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Wubben BM, Wittrock C. Simulation Improves Emergency Medicine Residents' Clinical Performance of Aorta Point-of-Care Ultrasound. West J Emerg Med 2024; 25:205-208. [PMID: 38596919 PMCID: PMC11000555 DOI: 10.5811/westjem.18449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 04/11/2024] Open
Abstract
Purpose Using point-of-care ultrasound (POCUS) to diagnose abdominal aortic aneurysm (AAA) is an essential skill in emergency medicine (EM). While simulation-based POCUS education is commonly used, the translation to performance in the emergency department (ED) is unknown. We investigated whether adding case-based simulation to an EM residency curriculum was associated with changes in the quantity and quality of aorta POCUS performed by residents in the ED. Methods A case-based simulation was introduced to resident didactics at our academic, Level I trauma center. A case of undifferentiated abdominal pain was presented, which required examination of an ultrasound phantom to diagnose an AAA, with a hands-on didactic. We compared the quantity, quality, and descriptive analyses of aorta POCUS performed in the ED during the four months before and after the simulation. Results For participating residents (17/32), there was an 86% increase in total studies and an 80% increase in clinical studies. On an opportunity-adjusted, per-resident basis, there was no significant difference in median total scans per 100 shifts (4.4 [interquartile range (IQR) 0-15.8 vs 8.3 [IQR] 3.3-23.6, P = 0.21) or average total quality scores (3.2 ± 0.6 vs 3.2 ± 0.5, P = 0.92). The total number of limited or inadequate studies decreased (43% vs 19%, P = 0.02), and the proportion of scans submitted by interns increased (7% vs 54%, P = < .001). Conclusion After simulation training, aorta POCUS was performed more frequently, and ED interns contributed a higher proportion of scans. While there was no improvement in quantity or quality scores on a per-resident basis, there were significantly fewer incomplete or limited scans.
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Affiliation(s)
- Brandon M. Wubben
- University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
| | - Cory Wittrock
- University of Iowa Hospitals and Clinics, Department of Emergency Medicine, Iowa City, Iowa
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Junker C, Vakkalanka P, Wittrock C. Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies. J Physician Assist Educ 2023; 34:329-332. [PMID: 37787744 DOI: 10.1097/jpa.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Clinical ultrasound training is essential to any emergency medicine (EM) clinician's skill set. We aim to understand the current training patterns of clinical ultrasound training within Advanced Practice Provider (APP) residencies. METHODS In a survey sent electronically to 17 active EM APP residencies, data were obtained from 21 responses to questions about structure of ultrasound faculty, quality assessment, feedback, and competency evaluation. RESULTS We had a response rate of 88%. Of programs surveyed, 93% were associated with EM physician residencies with 87% led by an ultrasound fellowship-trained EM physician. Ninety-three percent of programs required proctored scanning. Sixty percent of programs do not have any required number of scans to graduate. CONCLUSION We found that most EM APP residencies share clinical ultrasound faculty, structures, and processes with associated EM physician residencies. We believe that quality training within clinical ultrasound is attainable; however, proficiency guidelines across EM APP residency programs are lacking.
