Use of Hand-motion Analysis to Assess Competence and Skill Decay for Cardiac and Lung Point-of-care Ultrasound

Impact of an educational intervention utilising a three-dimensional-printed model for ultrasound-guided intra-articular injections of the dislocated shoulder

OBJECTIVE

Intra-articular injection of local anaesthetic provides safe and effective analgesia for patients with shoulder dislocation. We designed a three-dimensional-printed ultrasound model of the shoulder to educate ED clinicians on use of this technique. We aimed to evaluate the impact of a 1-h training session using this model on participants' knowledge, skills and clinical practice.

METHODS

This was a prospective study of the clinicians working at two EDs in New Zealand. Participants (n = 20) took part in a 1-h educational session. We tested participants' performance before the session, afterwards and at 3 months using a 10-point objective structured clinical examination. We reviewed clinical records to determine whether there was increased utilisation of this technique among ED patients before and after the training.

RESULTS

There was improvement in participants' OCSE performance (median pre-training score = 4.00, median 3-month post-training score = 7.00, P = 0.044) and self-reported competence and knowledge, which were sustained to the end of the study. There was increased use of intra-articular injection among ED patients with shoulder dislocation: 2 of 68 patients (3%) before and 11 of 76 patients (14.5%) after the study. Notably, most were performed by clinicians who did not take part in the study (n = 9).

CONCLUSION

A 1-h training session using a three-dimensional-printed model improved participants objective structured clinical examination performance in ultrasound-guided injection of the shoulder joint. Although there was minimal change in the practice of participating clinicians, overall use of the procedure increased.

Self-learning of cardiac ultrasound by medical students: can augmented online training improve and maintain manual POCUS skills over time?

BACKGROUND

The use of cardiac point of care ultra-sound is rapidly growing and so is the demand for quality POCUS teaching. POCUS teaching is usually conducted in small groups requiring much space and equipment. This study attempts to test whether providing access to an E-learning module as an adjunct to a cardiac POCUS course can increase students' image acquisition skills. This will show POCUS teaching can improve significantly without having to invest a significant amount of resources.

METHODS

Medical students (N = 125) were divided into two groups and had undergone a hands-on Cardiac POCUS course before their internal clerkship. During the clerkship, members of both groups got to practice their POCUS skills in the internal wards. One group was provided with accounts to a cardiac POCUS teaching E-learning platform (eMedical Academy©). After limited time for self- practice, both groups underwent a pre-validated ultrasound examination. The two groups' test results were then compared for each POCUS view and for the total exam score.

RESULTS

The E-learning group performed significantly better than the course-only group in the 6-min exam total score, and at acquiring the following views: parasternal long axis view, apical four-chamber view, and the inferior vena cava view.

CONCLUSION

E-learning platforms can be an efficient tool for improving cardiac POCUS teaching and maintaining POCUS skills. Using it as a supplement to a hands-on course provides better POCUS skills without the need of extra hands-on teaching.

Change in economy of ultrasound probe motion among general medicine trainees

OBJECTIVES

To observe change in economy of 9 ultrasound probe movement metrics among internal medicine trainees during a 5-day training course in cardiac point of care ultrasound (POCUS).

METHODS

We used a novel probe tracking device to record nine features of ultrasound probe movement, while trainees and experts optimized ultrasound clips on the same volunteer patients. These features included translational movements, gyroscopic movements (titling, rocking, and rotation), smoothness, total path length, and scanning time. We determined the adjusted difference between each trainee's movements and the mean value of the experts' movements for each patient. We then used a mixed effects model to trend average the adjusted differences between trainees and experts throughout the 5 days of the course.

RESULTS

Fifteen trainees were enrolled. Three echocardiographer technicians and the course director served as experts. Across 16 unique patients, 294 ultrasound clips were acquired. For all 9 movements, the adjusted difference between trainees and experts narrowed day-to-day (p value < 0.05), suggesting ongoing improvement during training. By the last day of the course, there were no statistically significant differences between trainees and experts in translational movement, gyroscopic movement, smoothness, or total path length; yet on average trainees took 28 s (95% CI [14.7-40.3] seconds) more to acquire a clip.

CONCLUSIONS

We detected improved ultrasound probe motion economy among internal medicine trainees during a 5-day training course in cardiac POCUS using an inexpensive probe tracking device. Objectively quantifying probe motion economy may help assess a trainee's level of proficiency in this skill and individualize their POCUS training.

Prehospital Ultrasound: A Narrative Review

Background: Point-of-care ultrasound is rapidly becoming more prevalent in the prehospital environment. Though considered a relatively new intervention in this setting, there is growing literature that aims to explore the use of prehospital ultrasound by EMS personnel.Methods: To better understand and report the state of the science on prehospital ultrasound, we conducted a narrative review of the literature.Results: Following a keyword search of MEDLINE in Ovid from inception to August 2, 2022, 2,564 records were identified and screened. Based on review of abstracts and full texts, with addition of seven articles via bibliography review, 193 records were included. Many included studies detail usage in air medical and other critical care transport environments. Clinicians performing prehospital ultrasound are often physicians or other advanced practice personnel who have previous ultrasound experience, which facilitates implementation in the prehospital setting. Emerging literature details training programs for prehospital personnel who are novices to ultrasound, and implementation for some study types appears feasible without prior experience. Unique use scenarios that show promise include during critical care transport, for triage in austere settings, and for thoracic evaluation of patients at risk of life-threatening pathology.Conclusion: There is a growing mostly observational body of literature describing the use of ultrasound by prehospital personnel. Prehospital ultrasound has demonstrated feasibility for specific conditions, yet interventional studies evaluating benefit to patient outcomes are absent.