Effectiveness of traditional, artificial intelligence-assisted, and virtual reality training modalities for focused cardiac ultrasound skill acquisition: a randomised controlled study.

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Abstract

Focused cardiac ultrasound (FCU) is increasingly used as an extension of physical examination to aid diagnosis and clinical decision-making. Emerging educational technologies such as artificial intelligence (AI)-enabled ultrasound devices and virtual reality (VR) simulators offer novel, cost-effective and self-directed approaches for FCU skill acquisition training. Prior studies suggest that VR-based training may be non-inferior to traditional teaching, while AI offers real-time feedback to enhance learning. This study aimed to evaluate the effectiveness and non-inferiority of AI and VR-assisted training compared to Traditional in-person instruction in achieving competency in FCU image acquisition. Secondary outcomes included time to acquire an optimal apical 4 chamber (A4C) view and self-reported confidence in image acquisition, assessed immediately post-training and at 3-month follow up. In this single-blind, randomized controlled pilot trial, 66 local medical students with no prior FCU experience were randomised into 3 arms: (1) AI-enabled ultrasound training using the Kosmos system, (2) VR-based stimulator (Vimedix), and (3) Traditional instructor-led teaching. All sessions were 60 min long. Image acquisition of 5 standard FCU views was assessed by blinded evaluators using the Rapid Assessment of Competency in Echocardiography (RACE) score at both time points. Two participants were lost to follow-up (one each from the AI and VR groups). In the first assessment, the Traditional group achieved the highest mean RACE score (15.77), followed by AI (13.39) and VR (13.23). Non-inferiority testing confirmed that both AI (95% CI -∞ to 3.60; p < 0.001) and VR (95% CI -∞ to 3.58; p < 0.001) methods were non-inferior to Traditional instruction. The AI group achieved the shortest mean time to acquire an optimal A4C view (158 ± 99.1 s), followed by the VR (189 ± 94.7 s), and traditional (199 ± 115.1 s), though differences were not statistically significant (p = 0.591). Confidence levels were initially highest in the Traditional group, while the VR group showed higher confidence at 3-month follow-up, particularly in parasternal long-axis view acquisition. AI and VR-based training methods were non-inferior to traditional instruction for FCU skill acquisition. Both modalities show promise as scalable, technology-enabled alternatives in ultrasound education. Trial registration This trial was registered on Clinicaltrials.gov (NCT06355557).

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