is, arguably, the most common technique used in obstetrical practice. From A mode, first described by Ian Donald for gynecology in the late 1950s, to B mode in the 1970s, real-time and gray-scale in the early 1980s, Doppler a little later, sophisticated color Doppler in the 1990s and three dimensional/four-dimensional ultrasound in the 2000s, DUS has not ceased to be closely associated with the practice of obstetrics. The latest innovation is the use of artificial intelligence which will, undoubtedly, take an increasing role in all aspects of our lives, including medicine and, specifically, obstetric ultrasound. In addition, in the future, new visualization methods may be developed, training methods expanded, and workflow and ergonomics improved.

A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study

Background

Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound.

Objective

This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality.

Methods

Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system.

Results

Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively).

Conclusions

The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).

Role of pelvic ultrasound simulation

BACKGROUND

Pelvic ultrasound is a critical diagnostic imaging tool in obstetrics and gynaecology. Training opportunities in transvaginal ultrasound have not kept pace with the demand among learners because of the increased complexity of modern ultrasound technology and duty-hour restrictions. Ultrasound simulation training has the potential to overcome this gap. Training opportunities in transvaginal ultrasound have not kept pace with the demand OBJECTIVE: Our study aimed to determine the usefulness, applicability and attitudes toward pelvic ultrasound simulation training among residents, sonographers and practising doctors.

METHODS

Pelvic ultrasound simulation activity using high-fidelity virtual reality ultrasound simulators lasted 4 hours and consisted of three modules: abnormal uterine bleeding, adnexal masses and bleeding in pregnancy. All learners completed a pre- and post-encounter quiz, and an anonymous post-simulation survey on the relevance of ultrasound simulation to clinical learning, and its usefulness to improve scanning performance and interpretation skills.

RESULTS

Thirty-one participants attended the workshop, and 28 (90.3%) of them responded to the survey. Five respondents agreed and 23 strongly agreed that pelvic ultrasound simulation applies to their clinical ultrasound practice, and seven of them agreed and 21 strongly agreed that their performance of ultrasound and interpretation skills will be improved following their simulation training. The average post-activity knowledge score for all three topics significantly increased (paired Student's t-test, p < 0.0001).

CONCLUSIONS

All 28 respondents believe that ultrasound simulation is a useful complement to learning with real patients, with the potential to improve their pelvic ultrasound performance, interpretation skills and clinical reasoning.

Sonography Simulators: Use and Opportunities in CAAHEP-Accredited Programs

Concern for patient safety and increased demands on health professionals have resulted in challenges for the clinical training of sonography students. The purpose of this study was to examine simulation use in Commission on Accreditation of Allied Health Education Programs (CAAHEP)–accredited sonography programs. A prospective cross-sectional study was conducted. Program directors were sent a survey that addressed the use of simulation and the perception of simulation’s educational value. Of the 230 sonography programs identified, 137 responded, for a response rate of 60%. Of the respondents, 75% indicated they used simulation and 89% reported that it was a good teaching tool. The programs indicated that 81% recorded a positive student experience using simulation. Simulation was rated most useful for improved anatomic identification (55%) and transducer manipulation (64%). Simulation is commonly used for educational training in CAAHEP-accredited sonography programs and is perceived as a positive tool to enhance education of students. More research is needed to establish best use and educational practice.

Striving for Better Medical Education: the Simulation Approach

Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties.

Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used.

Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators.

The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

Population-based trends in prenatal screening and diagnosis for aneuploidy: a retrospective analysis of 38 years of state-wide data

OBJECTIVE

To analyse population-based trends over the entire history of prenatal testing for aneuploidy.

DESIGN

Retrospective analysis of state-wide data sets.

SETTING

Australian state of Victoria with ~70 000 annual births.

POPULATION

All pregnant women undergoing invasive prenatal testing at <25 weeks' gestation from 1976 to 2013.

METHODS

Analysis of three state-wide data sets: (1) Prenatal diagnosis data set of 119 404 amniocenteses and chorionic villus samplings from 1976 to 2013; (2) central serum screening laboratory data set from 1996 to 2013; (3) government birth statistics from 1976 to 2013.

MAIN OUTCOME MEASURES

Annual numbers and uptake rates of invasive prenatal tests and serum screening, indications for invasive prenatal testing, prenatal diagnoses of aneuploidy, diagnostic yield of invasive tests.

RESULTS

Annual numbers of invasive prenatal tests climbed steadily from 1976, then declined from 2000. In 2013, the number of invasive prenatal tests was the lowest in 25 years, while the number of trisomy 21 diagnoses was the highest ever recorded. Annual uptake of serum screening climbed from 1.6 to 83% over 1996-2013. Results from 2013 showed a high diagnostic yield (15.8%) for a low rate of invasive testing (3.4% of births). Over four decades, the number of invasive procedures performed for each diagnosis of major chromosome abnormality declined from 100 to six.

CONCLUSIONS

This study demonstrates historic reductions in the proportion of women undergoing invasive testing and dramatic improvements in diagnostic yield. Monitoring the impact of new prenatal technologies on this progress remains an important research priority.

TWEETABLE ABSTRACT

Invasive prenatal testing has reached historic lows due to dramatic improvements in Down syndrome screening.