How to enhance the novices' learning in ultrasound-guided procedures utilizing handmade phantoms?

Introduction: This prospective study aims to evaluate the learning effect of US-guided thoracocentesis and pericardiocentesis in novices through simulation training using handmade phantoms.

Methods: The novices included undergraduate-year (UGY) students and first postgraduate-year (PGY-1) residents. Handmade phantoms were utilized for training and immediate assessment. Novices were re-evaluated using high-fidelity phantoms three months after training, while experienced PGY-3 emergency medicine residents were recruited and evaluated with high-fidelity phantoms simultaneously. Data on their performance, puncture time, and number of attempts were collected.

Results: Thirty-six novices (18 PGY-1 and 18 UGYs) and 12 PGY-3 emergency medicine residents were recruited. Alongside clinical observation, novices demonstrated improved skill retention and performance at the 3-month assessment compared to the immediate assessment [5 (4-5) vs. 3.5 (3-4), p = 0.0005] in thoracocentesis, achieving a comparable level of proficiency with the PGY-3 emergency medicine residents [5 (4-5) vs. 5 (5), p = 0.105]. Without clinical observation, novices exhibited a decline in skill proficiency in pericardiocentesis at the 3-month assessment [3 (3-4) vs. 4 (4-4.5), p = 0.015]. The puncture time was comparable between novices and PGY-3 emergency medicine residents for both thoracocentesis and pericardiocentesis. However, novices required a greater number of puncture attempts for pericardiocentesis.

Conclusions: Novices showed superior performance in thoracocentesis but experienced skill decay in pericardiocentesis at the 3-month assessment following training with handmade phantoms. This decline may be attributed to the very low frequency of pericardiocentesis cases encountered by novices after training, as well as the higher-stakes nature of the procedure. Further investigation is needed to evaluate the long-term effects of training, skill retention, and transfer of skills to actual patient care. Additionally, research should focus on determining optimal retraining intervals for pericardiocentesis and evaluating the use of standardized pericardiocentesis videos as an alternative to clinical observation.

Trial registration: Registered at ClinicalTrials.gov (NCT04792203) on March 7, 2021.