Abstract
Background
Gastric cancer remains a major health burden in China, with low early screening rates and limited access to endoscopic services. Gastric ultrasound offers a noninvasive, low-cost alternative but is underutilized due to the lack of effective training models. This study aimed to evaluate a novel standardized patient (SP)-based drinking simulation for teaching gastric ultrasound to residents.
Methods
In a self-controlled design, 32 ultrasound residents underwent a structured training program comprising a 90-minute theoretical lecture and a 2-hour hands-on workshop. Trainees acted as mutual SPs after ingesting warm water to simulate gastric filling. Outcomes included theoretical test scores, Direct Observation of Procedural Skills (DOPS) assessments, and Likert-scale self-assessment questionnaires. DOPS was conducted immediately after training and at one-month follow-up to assess skill retention. Statistical analyses were performed using SPSS v30.0.
Results
Theoretical scores significantly improved from 5.09 ± 0.89 to 8.28 ± 0.58 (P < 0.05, Pearson’s r = 0.87). Post-training DOPS scores averaged 41.03 ± 2.72, with 81.25% of residents achieving the passing threshold. However, scores declined at one month (32.78 ± 3.69, P < 0.05), highlighting the need for reinforcement. Self-assessment scores increased from 34.27% to 80.75% (P < 0.05), with marked gains in confidence, procedural readiness, and satisfaction. No correlation was observed between theoretical and procedural scores (R² = 0.001).
Conclusion
SP-based drinking simulation is a practical, low-cost, and educationally impactful method for teaching gastric ultrasound. It effectively improves residents’ theoretical knowledge, procedural ability, and self-confidence, while addressing the current gap in gastric-specific simulation training and supporting broader implementation in resource-limited settings. However, the observed short-term skill attrition highlights the need for continuous reinforcement and integration of interactive or computer-based theoretical modules. Future multicenter studies should validate its long-term effectiveness and clinical applicability.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-025-08282-5.
Keywords: Gastric ultrasound, Standardized patient, Ultrasound training, Residency education, Self-controlled study
Introduction
Gastric cancer remains a significant public health challenge in China, marked by a high incidence and poor five-year survival rate, primarily attributable to inadequate early screening coverage [1, 2]. Although endoscopic screening is regarded as the gold standard, its invasiveness, high cost, and low patient compliance limit its widespread adoption [3]. These challenges are especially pronounced in small- and medium-sized healthcare institutions, where shortages in equipment and trained personnel further hinder routine implementation and large-scale screening efforts [4–6].
Given this context, there is a growing demand for a noninvasive, accessible, and low-cost imaging modality for gastric assessment [7–9]. Gastric ultrasound, with its advantages of real-time imaging, noninvasiveness, and bedside feasibility, shows promising utility in preoperative assessment and postoperative gastric monitoring, aligning well with the Enhanced Recovery After Surgery (ERAS) framework [10–12]. However, the complexity of image acquisition and anatomical recognition limits its integration into residency training programs, resulting in generally low skill proficiency among trainees [13, 14].
Despite the growing use of high-fidelity simulators like CAE Vimedix in abdominal ultrasound education [15], no commercially available modules currently target gastric ultrasound specifically. In particular, simulations involving gastric functional dynamics—such as post-ingestion expansion or peristalsis—are notably absent, limiting their utility for comprehensive gastric ultrasound training [16].
To address this gap, we innovatively introduced a novel teaching approach using standardized patient (SP)-based drinking simulation. By instructing trainees to act as mutual SPs after ingesting warm water, the method creates optimal acoustic windows for practicing anatomical identification and functional assessment. This low-cost, easy-to-implement strategy is particularly suitable for training environments with constrained educational resources.
This study aims to evaluate the effectiveness of SP-based drinking simulation in gastric ultrasound education for residents, focusing on its impact on theoretical understanding, practical skill acquisition, and learner satisfaction. Ultimately, we seek to provide a practical and scalable teaching model that supports the integration of gastric ultrasound into routine clinical education.
