Southmead Hospital invests in BabyWorks to teach bedside ultrasound for neonates.

Southmead Hospital, Bristol has invested in the BabyWorks simulator to support hands-on teaching in bedside ultrasound for neonatology trainees in the south-west region. BabyWorks will allow trainees on the neonatal wards to develop skills in Point-of-Care Ultrasound (PoCUS) and echocardiography in a risk-free supportive environment.

Southmead Hospital is a regional tertiary center and joint-lead center for the northern sector of the Southwest Neonatal Network. In addition to internal training, the department has set up a regional training course using BabyWorks, designed around hands-on learning in neonatal PoCUS.

Dr David Evans MBE, Consultant Neonatologist & Director of Medical Education shared “The problem is that it takes people quite a while to just get the hand-eye coordination and the right views, and it’s quite difficult to learn on babies because they’ll start protesting, they get cold, and they’re being disturbed. So, it is very useful to get people to practise on a simulator.”

BabyWorks allows trainees to learn probe manipulation, viewing windows, and ultrasound image interpretation in a supported environment, without the pressures of clinical practice. This allows trainees to build confidence and technique to apply to real-life scanning, so when training in-clinic they can maximize time and reduce the stress to the infant.

“It means that they’re not rushing when they are scanning a baby” explained Dr Amiel Billetop, Consultant Neonatologist. “When scanning an infant, they have a lot of external factors that they’re worrying about at the same time as trying to scan. If they’ve already practised in a simulated way on a manikin, then they can maximize their time scanning the infant.”

Dr Evans added “The manikin also means you are able to slow down and unpick what they’re doing during the examination, because you can’t do that when scanning a real baby as that would prolong the examination, which would be at the detriment of the baby. The 3D models and the simulations offered with BabyWorks provide that ability to move offline if you like, and to explore just how you get the standard views.”

Prior to this, training centered around textbook-based learning, hands-on training on the neonatal unit and attending external courses. However, cases were limited by those which presented on the unit, and external courses were mainly centered around an older pediatric or adult patient population.

Dr Evans explained “People were going off on courses and were quite enthused coming back. But when they tried to scan a baby, and particularly preterm babies, they realized the views weren’t as easily obtained, the heart was beating much quicker, and the babies were less tolerant to being examined because of the cold stress, and so I think they got dispirited quite quickly.”

To fill this learning need, Southmead Hospital set up NeoBUS – Neonatal Bedside Ultrasound Course, using a mixture of hands-on learning with BabyWorks, and demonstrations using real babies. In the past, the department had run a cranial ultrasound course which was mainly lecture-based with limited demonstration at the cot-side, however, current learning requirements of neonatologists have much broader applications. With the addition of BabyWorks, the NeoBUS course focuses on the practical application of bedside ultrasonography of the heart, lungs and abdomen in neonates, and is open to ST4+ trainees throughout the region.

“I think it’s relatively easy to teach cranial ultrasound because you don’t disturb the babies as much and the image isn’t moving, the baby might move but the actual image isn’t moving” explained Dr Evans. “But the challenge is that clinically to be a neonatologist now you need to have some skills in being able to assess some function of the heart. Echo isn’t as easy to pick-up quickly because you’ve got a lot of complicated 3-dimensional anatomy and it is not really portrayed that well in textbooks. It doesn’t sit as a nice four-chamber view all the time, and of course it’s beating as well, so there are more practical problems with imaging in the heart. Many of the courses that trainees went on were often aimed more at pediatric cardiology and they would inevitably use older subjects for demonstration, and I think that’s fine for pediatric cardiology, but for babies it’s very different.”

Dr Billetop described how BabyWorks allowed the program to teach the wider applications of PoCUS. “Cardiac is a big feature, and it’s a large reason why trainees want to come on the course, but it’s not the only skills that they want to take away with them. They want to explore abdominal ultrasound, cranial and renal, and BabyWorks allowed us that variety.”

Dr Evans added that they did consider other options, but BabyWorks was the only option which allowed them to teach cardiac, cranial, lung, abdominal, and renal ultrasound, all in one comprehensive realistic simulator. “I think BabyWorks seemed to be the full package for cardiology but additionally for abdominal ultrasound, lungs, and cranial ultrasound, and I don’t think there were other viable alternatives that allowed that variety.”

The department now hopes to join with other neonatal experts around the country to develop further training opportunities in neonatal ultrasound, and to work with other centers to create a national syllabus and accreditation in neonatal bedside ultrasound.

Find out more about BabyWorks:

Hi-fidelity ultrasound simulators for Point-of-Care Ultrasound (PoCUS), Transesophageal and Transthoracic Echocardiography (TTE & TEE) in pediatric and neonatal care.