[Ultrasound training in emergency and intensive care medicine : Integration already in medical school?]

[Virtual training of practical competences in sonography]

OBJECTIVE

During the COVID-19 pandemic, a particular challenge in the transition to digital teaching was to teach practical skills such as sonography of the head and neck online. The aim of this study was to validate the digital sonography course for medical students established at the Freiburg University Hospital ENT Department.

METHODS

Participants were 178 students of human medicine. The study group simulated the sonography examination at home with a dummy transducer using the Peyton method under the guidance of a tutor via video seminar. In a subsequent learning success check, the results of the students in the online course were compared with those of the control group, who learned sonography in the classroom.

RESULTS

Students of the online course achieved comparable results to the classroom group.

CONCLUSION

This study shows that practical skills which require extensive equipment such as a sonography machine can be taught to a certain extent digitally or at least in a hybrid form.

Preliminary exploration of theory and practice training of 5G ultrasonic remote consultation in grassroot hospitals

Background

With the rapid development of science and technology, telemedicine diagnosis and treatment systems have gradually attracted increased attention and applications.5G ultrasound is an important branch of telemedicine, connecting grassroots hospitals at one end and provincal hospitals at the other, which provides remote guidance to grassroots doctors for ultrasound examination and image diagnosis. It is convenient for villagers obtaining diagnosis and advice from provincial ultrasound experts, saving time and economic costs, as well as benefiting from high-quality ultrasound medical resources. In this study, taishun County community grassroot hospitals were selected as the pilot study of 5G ultrasound application, to explore the effectiveness of their theory and practice, and gradually improve the remote ultrasound diagnosis and treatment standards, so as to improve their quality of grassroots hospitals and benefit grassroots people. 

Methods

This is a descriptive study. The Provincal Hospital will conduct ultrasonic theory and practice training for grassroot hospitals. The training subjects included 43 doctors in grassroots hospitals who were willing to carry out ultrasound examinations. Theories, skills training scores and trainees' questionnaires on teaching content were collected and analyzed. After passing theoretical and practical training, they will conduct ultrasound examinations in their respective communities and collect relevant cases. There are 148 cases thus far for analysis. It mainly included the type of disease, whether the patient was out-patient or inpatient, frequency of ultrasound visits in recent 5 years, and follow-up treatment measures.

Results

It mainly included three aspects: (1) Through theoretical and practical training, the ultrasonic diagnosis level of grassroot doctors was significantly improved. The difference in scores between the two practical trainings was statistically significant. (2) Forty-three questionnaires were sent out, feedback from trainees was very high. Most of them was very satisfied with our training. The total score of the questionnaire was 10, and 97.67% of them score more than 8. (3) In total, there were 148 remote consultation cases, including 67 males and 81 females, who were aged 21 to 101 years old (62.40 ± 15.73).mainly abdominal ultrasound, and typical cases involve fatty liver, hepatic cyst, gallbladder stone, kidney stone and so on. We analyzed case data and provided follow-up treatment recommendations.

Conclusion

As a “visual apparatus”, 5G ultrasound can be routinely carried out in grassroot hospitals, which can provide mutual benefit between doctors and patients and comprehensively promote healthy villages.

What is the Interobserver Reliability of an Ultrasound-enhanced Physical Examination of the Hip in Infants? A Prospective Study on the Ease of Acquiring Skills to Diagnose Hip Dysplasia

BACKGROUND

Developmental dysplasia of the hip (DDH) is the most common disorder found in newborns. The consequences of DDH can be mitigated with early diagnosis and nonoperative treatment, but existing approaches do not address the current training deficit in making an early diagnosis.

QUESTION/PURPOSE

Can ultrasound be taught to and used reliably by different providers to identify DDH in neonates?

METHODS

This was a prospective observational study of a series of neonates referred for an evaluation of their hips. An experienced clinician trained three second examiners (a pediatric orthopaedic surgeon, an orthopaedic resident, and a pediatrician) in performing an ultrasound-enhanced physical examination. The 2-hour training process included video and clinical didactic sessions aimed to teach examiners to differentiate between stable and unstable hips in newborns using ultrasound. The experienced clinician was a pediatric orthopaedic surgeon who uses ultrasound regularly in clinical practice. Materials required for training include one ultrasound device. A total of 227 infants (454 hips) were examined by one of the three second examiners and the experienced clinician (gold standard) to assess reliability. Of the 454 hips reviewed, there were 18 dislocations, 24 unstable hips, and 63 dysplastic hips, and the remainder had normal findings. The cohort was composed of a series of patients younger than 6 months referred to a specialty pediatric orthopaedic practice.

RESULTS

Ultrasound-enhanced physical examination of the hip was easily taught, and the results were reliable among different levels of providers. The intraclass correlation coefficient between the gold-standard examiner and the other examiners for all hips was 0.915 (p = 0.001). When adjusting for only the binary outcome of normal versus abnormal hips, the intraclass correlation coefficient was 0.97 (p = 0.001). Thus, the agreement between learners and the experienced examiner was very high after learners completed the course.

CONCLUSION

After a 2-hour course, physicians were able to understand and reliably examine neonatal children using ultrasound to assess for DDH. The success of the didactic approach outlined in this study supports the need for ultrasound-enhanced examination training for the diagnosis of DDH in orthopaedic surgery and pediatric residency core curriculums. Training programs would best be supported through established residency programs. Expansion of training more residents in the use of ultrasound-enhanced physical examinations would require a study to determine its efficacy. This finding highlights the need for further research in implementing ultrasound-enhanced physical examinations on a broader scale.

LEVEL OF EVIDENCE

Level II, diagnostic study.

[Sonography in intensive care and emergency medicine : A new training concept]

Structured sonography training in internal medicine intensive care and emergency medicine (SIN) comprises two levels and was proposed by three national societies in Germany (DGIIN, DGK and DEGUM). The curriculum consists of a basic level (SIN-I) and an expert level (SIN-II) which are consecutive levels teaching both theoretical and hands-on skills using a symptom-based approach. Competency is assessed using written, oral and practical structured assessments at the end of each level. The goal is to implement national and international recommendations regarding the use of point-of-care ultrasound into clinical practice.