Recently, the CEO of the American Society for Reproductive Medicine (ASRM), Richard Reindollar, M.D., and the Immediate-Past President, Christos Coutifaris, M.D., Ph.D. visited VirtaMed here in Switzerland. The ASRM and VirtaMed have a long relationship of collaboration, which started in January 2015 with the development of the ASRM’s Embryo Transfer simulator.
The ASRM is now concluding it’s most recent strategic plan (2014 – 2019) and we took this opportunity to speak with Drs. Reindollar and Coutifaris about the ASRM’s current success with simulation, as well as their perceived future prospects for simulation in the fields of fertility and ultrasound.
The ASRM and Simulation Innovation
The seed for collaboration was planted when the ASRM recognized an “absolute unmet need” in terms of training for ASRM fellows. During their fellowships, essentially 50% of fellows were not allowed to perform the actual embryo transfer, one of the most important parts of the in-vitro fertilization process. In response to this need, the ASRM sought a partnership with VirtaMed to create a simulation-based solution.
From the ASRM’s point of view, the project has two, equally important, components. The first was to coordinate with VirtaMed through an expert task force to develop the best possible hardware and software for the simulator itself. The second was to collaborate on a curriculum that would use simulators to the best of their potential as teaching tools. According to Dr. Reindollar, this was a very involved process, which included a comprehensive survey of IVF medical directors, and an extensive literature survey to develop appropriate guidelines for the simulation. Through this research, the ASRM developed a standard embryo transfer protocol which was then embedded into the simulator’s software. The development of a successful simulation depended on the continuous collaboration between the two organizations, and Dr. Reindollar noted that “we did it, along the way, totally with VirtaMed, and we were able to use the skills of each other to produce a terrific product.”
Collaboration has continued between the two organizations with the ongoing aim of enhancing the training value of the simulator and addressing the evolving needs of the ASRM’s membership. The most recent upgrades to the simulator include a comprehensive software update with more features and the addition of a retroverted uterine practice model.
Simulation in Embryo Transfer Training
The ASRM’s Embryo Transfer simulators have been made available to the Society’s membership as part of a certificate course. Most commonly, fellows first complete online course work including reading, learning materials, and other assessments. Participants then attend a day and a half long workshop where they get to practice their new skills with hands-on simulator practice. This includes working through progressively more complex cases, practicing on different uterine pathologies, and strategizing the different techniques available under the guidance of an instructor. Because the course takes place as part of a well-outlined program and over an extended period of time, fellows develop their skills naturally through repetition. This is an advantage over intensive courses or training via demonstration. Prior to the introduction of the ASRM’s ET Simulator, fellows often relied on doing ‘mock transfers’ to learn ET procedures. However, because the simulator mimics a live transfer, it is closer to reality, both in the steps undertaken and in how the procedure is perceived by fellows.
As part of its outreach efforts, the ASRM has also deployed the ET simulator to remote sections of the United State through a loan program. Lasting between four to six weeks, fellows can take advantage of having the simulator to practice their skills and develop their confidence with recently-learned procedures. Driven by the success of the certificate course in the United States, as well as consistent requests from overseas members, simulators are currently being utilized for global deployment.
Dr. Coutifaris, who currently supervises several fellows, has witnessed first-hand the benefits of simulation training. He notes that he recently “had the opportunity to take my own fellows through the whole course and the confidence they developed through doing the transfers was pretty amazing. It made them faster, not only in the mechanics of doing the transfer, but in how confident they felt…this is a major achievement of the simulator.”
In addition to training fellows, simulator-based training has also proven useful for standardizing embryo transfer techniques across all levels of experience and for refreshing the skills of more-experienced practitioners. As validation of simulation continues, it is likely to increasingly become part of both training and certificate maintenance processes. For instance, the ASRM’s ET certificate was recently approved to satisfy part 4 of the ‘Maintenance of Certification’ for OB/GYN. Furthermore, some fellowship programs which previously did not permit fellows to perform embryo transfers have started allowing them after they complete the Certificate Course.
Simulation for Ultrasound Training
Drawing upon the ultrasound technology developed as part of the ASRM’s ET simulator, VirtaMed recently completed development on both a transvaginal and transabdominal ultrasound simulator.
We at VirtaMed were excited to get the opinions of both Dr. Reindollar and Dr. Coutifaris on our new ultrasound simulators. It should be noted the neither Dr. Reindollar nor Dr. Coutifaris were involved in the development of these simulators; nor are these simulators affiliated with or endorsed by the ASRM.
After spending part of the day with us and getting hands-on demonstrations of our new ultrasound simulators, we asked Drs. Reindollar and Coutifaris to share their impressions. Dr. Coutifaris commented that he “found the whole experience very realistic, both with how it felt with the probe and of course the image. This was the first time that I [have] done this with a VirtaMed produce and I thought it was really, really excellent.”
Dr. Reindollar shared with us his perceived benefits of having an ultrasound simulator tor training. In his opinion the value of an ultrasound simulator is three-fold. First, it enables trainees to become comfortable with the basics of the procedure, such as instrument usage and procedure steps.
Second, trainees can learn to identify the very subtle signs of certain pathologies. For example, it is important to identify ectopic pregnancies early, however the signs are difficult to distinguish from normal structures and simulation allows trainees to practice discerning normal from abnormal pathologies in a risk-free environment.
Third, with simulation rare pathologies can be taught so they are recognized by trainees. To see all possible pathologies with traditional training methods, trainees would need to perform hundreds, if not thousands, of ultrasounds. An additional benefit is that trainees can practice how to best communicate these results with the patient, and clearly convey the type and meaning of abnormal findings.
The Future of Simulation in Medical Education
Given the diverse potential of simulation, both physicians agreed that simulation would only grow in importance for medical education. The days of ‘see one, do one, teach one,’ have passed, and the future is likely to be defined by training on simulators as more and more procedures are successfully simulated. And new learning tools are not only for beginners, as Dr. Reindollar pointed out, simulation “has an enormous opportunity to teach trainees in every phase of their training, and to do the teaching better.” The ultimate benefit, he emphasized, is for the patient because “better training leads to better patient outcomes.”