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Affiliation(s)
- Christian Junker
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Priyanka Vakkalanka
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Cory Wittrock
- Christian Junker, PA-C, is a clinical assistant professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Priyanka Vakkalanka, PhD, is an associate research scientist, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Cory Wittrock, MD, is a clinical associate professor, Department of Emergency Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
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Wubben BM, Wallum MR, Wittrock CA. Exploring a Cadaver-Based Model for Teaching Emergency Medicine Residents Ultrasound-Guided Serratus Anterior Plane Blocks. Cureus 2023; 15:e45178. [PMID: 37842508 PMCID: PMC10575712 DOI: 10.7759/cureus.45178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Background Ultrasound-guided regional anesthesia (USGRA) is increasingly being incorporated into ED clinical practice to provide pain control for a variety of traumatic injuries. The serratus anterior plane block (SAPB) has been shown to be effective at reducing intravenous opioid use and improving pulmonary function for patients with rib fractures, but there is limited prior research about how to safely teach this procedure to emergency medicine (EM) residents. Our goal was to examine the effect of a cadaver-based education model on EM residents' confidence in performing USGRA and provide a review of commonly encountered errors. Methods EM residents participated in a half-day cadaver-based education session that included a variety of less-commonly performed procedures including SAPB and fascia iliaca compartment block (FICB) USGRA. Residents received a didactic lecture and hands-on simulation practice during the month prior to the session. During the session, residents performed a SAPB and FICB on the cadaver patient using the same nerve block kit and ultrasound machine they would use for a living patient, with 1:1 supervision by an emergency ultrasound fellowship-trained physician who provided real-time feedback during the procedure. Representative ultrasound video clips were saved and reviewed. Surveys that were completed by residents after the session were analyzed. Results There were 23 residents who participated, and most had not performed any FICB (74%) or SAPB (87%) previously. The percentage of residents comfortable with general USGRA increased from 8.7% to 91.3% (p<0.001). Comfort with FICB increased from 9.1% to 77.3% (p<0.001), and comfort with SAPB increased from 9.1% to 77.3% (p<0.001). Instructors identified and corrected several common errors, such as overly aggressive needle insertion, instillation of air, and instillation of anesthetic into muscle rather than the fascial plane. Conclusion We found that a cadaver-based education model for teaching EM residents the SAPB and the FICB was associated with significant increases in resident confidence in performing the procedure and facilitated identification and correction of common procedural errors that may otherwise have gone undetected.
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Affiliation(s)
- Brandon M Wubben
- Department of Emergency Medicine, The University of Iowa, Iowa City, USA
| | - Michael R Wallum
- Department of Emergency Medicine, The University of Iowa, Iowa City, USA
| | - Cory A Wittrock
- Department of Emergency Medicine, The University of Iowa, Iowa City, USA
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Bailitz J, O'Brien J, McCauley M, Murray D, Jung C, Peksa G, Gottlieb M. Development of an expert consensus checklist for emergency ultrasound. AEM EDUCATION AND TRAINING 2022; 6:e10783. [PMID: 35936814 PMCID: PMC9348840 DOI: 10.1002/aet2.10783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Within today's competency-based medical education, traditional set number proficiency benchmarks have been called into question. Checklists may help guide individualized training and standardized outcomes. However, multicenter expert consensus checklists based on established guidelines with supporting validity evidence have not been published for specific emergency ultrasound (EUS) applications. We describe a robust national EUS expert consensus methodology for developing a checklist for the extended focused assessment with sonography in trauma (eFAST examination). METHODS Utilizing the ACEP imaging compendium as a primary reference, 10 national EUS experts iteratively refined and agreed upon a final checklist. To obtain initial reliability and validity evidence, two different EUS experts blinded to resident experience then assessed 24 residents performing an eFAST in a simulated environment. Inter-rater reliability of the checklist was assessed using Cohen's kappa coefficient. Validity was assessed by comparing mean performance with the Student's t-test and discriminant ability of individual checklist items using item-total correlation. RESULTS The 10 EUS experts agreed on the final checklist items after two rounds of iterations. When evaluating 24 emergency medicine (EM) PGY-1 to -4 residents, the kappa correlation between two blinded EUS faculty raters was moderate at 0.670. Kappa and agreement were near-perfect or perfect in right and left chest image optimization, right upper quadrant (RUQ) probe placement, RUQ anatomy identification, and pelvic first-view anatomy identification. The difference in checklist performance between junior and senior EM residents was significant at -8.1% (p = 0.004). Identification of pelvic structures and placement of the probe for pelvic views were found to have an excellent item-total correlation with values of >0.4. CONCLUSIONS We have described a robust national EUS expert consensus methodology for developing an eFAST checklist based on the ACEP imaging guidelines. Based on this encouraging initial reliability and validity evidence, further research and checklist development is warranted for additional EUS applications.