Methods
Participants
This self-controlled study enrolled 32 ultrasound residents undergoing standardized residency training at the Department of Ultrasound, Xiangya Hospital, Central South University, from 2023 to 2025. All participants provided written informed consent and had not received prior training in gastric ultrasound before this study. Ethical approval was obtained from the Ethics Committee of Xiangya Hospital (No. 2025071006). A self-controlled pre-post design was chosen due to ethical considerations and limited resources, as all residents were required to complete ultrasound training during their scheduled rotation. Establishing a non-intervention control group was therefore not feasible.
Instructional design
A self-controlled pre-post study design was implemented. The training was conducted in two sequential phases: a 90-minute theoretical lecture, followed immediately by a 2-hour hands-on practical workshop. The theoretical course covered gastric anatomy, standard scanning planes, image interpretation, and scanning techniques, delivered through lectures and annotated image examples.
During the hands-on workshop, residents worked in pairs, alternating as operators and standardized patients (SPs). Each SP ingested 500–1000 mL of warm water to simulate gastric filling. Scanning was performed in both the supine and right lateral decubitus positions to optimize visualization of different gastric regions.
Two senior ultrasound instructors (each with over 10 years of experience) provided real-time guidance. Trainees practiced probe positioning, plane acquisition, image optimization, anatomical identification, and dynamic assessment of gastric contents and motility. Ultrasound equipment included Mindray Resona R9T and EPIQ Elite 7 systems with 2–5 MHz curvilinear and 5–12 MHz linear array transducers.
The training aimed to develop competence in identifying key gastric landmarks, recognizing the five-layer gastric wall, evaluating gastric contents, and assessing gastric function—skills essential for enhancing the effectiveness of ultrasound-based gastric cancer screening in China (Fig. 1).
Fig. 1.
Representative ultrasound images and training scenario from SP-based drinking simulation. A Longitudinal scan showing five-layer gastric wall after water ingestion. B Antral and duodenal bulb image with well-defined structures. C Gastric body image showing luminal contents and typical morphology. D Peer-to-peer hands-on session supervised by an instructor. Written informed consent was obtained for publication of image D
Assessment and evaluation
Theoretical knowledge
Trainees completed a 10-question single-choice test assessing knowledge of gastric anatomy, scanning planes, and typical ultrasound images (total score = 10). The theoretical test was administered immediately before and after the theoretical lecture. To minimize recall bias and enhance reliability, the pre-test (Form A) and post-test (Form B) contained identical questions presented in a different order.
Procedural skills (DOPS assessment)
Practical skills were assessed using the Direct Observation of Procedural Skills (DOPS) checklist [17], which evaluated learners across 10 domains such as probe manipulation, acquisition of standard planes, image optimization, anatomical recognition, and assessment of gastric function.Each criterion was scored on a 1–5 scale, yielding a total score out of 50. Evaluations were independently performed by two senior ultrasound faculty members, and the average score was used. DOPS assessments were administered immediately after training and repeated one month later to evaluate skill retention. Key performance domains such as “antral and pyloric plane acquisition” and “functional observation” were analyzed for change over time.
Self-assessment questionnaire
Learners completed a structured Likert-scale questionnaire at two time points: before the theoretical lecture (Form A, 6 items) and after the practical workshop (Form B, 10 items), to evaluate their self-perceived competence and satisfaction. Each item was rated on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Form A assessed baseline confidence in anatomical recognition and procedural understanding. Form B included the same six core items, along with four additional items addressing satisfaction with the training process and teaching preferences. The maximum possible scores were 30 (pre) and 50 (post), with higher scores indicating greater self-efficacy and satisfaction.
Statistical analysis
All statistical analyses were conducted using SPSS version 30.0 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was tested using the Shapiro-Wilk test. If the data followed a normal distribution, results were expressed as mean ± standard deviation (SD) and paired t-tests were used for within-group comparisons. If the data did not follow a normal distribution, results were presented as median (M) and interquartile range (IQR) and comparisons were made using the Wilcoxon signed-rank test.
