Simulator training improves ultrasound scanning performance on patients: a randomized controlled trial

  • Mia Louise ØstergaardEmail author
  • Kristina Rue Nielsen
  • Elisabeth Albrecht-Beste
  • Annette Kjær Ersbøll
  • Lars Konge
  • Michael Bachmann Nielsen
Radiological Education



Simulation-based mastery training may improve clinical performance. The aim of this study was to determine the effect of simulation-based mastery training on clinical performance in abdominal diagnostic ultrasound for radiology residents.


This study was a multicenter randomized controlled trial registered at (identifier: NCT02921867) and reported using the Consolidated Standards of Reporting Trials (CONSORT) statement. Twenty radiology residents from 10 different hospitals were included in the study. Participants were randomized into two groups: (1) simulator-based training until passing a validated test scored by a blinded reviewer or (2) no intervention prior to standard clinical ultrasound training on patients. All scans performed during the first 6 weeks of clinical ultrasound training were scored. The primary outcome was performance scores assessed using Objective Structured Assessment of Ultrasound Skills (OSAUS). An exponential learning curve was fitted for the OSAUS score for the two groups using non-linear regression with random variation. Confidence intervals were calculated based on the variation between individual learning curves.


After randomization, eleven residents completed the simulation intervention and nine received standard clinical training. The simulation group participants attended two to seven training sessions using between 6 and 17 h of simulation-based training. The performance score for the simulation group was significantly higher for the first 29 scans compared to that for the non-simulation group, such that scores reached approximately the same level after 49 and 77 scans, respectively.


We showed improved performance in diagnostic ultrasound scanning on patients after simulation-based mastery learning for radiology residents.

Trial registration


Key Points

• Improvement in scanning performance on patients is seen after simulation-based mastery learning in diagnostic abdominal ultrasound.

• Simulation-based mastery learning can prevent patients from bearing the burden of the initial steep part of trainees’ learning curve.


Ultrasonography Abdomen Education, radiology Computer simulation 



Consolidated Standards of Reporting Trials


European Federation of Societies for Ultrasound in Medicine and Biology


Objective Structured Assessment of Ultrasound Skills



The authors would like to thank Kirsten Engel at Copenhagen Academy for Medical Education and Simulation for language revision and all participants and raters for their time.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Michael Bachmann Nielsen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• randomized controlled trial

• multicenter study


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
  2. 2.Department of Clinical Physiology, Nuclear Medicine and PETCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
  3. 3.National Institute of Public HealthUniversity of Southern DenmarkCopenhagenDenmark
  4. 4.Copenhagen Academy for Medical Education and Simulation CAMES, The Capital Region of DenmarkCopenhagenDenmark

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