Simulation-Based Ultrasound Curricula in Surgical Resident Education: A Review of the Literature
Yi-Hsueh Lu1, Katherine Chemakin1, Fei Wang1, Joseph A. Ricci1
1Division of Plastic & Reconstructive Surgery, Montefiore Medical Center, Bronx, NY, USA
Background: Ultrasound is a versatile tool with numerous procedural and diagnostic applications in surgical settings. Simulation-based training is gaining popularity in surgical residency but implementation in ultrasound teaching is not universal. Presently, there is limited literature regarding the breadth and depth of these practices. This study aims to assess the current state of simulation-based ultrasound training across different surgical specialties.
Methods: An analytical review of existing literature in simulation-based ultrasound training in surgical residency was performed using PubMed/Ovid MEDLINE database. Original studies that reported on simulation-based ultrasound curricula in surgical residencies were noted. The identified studies were characterized by specialty, methodology, evaluation, and outcomes. Study results were synthesized and compared with information published by ACGME programs of the same time period to understand if ultrasound curricula were evenly distributed across various surgical residencies. Content of ultrasound curricula were also noted and included: central venous access, point-of-care, regional nerve blocks, and spinal procedures.
Results: A total of 143 articles were identified and 93 were included after applying all exclusion criteria. Studies on central venous access consisted of 38% of all studies, followed by point-of-care ultrasound, regional nerve block, and spinal procedures, 17%, 15%, and 6% respectively. Pre-post comparison (n=33, 40%) was the most common study design, followed by ideas and innovation (n=20, 24%), prospective cohort study (n=17, 20%), and randomized trial (n=13, 16%). Anesthesia and emergency medicine constituted 48% and 14% of articles, respectively, while general surgery made up 25% of existing literature. Two specialties -- plastic surgery and orthopedic surgery – were significant underrepresented in the literature after accounting for the proportion of residency programs and residents nationwide in relation to the overall pool of programs and residents. Despite having 3% of total residents and 6% of total ACGME-accredited programs, plastic surgery contributed 0% of the literature (p=0.048 and 0.007, respectively).
Conclusions: Disparities in education among certain surgical subspecialties calls for further investigation. A review of the methodologies in ultrasound simulation provides guidelines for future studies and opportunity to provide evidence-based medical education and effective resident training in these underrepresented fields.
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