Self-assessment questionnaire scores were analyzed at both the item and domain levels. Paired comparisons were performed for each item, and composite scores were also calculated for specific domains, including “image interpretation confidence” (Q1-Q2) and “procedural readiness” (Q4-Q6), using the same statistical approach.
DOPS scores were summarized using descriptive statistics, including mean, standard deviation, minimum, maximum, median, and interquartile range. Changes in key performance domains between the immediate post-training assessment and the one-month follow-up were analyzed using the Wilcoxon signed-rank test.
All statistical tests were two-tailed, and a P value < 0.05 was considered statistically significant.
Results
Participant characteristics
A total of 32 residents participated in the study, including 6 males and 26 females, with a mean age of 26.6 ± 3.1 years.
Theoretical knowledge
Theoretical test scores improved significantly after the training intervention. The pre-training mean score was 5.09 ± 0.89 (range: 3–7), while the post-training score increased to 8.28 ± 0.58 (range: 7–9). Shapiro–Wilk tests indicated that both pre- and post-test scores were not normally distributed (P < 0.05); therefore, the Wilcoxon signed-rank test was used.
The Wilcoxon signed-rank test indicated a significant improvement in theoretical knowledge after the training (Z = − 4.94, P < 0.05), with a large effect size (Pearson’s r = 0.87).These results indicate that the SP-based drinking simulation significantly improved participants’ theoretical test performance in gastric ultrasound.
Procedural performance (DOPS)
Immediately following the training, the mean DOPS score was 41.03 ± 2.72 (median: 41.5, IQR: 40.0–43.0), with 26 out of 32 trainees (81.25%) meeting the passing threshold of 40 points. The scores were relatively concentrated, suggesting most learners acquired a satisfactory level of skill.
The average scores across the 10 DOPS dimensions ranged from 3.94 to 4.31. The highest-performing domains included “functional observation” and “antrum/pylorus plane identification”, while relatively lower scores were seen in “five-layer gastric wall recognition” and “gastric content identification and grading”(see Table 1). Linear regression analysis revealed no significant correlation between theoretical scores and DOPS performance (R² = 0.001, P > 0.05).
Table 1.
Descriptive statistics of DOPS scores across assessment items (n = 32)
| Assessment Item | Mean | SD | Min | Max |
|---|---|---|---|---|
| Probe selection and image adjustment | 4.00 | 0.95 | 1 | 5 |
| Patient positioning and water ingestion guide | 4.06 | 0.91 | 1 | 5 |
| Cardia/fundus/body plane identification | 4.06 | 0.84 | 2 | 5 |
| Antrum/pylorus plane identification | 4.31 | 0.86 | 3 | 5 |
| Gastric wall (five-layer) recognition | 3.97 | 1.06 | 1 | 5 |
| Gastric content identification and grading | 3.94 | 0.95 | 2 | 5 |
| Functional observation | 4.25 | 0.84 | 1 | 5 |
| Image stabilization and procedural flow | 4.16 | 0.92 | 2 | 5 |
| Communication and patient care | 4.19 | 0.74 | 2 | 5 |
| Overall impression of procedural skill | 4.09 | 0.78 | 3 | 5 |
| Total Score (out of 50) | 41.03 | 2.72 | 35 | 46 |
At the one-month follow-up, DOPS scores declined to a mean of 32.78 ± 3.69 (median: 34.0, IQR: 30.0–36.0), with 20 trainees (62.50%) achieving a passing score. Key skills such as “antrum/pylorus identification” and “functional observation” showed statistically significant decreases, indicating some skill attrition over time in the absence of clinical reinforcement (see Table 2).
Table 2.
