High-Fidelity Ultrasound Simulation Increases Nephrology Fellows' Confidence with Kidney/Bladder Point-of-Care Ultrasonography

Background: Point-of-care ultrasonography (POCUS) is expanding in nephrology training and practice. Previously reported nephrology fellowship POCUS curricula blend didactic and hands-on teaching methods to foster learner competency. Ultrasound-based simulation offers a promising approach to reinforce POCUS image acquisition, interpretation, and clinical integration skills. We evaluated the effectiveness of a high-fidelity ultrasound simulation POCUS activity in our nephrology fellowship program. Methods: This was a single-center study of five nephrology fellows who participated in a high-fidelity ultrasound simulation using the Simbionix U/S Mentor™. Participants previously completed Kidney/Bladder POCUS didactics and orientation with the simulator platform. Fellows performed Kidney/Bladder POCUS on a simulated case of bilateral hydronephrosis due to obstructive urolithiasis. Image acquisition was observed and scored by POCUS-trained faculty. Fellows completed pre- and post-simulation surveys assessing confidence across three domains: image acquisition, interpretation, and clinical synthesis. Wilcoxon signed-rank tests were used to analyze paired confidence scores. Results: Survey response rates were 100%. After participating in the simulation, fellows reported improvement in self-reported confidence: image acquisition (20% to 80%), interpretation (20% to 60%), and clinical synthesis (20% to 80%). All p-values approached statistical significance (p = 0.0625). Objective image quality averaged 3.6/5, with PGY-5 fellows scoring higher than PGY-4. All participants correctly identified the pathology and proposed appropriate management. Post-simulation, 100% of fellows strongly agreed that the experience enhanced their skills. The majority of participants agreed that the simulation experience was sufficiently realistic and were interested in more opportunities to participate in simulation-based POCUS education. Conclusion: High-fidelity ultrasound simulation improved nephrology fellows’ confidence with Kidney/Bladder POCUS. As a realistic and well-received modality, simulation may be a valuable supplement to traditional POCUS education. While the availability of simulator technology is a possible barrier, broader implementation of simulation-based training has the potential to enhance POCUS skill acquisition and utilization in nephrology practice.