Medical schools and residencies are currently facing a shift in their teaching paradigm. The increasing amount of medical information and research makes it difficult for medical education to stay current in its curriculum. As patients become increasingly concerned that students and residents are "practicing" on them, clinical medicine is becoming focused more on patient safety and quality than on bedside teaching and education. Educators have faced these challenges by restructuring curricula, developing small-group sessions, and increasing self-directed learning and independent research. Nevertheless, a disconnect still exists between the classroom and the clinical environment. Many students feel that they are inadequately trained in history taking, physical examination, diagnosis, and management. Medical simulation has been proposed as a technique to bridge this educational gap. This article reviews the evidence for the utility of simulation in medical education. We conducted a MEDLINE search of original articles and review articles related to simulation in education with key words such as simulation, mannequin simulator, partial task simulator, graduate medical education, undergraduate medical education, and continuing medical education. Articles, related to undergraduate medical education, graduate medical education, and continuing medical education were used in the review. One hundred thirteen articles were included in this review. Simulation-based training was demonstrated to lead to clinical improvement in 2 areas of simulation research. Residents trained on laparoscopic surgery simulators showed improvement in procedural performance in the operating room. The other study showed that residents trained on simulators were more likely to adhere to the advanced cardiac life support protocol than those who received standard training for cardiac arrest patients. In other areas of medical training, simulation has been demonstrated to lead to improvements in medical knowledge, comfort in procedures, and improvements in performance during retesting in simulated scenarios. Simulation has also been shown to be a reliable tool for assessing learners and for teaching topics such as teamwork and communication. Only a few studies have shown direct improvements in clinical outcomes from the use of simulation for training. Multiple studies have demonstrated the effectiveness of simulation in the teaching of basic science and clinical knowledge, procedural skills, teamwork, and communication as well as assessment at the undergraduate and graduate medical education levels. As simulation becomes increasingly prevalent in medical school and resident education, more studies are needed to see if simulation training improves patient outcomes.

The utility of simulation in medical education: what is the evidence?

PURPOSE AND SCOPE The purpose of these Guidelines is to review the published techniques of ultrasound in labor and their practical applications, to summarize the level of evidence regarding the use of ultrasound in labor and to provide guidance to practitioners on when ultrasound in labor is clinically indicated and how the sonographic findings may affect labor management We do not imply or suggest that ultrasound in labor is a necessary standard of care

ISUOG Practice Guidelines: intrapartum ultrasound.

Objective
To investigate the ability of intrapartum translabial sonography to diagnose fetal station in the second stage of labor.

Methods
Patients with uncomplicated pregnancies at term gestation with fetuses in vertex presentation in the second stage of labor underwent serial translabial sonography and digital examinations. In a sagittal section of the maternal pelvis, the direction of the head was noted and categorized as downward, horizontal or upward. By rotating the transducer in the transverse plane the cerebral midline echo was also visualized and the rotation of the head was noted. Clinical and ultrasound data were compared using Somer's d-test.

Results
Sixty patients underwent a total of 168 clinical and sonographic examinations. When on the sonogram the fetal head was directed downward, the station assessed clinically was most frequently ≤ + 1 cm from the ischial spines (44/57 (77.2%) cases); when the direction was horizontal, the station was most frequently ≤ + 2 cm (53/59 (89.8%) cases); when the fetal head was directed upward, the station was usually ≥ + 3 cm (46/52 (88.5%) cases). Failure to visualize the cerebral midline or a rotation ≥ 45° were associated with a station of + 2 cm or less in 98/103 (95.1%) examinations. Conversely, a rotation of < 45° was associated with a station of + 3 cm or more in 45/65 (69.2%) examinations. All comparisons between clinical and sonographic findings demonstrated a statistically significant relationship (P < 0.0001). The probability of a station + 3 cm or more was particularly high when an upward direction of the head was seen in combination with a rotation of < 45° (40/42 (95.2%) examinations). The interobserver variability (Cohen's kappa 0.795 and 0.727 for station and rotation, respectively; P < 0.001) and intraobserver variability (0.845 for both station and rotation, P < 0.001) suggested good reproducibility of the method.

Conclusions
Translabial sonography allows a diagnosis of fetal station with an accuracy comparable to that of digital examination and may provide useful information for diagnosing obstructed labor in the second stage as well as assisting in the choice of instrumental delivery. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

Diagnosis of station and rotation of the fetal head in the second stage of labor with intrapartum translabial ultrasound

Objectives
To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience.

Methods
One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland–Altman analysis was used to assess interobserver agreement.

Results
In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63–0.81). ICCs were 0.82 (95% CI, 0.70–0.89), 0.81 (95% CI, 0.71–0.88) and 0.61 (95% CI, 0.43–074) for observers with > 10 years', 10 years' and < 5 years' ultrasound experience (bias, −1.09°; 95% limits of agreement, −8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70–0.93).

Conclusions
Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/uog.7521

Measurement of fetal head descent using the ‘angle of progression’ on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise

Objective

Several ultrasound parameters, including intrapartum transperineal ultrasound (ITU) head station, angle of progression (AOP), head–perineum distance (HPD) and head-symphysis distance (HSD), have been suggested to assess fetal head station during labor. The aim of this study was to analyze the relationship between these ultrasound parameters and to compare them with digital palpation.



Methods

We analyzed 106 stored volume dataset pairs that had been acquired at Stavanger University Hospital, Norway, from nulliparous women at term with prolonged first stage of labor. The volumes were acquired using a three-dimensional transducer applied between the labia majora in a mid-sagittal plane and perineally in a transverse plane. Digitally palpated head station and cervical dilatation were also noted. The results were compared using regression and correlation coefficients.



Results

There were good correlations between ITU head station and HPD (r = 0.71), between ITU head station and HSD (r = 0.74) and between HSD and HPD (r = 0.75). Palpated head station showed only moderate correlation with ITU head station (r = 0.52). Cervical dilatation showed a weak correlation with ITU head station (r = 0.30).



Conclusion

The ultrasound parameters showed a high degree of correlation with each other, but only moderate correlation to vaginally palpated fetal head station. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.

Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor

Birth simulator: Reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification

A new obstetric forceps for the training of junior doctors: A comparison of the spatial dispersion of forceps blade trajectories between junior and senior obstetricians

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Adrien Zentner

Author Tools

Chat about Author

Papers

Birth simulator: Reliability of transvaginal assessment of fetal head station as defined by the American College of Obstetricians and Gynecologists classification

A new obstetric forceps for the training of junior doctors: A comparison of the spatial dispersion of forceps blade trajectories between junior and senior obstetricians