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Context The knowledge of normal variation of reproductive hormones, internal genitalia imaging, and the prevalence of gynecological disorders in adolescent girls is limited. Objective The study aimed to describe reproductive parameters in postmenarchal girls from the general population including the frequency of oligomenorrhea, polycystic ovary syndrome, and use of hormonal contraception. Design The Copenhagen Mother-Child Cohort is a population-based longitudinal birth cohort of 1210 girls born between 1997 and 2002. Setting University hospital. Participants A total of 317 girls were included, with a median age of 16.1 years and time since menarche of 2.9 years. Main Outcome Measure(s) Tanner stage, height, weight, age at menarche, menstrual cycle length and regularity, ovarian/uterine volume, and number of follicles were recorded. Serum concentrations of FSH, LH, anti-Müllerian hormone (AMH), inhibin B, estradiol, testosterone, SHBG, androstenedione, dehydroepiandrosterone sulfate, 17-OH-progesterone, and IGF-1 were measured. Results Twenty girls (6.3%) had oligomenorrhea and differed significantly in serum androgens and AMH, age at and time since menarche from girls with regular cycles. Twenty-seven girls were classified with PCOS (8.5%) and had significantly higher 17-OH-progesterone, estradiol, AMH, LH, and age at menarche than the reference group. Girls on oral contraception had significantly higher serum SHBG concentrations and lower serum concentrations of all hormones except AMH and IGF-1. Ovarian follicles 2 to 29.9 mm correlated positively with serum AMH (P < 0.0001). Conclusions Most 16-year-old girls had regular menstrual cycles, normal reproductive hormones, and uterine and ovarian ultrasound. Serum AMH reflected ovarian follicle count and may be a useful biomarker of ovarian reserve.

The purpose of this systematic review and meta-analysis was to examine the effects of simulation-based ultrasound training (SIM-UT) in obstetrics and gynecology compared to non-SIM-UT on trainee learning, clinical performance, patient-relevant outcomes, and cost of training. A systematic search was performed in June 2019 in PubMed, Embase, and Scopus using search terms for the topic and the intervention as well as certain MESH terms. Inclusion criteria were defined in accordance with the PICO question. Studies published in any language involving SIM-UT in obstetrics and gynecology compared to non-SIM-UT or no training were included. The outcomes included effects on health care provider learning and clinical performance, patient-relevant outcomes, and cost of training. Two authors evaluated the study quality with the MERSQI instrument and the Oxford Quality Scoring System. A meta-analysis was planned for the included randomized controlled trials. 15 studies were included, and 11 studies were eligible for meta-analysis. SIM-UT was significantly superior to clinical training only and theoretical teaching with standard mean differences (SMD) of 0.84 (0.08-1.61) and 1.20 (0.37-2.04), respectively. However, SIM-UT was not superior to live model training; SMD of 0.65 (-3.25-4.55). Of all studies included in the meta-analysis, 91 % favored SIM-UT over clinical training alone, theoretical teaching, or in some cases live model training. In the field of obstetrics and gynecology, SIM-UT in addition to clinical training markedly improves trainee learning, clinical performance, as well as patient-perceived quality of care.ZIEL: Ziel dieser systematischen Übersicht und Metaanalyse war es, die Auswirkungen des simulationsbasierten Ultraschalltrainings (SIM-UT) in der Geburtshilfe und Gynäkologie im Vergleich zu Nicht-SIM-UT auf das Lernen der Auszubildenden, die klinische Leistung, den patientenrelevanten Outcome und die Kosten der Ausbildung zu untersuchen. Im Juni 2019 wurde eine systematische Suche in PubMed, Embase und Scopus mit Suchbegriffen zum Thema und zur Intervention sowie mit bestimmten MESH-Begriffen durchgeführt. Die Einschlusskriterien wurden gemäß des PICO-Schemas definiert. Eingeschlossen wurden Studien jeglicher Sprache, die SIM-UT in der Geburtshilfe und Gynäkologie beinhalten und dieses mit Nicht-SIM-UT oder keiner Schulung verglichen. Die Ergebnisse umfassten Auswirkungen auf das Lernen und die klinische Leistung von Gesundheitsdienstleistern, den patientenrelevanten Outcome und Schulungskosten. Zwei Autoren bewerteten die Studienqualität mit dem MERSQI-Instrument und dem Oxford Quality Scoring System. Für die eingeschlossenen randomisierten kontrollierten Studien war eine Metaanalyse geplant. 15 Studien wurden eingeschlossen, 11 Studien waren für eine Metaanalyse geeignet. SIM-UT war der reinen klinischen Ausbildung und dem theoretischen Unterricht mit mittleren Standarddifferenzen (SMD) von 0,84 (0,08–1,61) bzw. 1,20 (0,37–2,04) signifikant überlegen. Allerdings war SIM-UT der Ausbildung am lebenden Modell nicht überlegen. Die SMD betrug 0,65 (–3,25–4,55). Von allen in die Metaanalyse einbezogenen Studien bevorzugten 91 % SIM-UT gegenüber der reinen klinischen Ausbildung, dem theoretischen Unterricht oder in einigen Fällen gegenüber der Ausbildung am lebenden Modell. Im Bereich der Geburtshilfe und Gynäkologie verbessert SIM-UT zusätzlich zur klinischen Ausbildung das Lernen der Auszubildenden, die klinische Leistung sowie die vom Patienten wahrgenommene Qualität der Versorgung deutlich.

