Digital Simulation-Based Ultrasound Training for Physiotherapy Students: Prospective Randomized Controlled Trial.

Background: Ultrasound education has traditionally relied on on-site training, but scalable digital solutions are increasingly needed. Objective: This study aimed to evaluate the effectiveness of a simulation-based online ultrasound platform compared with traditional on-site training. Methods: A prospective randomized blinded study was conducted with 68 physiotherapy students (n=34 per group). Participants were assigned to a simulation-based online training platform (WAZO) or traditional on-site instruction. Both groups completed identical theoretical and practical assessments. Item response theory using a Rasch model was applied to evaluate item difficulty and student ability. Results: No significant differences were found between the online and on-site groups in theoretical scores (mean 4.94, SD 1.47 vs mean 5.08, SD 1.14; P=.65) or practical performance variables, including probe handling (26/34, 76.5% vs 28/34, 82.4%; P=.37) and structure identification (24/34, 70.6% vs 22/34, 64.7%; P=.19). Measurement outcomes also showed no significant differences, including structure diameter (mean 3.78, SD 0.79 mm vs mean 3.98, SD 1.27 mm; P=.46) and structure surface distance (mean 3.94, SD 1.97 mm vs mean 3.24, SD 0.64 mm; P=.06). Item response theory analysis identified image optimization, structure diameter, and structure surface distance as the most difficult items, while probe handling and structure identification were the most informative. The model demonstrated high discriminative performance (area under the curve=0.93), with sensitivity of 87% and specificity of 80%. Conclusions: Simulation-based online ultrasound training provides comparable theoretical and practical outcomes to traditional on-site instruction, supporting its use as a scalable and accessible educational alternative.