Accepted for/Published in: JMIR Medical Education
Date Submitted: Nov 17, 2025
Open Peer Review Period: Nov 20, 2025 - Jan 15, 2026
Date Accepted: Apr 22, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Digital Simulation–Based Ultrasound Training for Physiotherapy Students: A Blinded Randomized Trial Applying Item Response Theory
ABSTRACT
Background:
Background:
Ultrasound education across health sciences has traditionally relied on onsite, instructor-led training. The growing need for scalable, cost-effective, and competency-based education has accelerated the adoption of simulation-based e-learning. WAZO is an online ultrasound simulator designed to reproduce practical scanning experiences through interactive digital training.
Objective:
Objective:
This study aimed to evaluate the effectiveness of WAZO as an online simulation-based platform for teaching musculoskeletal ultrasound compared with traditional onsite training. Additionally, we used Item Response Theory (IRT) to assess the psychometric properties and discriminative performance of the practical evaluation items.
Methods:
Methods:
A prospective randomized blinded study was conducted with 68 second-year physiotherapy students at the University of Alcalá (Spain). Participants were randomized into two groups: online training using the WAZO platform (experimental) and traditional onsite instruction (control). Both groups completed identical theoretical and practical exams. Rasch modeling under the IRT framework was used to examine item difficulty (δ), student ability (θ), and model fit. Reliability and agreement were analyzed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC).
Results:
Results:
No significant differences were found between online and onsite groups in theoretical or practical performance (P>.05). IRT analysis revealed an adequate unidimensional model fit, identifying “image optimization,” “structure diameter,” and “surface distance” as the most difficult items, and “probe handling” and “structure identification” as the most informative for competency assessment. The model achieved excellent discrimination (area under the curve 0.93) with high sensitivity (87%) and specificity (80%).
Conclusions:
Conclusions:
Simulation-based e-learning using WAZO achieved comparable learning outcomes to traditional ultrasound instruction while offering enhanced scalability, accessibility, and potential cost-effectiveness. The use of Item Response Theory provided deeper psychometric insight into assessment design, supporting its inclusion as a methodological asset in future digital ultrasound education research.
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Copyright
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