SECTION III. Virtual Reality for Health Education

Simulation-Based Training for Ultrasound Practice


Ultrasonography has become one of the most commonly requested imaging utilities for both diagnostic and therapeutic purposes. Several reasons contribute to the extensive usage of ultrasound; for example, ultrasound applies non-ionising radiation which is considered reasonably safe for both patients and users. Moreover, ultrasound devices are relatively small compared to other imaging devices, which make them effortlessly portable, and their lower cost facilitates their availability in clinics (Cavanagh and Smith, 2017). However, ultrasound is highly operator-dependent, and the accuracy of scanning examinations relies fundamentally on various complex skills (SCoR/BMUS, 2019). For example, the UK based Consortium for the Accreditation of Sonographic Education (UK-CASE) reported that ‘the acquisition of suitable images and assessment of them is entirely operator-dependent at the time of the scan. Deficiencies in acquisition cannot be rectified by involving a more skilled practitioner at a later stage’ (Harrison and Dolbear, 2018, p. 6). Achieving competency in ultrasound practice requires adequate efforts in the provision of optimum training methods for ultrasound-novice healthcare practitioners. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) highlighted the requirements needed to effectively deliver ultrasound training, including the acknowledgement of the training courses that must be completed and the time that must be put in by the trainee in clinical settings (EFSUMB, 2005).

Some challenges have emerged in recent years that could prove to be obstacles for the implementation of optimum ultrasound training programmes in clinical settings. For example, the shortage of available supervisors for training, busy departments being non-learning-friendly environments and the necessity of assuring patient safety are the main concerns that surround clinical-based training. These challenges have contributed to the incorporation of alternative training methods that are mainly based on virtual reality (VR) simulation.

VR simulation has provided a number of positive impacts on ultrasound training in recent years. According to the current literature, ultrasound simulators provide a safe learning environment that contributes to the development and enhancement of both cognitive and psychomotor skills which are essential for performing competent ultrasound practice. Moreover, VR simulators, computer-based especially, usually provide immediate automatic feedback to learners, offering a suitable solution to the absence of direct clinical supervision. Simulators contribute to ensuring patient safety by decreasing scanning time for cases that are sensitive to the prolonged scans such as transvaginal ultrasound in early pregnancy (Tolsgaard et al., 2017). To justify the significance of employing VR simulation in ultrasound training, this chapter starts with a brief overview of the concerns associated with clinical-based training and then discusses the positive influence of VR simulation on the cognitive and psychomotor skills of ultrasound practitioners.


It is a general practice to train healthcare practitioners to perform independent ultrasound scanning, for which training is based on clinical life and real patients. However, many concerns have been raised in recent years that could constrain the provision of an optimum educational programme based on live clinical training. The following section outlines the main challenges that relate to performing optimum clinical-based training in ultrasound, namely, a shortage of available ultrasound trainers, the environment of clinical practice and the necessity for ensuring patient safety.

Supervision Shortage

With the recent rise of the international population, workloads in hospitals have increased, impacting the training capacity in clinical sites as the demands of qualified practitioners to complete their non-teaching duties have intensified. The issue is further complicated within ultrasound practice due to the decreasing chance of finding an expert sonographer who could be available to train novice practitioners. The last statistics report of the UK National Health Service (NHS) indicates a 21% rise in non-obstetric ultrasound examinations over the previous five years (Baker, 2019). Crucially, one-third of UK sonographers are over 50 years of age, and thus many could be retiring over the following ten years (Thomson, 2014). This was one of the rationales that promoted UK-CASE to update the sonographic education standards to improve the future workforce in the field of ultrasound (Harrison and Dolbear, 2018). Consequently, it has become crucial that the healthcare system considers the incorporation of alternative training methods that reduce the reliance on receiving clinical supervision and therefore enhance the process of ultrasound learning and skills acquisition.

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