Comparison of key DOPS scores between immediate post-training and 1-month follow-up (n = 32)
| Item | Post-training (Mean ± SD) | 1-Month Follow-up (Mean ± SD) |
P value (Wilcoxon test) |
|---|---|---|---|
| Antrum/pylorus identification | 4.31 ± 0.86 | 3.47 ± 1.14 | < 0.05 |
| Functional observation | 3.91 ± 1.00 | 3.44 ± 1.13 | < 0.05 |
| Total DOPS score | 41.03 ± 2.72 | 32.78 ± 3.69 | < 0.05 |
Learner self-assessment
All 32 residents completed the self-assessment questionnaire before and after training using a 5-point Likert scale. The pre-training form (Form A) included six items (Q1-Q6), and the post-training form (Form B) extended to ten items (Q1-Q10), with Q7-Q10 assessing learner satisfaction and instructional preferences.
The overall score rate significantly increased from 34.27% ± 3.03% pre-training to 80.75% ± 5.99% post-training (P < 0.05), indicating substantial improvements in perceived competence and training satisfaction.
At the item level, all six shared items (Q1-Q6) showed significant improvement after training (all P < 0.05). Notably, Q1 (confidence in image interpretation) improved from 1.34 ± 0.48 to 3.91 ± 0.64, and Q3 (theoretical understanding) from 1.12 ± 0.34 to 4.03 ± 0.59. Procedural-related items such as Q5 and Q6 also improved markedly.
To better reflect core instructional outcomes, composite scores were calculated by averaging related items. “Image interpretation confidence” (Q1-Q2) increased from 1.25 ± 0.31 to 3.75 ± 0.40 (P < 0.05), and “procedural readiness”(Q4-Q6) from 2.22 ± 0.23 to 4.01 ± 0.41 (P < 0.05). These findings demonstrate that the SP-based drinking simulation enhanced both cognitive understanding and procedural confidence.
The post-training-only items (Q7-Q10) also received high scores. Q9 (overall satisfaction) and Q10 (preference for simulation-based learning) scored 4.38 ± 0.49 and 4.41 ± 0.50, respectively, reflecting high learner engagement and endorsement of the instructional approach (see Fig. 2).
Fig. 2.
Comparison of average Likert-scale scores before and after training. The figure presents the mean scores (± standard deviation) of 32 residents on a 5-point Likert scale, comparing responses before (blue bars) and after (orange bars) training. Questions Q1–Q6 were administered both pre- and post-training, focusing on trainees’ confidence in image interpretation, theoretical understanding, and procedural readiness. Questions Q7–Q10 were included only in the post-training survey to evaluate satisfaction with the instructional design, perceived utility, and learning preference. All items showed significant improvement after the SP-based drinking simulation, indicating enhanced self-perceived competence, confidence, and training satisfaction. Detailed questionnaire items are provided in the supplementary materials
Discussion
This study demonstrates that standardized patient (SP)-based drinking simulation is an effective approach for gastric ultrasound training in residency programs. It significantly improved residents’ theoretical knowledge, procedural performance, and self-reported confidence and satisfaction. The method proved to be highly adaptable, low-cost, and well-suited to settings with limited training resources.
In terms of knowledge acquisition, trainees’ theoretical scores increased substantially following training, with a large effect size(Pearson’s r = 0.87). In parallel, Likert-scale survey results revealed significant gains in cognitive understanding, procedural confidence, and teaching satisfaction, indicating that the approach not only improved competence but also enhanced motivation and engagement.
From an educational theory perspective, our training design aligns well with Miller’s Pyramid of Clinical Competence [18, 19]. The theoretical component addressed the “knows” and “knows how” levels, while the SP-based hands-on session and DOPS assessment corresponded to the “shows how” and “does” levels [20–23]. This vertical integration facilitated both knowledge acquisition and skill demonstration.
In parallel, our evaluation strategy reflects the Kirkpatrick Four-Level Model [24–26], capturing learner reaction (satisfaction), learning outcomes (knowledge and skills), and behavioral change (enhanced procedural confidence). Although direct clinical outcomes were not measured, the training holds clear potential to impact patient care, representing movement toward the highest level of Kirkpatrick’s hierarchy [27–30].