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Affiliation(s)
- John Bailitz
- Department of Emergency Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - James O'Brien
- Department of Emergency Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Matt McCauley
- Department of Emergency Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - David Murray
- Department of Emergency MedicineCook County HospitalChicagoIllinoisUSA
| | - Christine Jung
- Department of Emergency MedicineCook County HospitalChicagoIllinoisUSA
| | - Gary Peksa
- Department of Emergency MedicineRush Medical CollegeChicagoIllinoisUSA
| | - Michael Gottlieb
- Department of Emergency MedicineRush Medical CollegeChicagoIllinoisUSA
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Wang PH, Chen JY, Ling DA, Lee AF, Ko YC, Lien WC, Huang CH. Earlier point-of-care ultrasound, shorter length of stay in patients with acute flank pain. Scand J Trauma Resusc Emerg Med 2022; 30:29. [PMID: 35449010 PMCID: PMC9021562 DOI: 10.1186/s13049-022-01017-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/10/2022] [Indexed: 12/23/2022] Open
Abstract
Background The effects of early integration of point-of-care ultrasound (PoCUS) into patient care are uncertain. This study aims to investigate the effects of early PoCUS on patients with acute flank pain. Methods Adult non-traumatic patients with acute flank pain receiving PoCUS were enrolled. Expert physicians reviewed the medical records and made the “final diagnosis” for the cause of acute flank pain. The primary outcome was the relationship between the door to ultrasound (US) time and length of stay (LOS). The secondary outcomes included the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the sonographic diagnosis, compared with the final diagnosis. Results Eight hundred and eighty-eight patients were included in the analysis. Patients receiving early PoCUS (≤120 min) had a shorter LOS (128 vs. 217 min, p < 0.0001). Patients in the late POCUS group (> 120 min) had a trend to receive more CT scans. The disease distribution, sensitivity, specificity, PPV, and NPV were similar in patients receiving early or late PoCUS for target diagnoses. After adjusting for the confounders, early PoCUS (OR, 2.77, 95% CIs, 1.93–3.98) had a positive impact on shorter LOS. In addition, the effect of early PoCUS became more prominent (OR, 4.91, 95% CIs, 3.39–7.13) on LOS in less than 3 h. Conclusions Early integration of PoCUS is significantly related to shorter LOS in patients with acute flank pain without increasing morbidity and mortality. Our results suggested “PoCUS early” in these patients to possibly alleviate emergency department crowding. Trial registration NCT04149041 at the ClinicalTrial.gov.
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Affiliation(s)
- Pei-Hsiu Wang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Jia-Yu Chen
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Dean-An Ling
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - An-Fu Lee
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Ying-Chih Ko
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan. .,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Chien-Hua Huang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, 100, Taiwan.,Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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PoSaw LL, Wubben BM, Bertucci N, Bell GA, Healy H, Lee S. Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods. J Am Coll Emerg Physicians Open 2021; 2:e12439. [PMID: 34142104 PMCID: PMC8202829 DOI: 10.1002/emp2.12439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Over the past 2 decades, emergency ultrasound has become essential to patient care, and is a mandated competency for emergency medicine residency graduation. However, the best evidence regarding emergency ultrasound education in residency training is not known. We performed a scoping review to determine the (1) characteristics and (2) outcomes of published structured training methods, (3) the quality of publications, and (4) the implications for research and training. METHODS We searched broadly on multiple electronic databases and screened studies from the United States and Canada describing structured emergency ultrasound training methods for emergency medicine residents. We evaluated methodological quality with the Medical Education Research Study Quality Instrument (MERSQI), and qualitatively summarized study and intervention characteristics. RESULTS A total of 109 studies were selected from 6712 identified publications. Publications mainly reported 1 group pretest-posttest interventions (38%) conducted at a single institution (83%), training in image acquisition (82%) and interpretation (94%) domains with assessment of knowledge (44%) and skill (77%) outcomes, and training in cardiac (18%) or vascular access (15%) applications. Innovative strategies, such as gamification, cadaver models, and hand motion assessment are described. The MERSQI scores of 48 articles ranged from 0 to 15.5 (median, 11.5; interquartile range, 9.6-13.0) out of 18. Low scores reflected the absence of reported valid assessment tools (73%) and higher level outcomes (90%). CONCLUSIONS Although innovative strategies are illustrated, the overall quality of research could be improved. The use of standardized planning and assessment tools, intentionally mapped to targeted domains and outcomes, might provide valuable formative and summative information to optimize emergency ultrasound research and training.
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Affiliation(s)
- Leila L. PoSaw
- Division of Emergency MedicineJackson Memorial HospitalMiamiFloridaUSA
| | | | | | - Gregory A. Bell
- Department of Emergency MedicineUniversity of IowaIowa CityIowaUSA
| | - Heather Healy
- Hardin Library for the Health SciencesUniversity of Iowa LibrariesIowa CityIowaUSA
| | - Sangil Lee
- Department of Emergency MedicineUniversity of IowaIowa CityIowaUSA
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