This study looks at the best way to remotely teach and guide doctors-in-training to perform a bedside ultrasound exam called eFAST (extended Focused Assessment with Sonography for Trauma), which is used to quickly check injured patients for internal bleeding or air around the lungs.
The study takes place in a simulation setting, with no real patients. Resident physicians who have completed the basic ultrasound courses each watch the same short instructional video and then perform three eFAST examinations on the same healthy volunteer. Participants are randomly assigned to one of three groups: (1) the instructional video only, with no live help; (2) the video plus real-time audio guidance from a remote expert who can see the live ultrasound image; or (3) the video plus guidance through a head-mounted device that also lets the expert see the participant's own point of view.
Afterwards, experts who were not involved in a given exam review the recorded ultrasound images, without knowing which group the participant was in, and rate the image quality and skill. The study also measures how long the exams take, the participants' workload, and the comfort and usability of the system.
The goal is to learn whether real-time remote guidance, and in particular guidance through a head-mounted device, helps trainees produce better and faster eFAST examinations than an instructional video alone.
Age 18 years or older
Resident physician currently in postgraduate training
Completion of the national Basic Course in Abdominal Ultrasound and the Basic Course in Emergency Ultrasound (SGUM)
Sufficient proficiency in English to understand study instructions, questionnaires, and expert guidance
Physical limitations that impair ultrasound performance (e.g., upper-limb injury, uncorrected severe visual impairment)
Unable to attend the scheduled session
Participation in conflicting educational studies
Parallel
Standardized instructional eFAST video
BehavioralAll participants watch the same brief standardized instructional eFAST video and receive a short standardized introduction to the ultrasound system, then perform three consecutive complete eFAST examinations on a standardized healthy volunteer. In the video-only arm this is the only instruction; no live expert guidance is provided during the examinations.
Real-time audio remote expert guidance (Microsoft Teams)
BehavioralA remote emergency-ultrasound expert joins the session via Microsoft Teams, views the participant's live ultrasound image in real time (streamed from the GE system to a study laptop that shares it in the call), and provides verbal, audio-only guidance during the eFAST examinations. The expert does not see the participant's point of view. Guidance is real-time only.
Head-mounted-device remote expert guidance (Arc 3, RealWear)
DeviceIn addition to the live ultrasound image shared via Microsoft Teams, the participant wears the Arc 3 head-mounted device (RealWear), which transmits their point-of-view video to the remote expert in the same Teams call. The expert sees both the point-of-view stream and the live ultrasound image and gives real-time guidance; the participant can see the expert's video on the head-mounted display.
eFAST image-quality score (QUICk Global Rating Scale, GRS)
Participant-level mean QUICk Global Rating Scale across the three eFAST examinations. The GRS has four domains (image adjustment, image sweeping, flow of procedure, overall performance), each rated 1 (Poor) to 5 (Excellent); total 4 to 20. Each examination is scored by two blinded experts who did not supervise it. Minimum 4, maximum 20; higher scores indicate better image quality. Unit of Measure: score on a 4 to 20 scale
eFAST image quality, QUICk Task-Specific Checklist (TSC)
Participant-level mean QUICk Task-Specific Checklist score across the three eFAST examinations. The TSC has 28 image-based items, each scored 1 (performed adequately) or 0, covering the four abdominal and cardiac windows and the right and left lung separately; total 0 to 28. Each examination is scored by two blinded experts who did not supervise it. Minimum 0, maximum 28; higher scores indicate better image quality. Unit of Measure: score on a 0 to 28 scale
eFAST operator competence, Adapted OSAUS
Participant-level mean Adapted OSAUS (Objective Structured Assessment of Ultrasound Skills) across the three examinations. Three domains (image optimization, systematic examination, interpretation/diagnostic value) are each rated 1 (Poor) to 5 (Excellent); total 3 to 15. Each examination is scored by two blinded experts who did not supervise it. Minimum 3, maximum 15; higher scores indicate better operator competence. Unit of Measure: score on a 3 to 15 scale
Global diagnostic adequacy rating
Participant-level mean global diagnostic-adequacy rating across the three examinations, scored by blinded experts on a 0 to 10 scale (a separate Yes/No "diagnostically adequate" judgement is also recorded). Minimum 0, maximum 10; higher scores indicate greater diagnostic adequacy. Unit of Measure: score on a 0 to 10 scale
Mean eFAST examination duration
Participant-level mean examination duration, averaged across the three eFAST examinations, measured from first probe-skin contact to final eFAST interpretation. Unit of Measure: minutes
Learning effect on image-quality score (exam 1 to 3)
Exploratory learning effect: change in the participant's QUICk Global Rating Scale score from the first to the third consecutive examination. A larger positive change indicates greater improvement in image quality. Unit of Measure: QUICk GRS score (4 to 20 scale)
Learning effect on examination duration (exam 1 to 3)
Exploratory learning effect: change in examination duration from the first to the third consecutive examination. A larger reduction indicates greater improvement in speed. Unit of Measure: minutes
Time spent per eFAST region/window
Exploratory scanning-workflow metric derived from optical probe tracking: time spent per eFAST region/window. Unit of Measure: seconds
Probe dwell time
Exploratory scanning-workflow metric derived from optical probe tracking: probe dwell time at eFAST windows. Unit of Measure: seconds
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Philipp Fürnstahl
Lead sponsor
Balgrist University Hospital
Sponsor institution
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