The DOPS assessment results further reinforce the effectiveness of the training model. Following the intervention, 81.25% of trainees achieved passing scores, reflecting solid skill acquisition. However, at the one-month follow-up, performance declined in key procedural domains—particularly in antral recognition and functional observation—indicating that while short-term mastery was attained, long-term retention remains a challenge without continued reinforcement. These findings align with previous research demonstrating that, in the absence of clinical practice or refresher training, newly acquired ultrasound skills tend to deteriorate over time [31–33].
Notably, no significant correlation was found between theoretical scores and DOPS performance, highlighting the distinction between cognitive knowledge and psychomotor skill. This underscores the need for integrative teaching approaches that bridge understanding with practical application.
Previous studies have explored the learning process of gastric ultrasound using live model–based training. Arzola et al. demonstrated that anesthesiologists could achieve a 90–95% success rate in qualitative assessment of gastric content after performing approximately 24–33 examinations.Their research focused on learning curves and technical competence among anesthesiologists, using expert-supervised, case-based training [34]. In contrast, our study emphasized an educational innovation—standardized patient (SP) based drinking simulation.This method enhances the visualization of structures, facilitates realistic procedural training, and enables trainees to observe dynamic gastric changes after water ingestion, this method compensates for the lack of gastric modules in most current ultrasound simulators. It is cost-effective, easily reproducible, and ideal for real-world educational settings, especially where high-fidelity simulation tools are unavailable.Ultimately, this approach may help bridge the gap between training and clinical practice, contributing to the early detection of gastric diseases, particularly in resource-limited settings, offering a more feasible solution.
This study represents an initial, feasibility-stage exploration demonstrating that novice residents can acquire basic gastric sonography skills through an SP-based drinking simulation. However, the present findings should be interpreted as an early step toward clinical application. The training was conducted in a controlled environment using healthy volunteers, and the transferability of these skills to real patient scenarios—particularly in detecting and accurately assessing pathological findings—remains to be established. Future studies involving patient populations and comparative designs are warranted to further validate the clinical relevance and diagnostic value of this educational model.
Despite inherent limitations—including a modest sample size from a single program and the lack of a control group—this study provides promising evidence supporting the educational value of the intervention. A self-controlled design was used to address ethical constraints. Building on these findings, future multi-center randomized studies are recommended to strengthen generalizability. Further research could also examine the integration of gastric ultrasound skills into clinical practice, uptake among trainees, and impact on clinical decision-making, contributing to broader curriculum development and educational policy planning.
Conclusion
This study demonstrates the feasibility and educational value of a structured training approach using standardized patient (SP)-based drinking simulation to enhance gastric ultrasound competency among residents. By simulating post-ingestion gastric filling, this method offers an optimal acoustic window for anatomical identification and functional assessment. Its low cost, high realism, and ease of implementation make it well-suited for widespread adoption, especially in training environments lacking high-fidelity simulators.
Among 32 participants, significant improvements were observed in theoretical knowledge, procedural skills, and self-reported confidence. The structured training design enabled learners to systematically acquire both anatomical understanding and hands-on proficiency in a short period.
Importantly, this model addresses the current lack of gastric-specific simulation tools in ultrasound education. In China, where gastric ultrasound remains underutilized and endoscopic screening is not universally accessible, this approach may help bridge the training gap and contribute to earlier detection of gastric diseases.
However, this study has several limitations. The observed skill attrition at the one-month follow-up indicates that without continued reinforcement, procedural competence may decline over time. Moreover, the lack of significant correlation between theoretical knowledge and practical performance suggests that conceptual learning alone may not ensure procedural proficiency. Future training should therefore integrate theory with practice through computer-based or interactive modules to enhance learner engagement, knowledge retention, and clinical transferability.Future research should include multi-center validation and longer follow-up to evaluate sustained learning outcomes, clinical decision-making, and patient impact, ultimately supporting the integration of gastric ultrasound into routine medical education.
