Training in transvaginal sonography using pelvic ultrasound simulators versus live models: a randomized controlled trial.

PURPOSE: To compare pelvic ultrasound simulators (PSs) with live models (LMs) for training in transvaginal sonography (TVS). METHOD: The authors conducted a prospective, randomized controlled trial of 145 eligible medical students trained in TVS in 2011-2012 with either a PS or an LM. A patient educator was used for LM training. Simulated intrauterine and ectopic pregnancy models were used for PS training. Students were tested using a standardized patient who evaluated their professionalism. A proctor, blinded to training type, scored their scanning technique. Digital images were saved for blinded review. Students rated their training using a Likert scale (0 = not very well; 10 = very well). The primary outcome measure was students' overall performance on a 40-point assessment tool for professionalism, scanning technique, and image acquisition. Poisson regression and Student t test were used for comparisons. RESULTS: A total of 134 students participated (62 trained using a PS; 72 using an LM). Mean overall test scores were 56% for the PS group and 69% for the LM group (P = .001). A significant difference was identified in scanning technique (PS, 60% versus LM, 73%; P = .001) and image acquisition (PS, 37% versus LM, 59%; P = .001). None was observed for professionalism. The PS group rated their training experience at 4.4, whereas the LM group rated theirs at 6.2 (P < .001). CONCLUSIONS: Simulators do not perform as well as LMs for training novices in TVS, but they may be useful as an adjunct to LM training.

Emergency bedside sonographic diagnosis of subclavian artery pseudoaneurysm with brachial plexopathy after clavicle fracture.

Clavicle fractures are common; however, complications are unusual. Two such complications, subclavian artery pseudoaneurysm and brachial plexopathy, are rare events that can cause significant morbidity and mortality. We report the case of a 53-year-old man who presented with shoulder swelling and right arm weakness for 1 week. Three weeks before, he had fallen and fractured his right clavicle. On presentation to our emergency department, his examination revealed a brachial plexopathy and a large supraclavicular mass. An emergency bedside triplex sonogram was performed to characterize the mass and revealed a swirling pattern within a fluid collection anterior to the subclavian artery, suggestive of a pseudoaneurysm. After computed tomography-angiography, the patient was taken to the operating room, where he underwent hematoma washout and subclavian artery stent-graft placement. This case illustrates how bedside point-of-care sonography can rapidly assist in the initial assessment of subclavian artery injury.