INTRODUCTION: There is no international consensus on the orientation of transvaginal ultrasound images and no evidence exists to support the superiority of one image orientation over the other. The aim of this study was to compare learning curves and skills transfer in a group of novices randomized to top-down or bottom-up image orientation, and to determine whether individual preferences for image orientation affect learning and skills transfer.MATERIAL AND METHODS: 60 senior medical students, with no prior ultrasound experience, were randomized to orient the image top-down or bottom-up during training on an ultrasound simulator until attaining expert levels of performance. Participants then completed a transfer test involving a systematic ultrasound examination on a physical mannequin using real ultrasound equipment. Performance was assessed during the transfer test by two independent raters using the objective structured assessment of ultrasound skills (OSAUS) score and a global rating score.RESULTS: The bottom-up group reached the expert level with significantly fewer attempts than did the top-down group [median ± interquartile range: 4 ± 2 vs 5 ± 3] (U = 285.5, P = 0.014). The bottom-up group used less time to achieve the expert level (median ± interquartile range: 3 h 2 m ± 1 h 14 m vs 3 h 28 m ± 2 h 21 m) (U = 301.5, P = 0.029). The two groups performed similarly during the transfer test with respect to their OSAUS scores (top-down 56.7% vs bottom-up 53.2%, P = 0.13). The global rating scores were higher in the top-down group (top-down 57.1% vs bottom-up 50.0%, P = 0.02).CONCLUSIONS: Orientation of the images bottom-up rather than top-down, led to a steeper learning curve, but had little or no impact on the subsequent transfer of skills.

BACKGROUND: Point-of-care ultrasonography plays an increasingly important role in the initial resuscitation of critically ill patients but acquisition of the skill is associated with long learning curves. The skills required to perform ultrasound examinations can be practiced in a simulated setting before being performed on actual patients. The aim of this study was to investigate the learning curves for novices training the FAST protocol on a virtual-reality simulator.METHODS: Ultrasound novices (N = 25) were instructed to complete a FAST training program on a virtual-reality ultrasound simulator. Participants were instructed to continue training until they reached a previously established mastery learning level, which corresponds to the performance level of a group of ultrasound experts. Performance scores and time used during each FAST examination were used to determine participants' learning curves.RESULTS: The participants attained the mastery learning level within a median of three (range two to four) attempts corresponding to a median of 1 h 46 min (range 1 h 2 min to 3 h 37 min) of simulation training. The ultrasound novices' examination speed improved significantly with training, and continued to improve even after they attained the mastery learning level (P = 0.011). Twenty-three participants attained the mastery learning level.CONCLUSION: Novices can attain mastery learning levels using simulation-based ultrasound training with less than, on average, 2 h of practice. However, we found large variations in the amount of training needed, which raises questions about the adequacy of current volume-based models for determining ultrasound competency.

The aim of this study was to examine the validity of a simulator test designed to evaluate focused assessment with sonography for trauma (FAST) skills.Participants included a group of ultrasound novices (n = 25) and ultrasound experts (n = 10). All participants had their FAST skills assessed using a virtual reality ultrasound simulator. Procedural performance on the 4 FAST windows was assessed by automated simulator metrics, which received a passing or failing score. The validity evidence for these simulator metrics was examined by a stepwise approach according to the Standards for Educational and Psychological Testing. Metrics with validity evidence were included in a simulator test, and the reliability of test scores was determined. Finally, a pass/fail level for procedural performance was established.Of the initial 55 metrics, 34 (61.8%) had validity evidence (P .01). A simulator test was constructed based on the 34 metrics with established validity evidence, and test scores were calculated as percentages of the maximum score. The median simulator test scores were 14.7% (range, 0%-47.1%) and 94.1% (range, 94.1%-100%) for novices and experts, respectively (P .001). The pass/fail level was determined to be 79.7%.The performance of FAST examinations can be assessed in a simulated setting using defensible performance standards, which have both good reliability and validity.

PURPOSE: To collect validity evidence for the assessment of mastery learning on a virtual reality transabdominal ultrasound simulator.MATERIALS AND METHODS: We assessed the validity evidence using Messick's framework for validity. The study included 20 novices and 9 ultrasound experts who all completed 10 obstetric training modules on a transabdominal ultrasound simulator that provided automated measures of performance for each completed module (i. e., simulator metrics). Differences in the performance of the two groups were used to identify simulator metrics with validity evidence for the assessment of mastery learning. The novices continued to practice until they had attained mastery learning level.RESULTS: One-third of the simulator metrics discriminated between the two groups. The median simulator scores from a maximum of 40 metrics were 17.5 percent (range 0 - 45.0 percent) for novices and 90.0 percent (range 85.0 - 97.5) for experts, p CONCLUSION: This study found that validity evidence for the assessment of mastery learning in simulation-based ultrasound training can be demonstrated and that ultrasound novices can attain mastery learning levels with less than 5 hours of training. Only one-third of the standard simulator metrics discriminated between different levels of competence.