Supplementary Information
Acknowledgements
We thank all the ultrasound residents who participated in this study. We also acknowledge the administrative and teaching support provided by the Department of Ultrasound at Xiangya Hospital, Central South University.
Abbreviations
- SP
Standardized Patient
- DOPS
Direct Observation of Procedural Skills
- ERAS
Enhanced Recovery After Surgery
Authors’ contributions
MK and TW conceptualized and designed the study. MK, ZH, and WL conducted the training sessions and collected data. XX performed the statistical analysis. MK drafted the manuscript. TW supervised the study and critically revised the manuscript. All authors read and approved the final manuscript.
Funding
This study was supported by the Natural Science Foundation of Changsha, China (Grant No. kq2403007) and the National Key Research and Development Program of China (Grant No. 2022YFC2504700). This study was additionally supported by the 2025 Xiangya Hospital Postgraduate Medical Education Research Project, Central South University (No. 2025bj008).
Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Xiangya Hospital, Central South University (Approval No. 2025071006). Written informed consent was obtained from all participants prior to their inclusion in the study.
Consent for publication
Written informed consent was obtained from all participants for publication of the anonymized data and any accompanying images.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Yan X, Lei L, Li H, Cao M, Yang F, He S, et al. Stomach cancer burden in China: epidemiology and prevention. Chin J Cancer Res. 2023;35(2):81–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Gao K, Wu J. National trend of gastric cancer mortality in China (2003–2015): A population-based study. Cancer Commun. 2019;39(1):24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chen X, Ze Y, Yi W, Yang Y, Sun R, Tu H. Barriers to upper gastrointestinal screening among the general population in high-prevalence areas: a cross-sectional study. JBI Evid Implement. 2024;22(2):218–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Fan X, Qin X, Zhang Y, Li Z, Zhou T, Zhang J, et al. Screening for gastric cancer in China: advances, challenges and visions. Chin J Cancer Res. 2021;33(2):168–80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Huang Z, Hu Z, Wong LP, Lin Y. Determinants of gastric cancer screening attendance in southeastern China: a cross-sectional study. BMJ Open. 2023;13(7):e073925. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.He X, Qi W, Wang Q, Zhao S. Knowledge and practice of early gastric cancer screening among adults aged ≥ 45 years in China: a cross-sectional study. BMC Public Health. 2024;24(1):3099. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Wang Z, Wu Q. Advancements in non-invasive diagnosis of gastric cancer. World J Gastroenterol. 2025;31(6): 101886. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Roopan S, Gilja OH. Transabdominal ultrasound of the stomach in patients with functional dyspepsia: a review. Diagnostics. 2024;14(19):2193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Liang Y, Jing WY, Song J, Wei QX, Cai ZQ, Li J, et al. Clinical application of oral contrast-enhanced ultrasound in evaluating the preoperative T staging of gastric cancer. World J Gastroenterol. 2024;30(41):4439–48. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Chan KM. Gastric ultrasound: enhancing preoperative risk assessment and patient safety. J Perioper Pract. 2025;35(11):501–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Razak A, Baburyan S, Lee E, Costa A, Bergese SD. Role of point-of-care gastric ultrasound in advancing perioperative fasting guidelines. Diagnostics. 2024;14(21):2366. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Van de Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014;113(1):12–22. [DOI] [PubMed] [Google Scholar]
- 13.Caterina C, Mench K. Gastric ultrasound education in nurse anesthesia residents [dissertation]. Philadelphia (PA): Drexel University; 2025.
- 14.Filipovic MG, Baettig SJ, Hebeisen M, Meierhans R, Ganter MT. Gastric ultrasound performance time and difficulty: a prospective observational study. Anaesthesia. 2025;80(2):161–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Vasilev VA, Kondrichina SN. Possibilities for using the vimedix 3.2 virtual simulator to train ultrasound specialists. Digit Diagn (Mosc). 2024;5(1):41–52. [Google Scholar]
- 16.Recker F, Neubauer R, Dong Y, Gschmack AM, Jenssen C, Möller K, et al. Exploring the dynamics of ultrasound training in medical education: current trends, debates, and approaches. BMC Med Educ. 2024;24(1):1311. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound curricula in undergraduate medical education: a scoping review. J Ultrasound Med. 2018;37(1):69–82. [DOI] [PubMed] [Google Scholar]
- 18.Witheridge A, Ferns G, Scott-Smith W. Revisiting Miller’s pyramid in medical education: the gap between traditional assessment and diagnostic reasoning. Int J Med Educ. 2019;10:1–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9 Suppl):S63-7. [DOI] [PubMed] [Google Scholar]
- 20.Williams BW, Byrne PD, Williams NV, Williams MV. Miller’s pyramid and core competency assessment: a study in relationship construct validity. J Contin Educ Health Prof. 2016;36(4):295–9. [DOI] [PubMed] [Google Scholar]
- 21.Weimer JM, Rink M, Müller L, Dirks K, Ille C, Bozzato A, et al. Development and integration of DOPS as formative tests in head and neck ultrasound education: proof-of-concept study. Diagnostics (Basel). 2023;13(4):661. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Le KDR. Principles of effective simulation-based teaching sessions in medical education: a narrative review. Cureus. 2023;15(11):e49159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Ten Cate O. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ. 2017;34(5):Doc69. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Department of Anatomy. Using Kirkpatrick Four-Level evaluation model to assess a 12-week accelerated ultrasound intensive course. Sonography. 2017.
- 25.Johnston S, Coyer FM, Nash R. Kirkpatrick’s evaluation of simulation and debriefing in health care education: a systematic review. J Nurs Educ. 2018;57(7):393–8. [DOI] [PubMed] [Google Scholar]
- 26.Ross B, Penkunas MJ, Maher D, Certain E, Launois P. Evaluating results of the implementation research MOOC using kirkpatrick’s four-level model: a cross-sectional mixed-methods study. BMJ Open. 2022;12(5):e054719. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Bradley P. The history of simulation in medical education and possible future directions. Med Educ. 2006;40(3):254–62. [DOI] [PubMed] [Google Scholar]
- 28.Rouse DN. Employing Kirkpatrick’s Evaluation Framework to determine the impact of courses: a health information management perspective. Perspect Health Inf Manag. 2011;Spring. [PMC free article] [PubMed]
- 29.Neubauer R, Bauer CJ, Dietrich CF, Strizek B, Schäfer VS, Recker F. Evidence-based ultrasound education? A systematic literature review of undergraduate ultrasound training studies. Ultrasound Int Open. 2024;10: a22750702. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Heydari MR, Taghva F, Amini M, Delavari S. Using Kirkpatrick’s model to measure the effect of a new teaching and learning methods workshop for health care staff. BMC Res Notes. 2019;12(1):388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Jujo S, Sakka BI, Lee-Jayaram JJ, Kataoka A, Izumo M, Kusunose K, et al. Medical student medium-term skill retention following cardiac point-of-care ultrasound training based on the American society of echocardiography curriculum framework. Cardiovasc Ultrasound. 2022;20(1):26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Okuda Y, Bryson EO, DeMaria S Jr, Jacobson L, Quinones J, Shen B, et al. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med. 2009;76(4):330–43. [DOI] [PubMed] [Google Scholar]
- 33.Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE guide 31. Med Teach. 2007;29(9):855–71. [DOI] [PubMed] [Google Scholar]
- 34.Arzola C, Carvalho JCA, Cubillos J, Ye XY, Perlas A. Anesthesiologists’ learning curves for bedside qualitative ultrasound assessment of gastric content: a cohort study. Can J Anaesth. 2013;60(8):771–9. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.