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Breunig M, Chelf C, Kashiwagi D. Point-of-Care Ultrasound Psychomotor Learning Curves: A Systematic Review of the Literature. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38712576 DOI: 10.1002/jum.16477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES Use of point-of-care ultrasound (POCUS) in clinical medicine and inclusion in medical training is increasing. Some professional societies recommend that 25-50 POCUS examinations be completed for each application learned; however, the amount of practice required is not well studied. As such, a better understanding of the learning curves of POCUS psychomotor skills is needed. This systematic review characterizes the learning curves for POCUS psychomotor skill acquisition. METHODS With the assistance of a research librarian, the available literature through August 28, 2023, was identified. The titles and abstracts, and then the full text were reviewed by two reviewers to screen for inclusion. All studies included after full-text review then underwent data extraction and analysis. RESULTS The search identified 893 unique studies. Forty-five studies underwent full-text review, with 17 meeting full inclusion criteria. Substantial heterogeneity was noted in study design, duration of education, number and type of learners, and methods for statistical analysis. Clear and validated definitions for learning endpoints, such as plateau points or competency, are lacking. Learning curves and endpoints differ for different applications of POCUS. CONCLUSION The results are overall supportive of the recommendations to complete 25-50 examinations per application of POCUS learned. However, specific applications require more practice than others. Certain applications, such as cardiac and the Focused Assessment with Sonography in Trauma (FAST) exams, are closer to 50; while others, such as soft tissue, airway, and eye require no more than 25.
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Affiliation(s)
- Mike Breunig
- Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cynthia Chelf
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - Deanne Kashiwagi
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Eimer C, Lorenzen U, Reifferscheid F, Passau N, Helzel K, Schmuck A, Seewald S, Köser A, Weiler N, Gässler H, Hossfeld B, Gruenewald M, Feth M. [Ultrasound diagnostics in prehospital emergency care-do we need a standardized educational approach?]. Med Klin Intensivmed Notfmed 2024; 119:309-315. [PMID: 37656173 PMCID: PMC11058608 DOI: 10.1007/s00063-023-01045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Limited diagnostic capabilities represent an ongoing obstacle in out-of-hospital emergency settings. Prehospital deployment of ultrasound might reduce this particular diagnostic gap. So far, little is known about the availability and usage of ultrasound in emergency medical services (EMS) or about the level of education of EMS physicians regarding prehospital ultrasound (point-of-care ultrasound, POCUS). METHODS A nationwide survey was conducted among emergency physicians in Germany focusing on POCUS education and experience. RESULTS Between 02/2022 and 05/2022, 1079 responses were registered, of which 853 complete responses were analyzed. Of the emergency physicians, 71.9% consider POCUS beneficial for out-of-hospital diagnostics and 43.8% had participated in a certified POCUS training prior to the survey. The self-evaluation of POCUS skills among emergency physicians depended significantly on their participation in a certified training (p < 0.001) and frequent ultrasound routine (p < 0.001). CONCLUSION The majority of participating emergency physicians in Germany consider POCUS to improve out-of-hospital diagnostic capabilities. Participation in a certified POCUS training and frequent use of ultrasound facilitated higher self-confidence in POCUS skills.
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Affiliation(s)
- Christine Eimer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland.
| | - Ulf Lorenzen
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Florian Reifferscheid
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
- Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte, Lübeck, Deutschland
| | - Nils Passau
- analytix GmbH, Institut für Qualitative Marktforschung und Datenanalyse, Kiel, Deutschland
| | - Katharina Helzel
- analytix GmbH, Institut für Qualitative Marktforschung und Datenanalyse, Kiel, Deutschland
| | - Alexander Schmuck
- Klinik für Anästhesiologie und Notfallmedizin, Ameos-Klinik Eutin, Eutin, Deutschland
| | - Stephan Seewald
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
- Institut für Rettungs- und Notfallmedizin, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - Andrea Köser
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Norbert Weiler
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Holger Gässler
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Björn Hossfeld
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
| | - Matthias Gruenewald
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Christian-Albrechts-Universität Kiel, Kiel, Deutschland
| | - Maximilian Feth
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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Takeda K, Kasai H, Tajima H, Hayama N, Saito M, Kawame C, Suzuki T. Effectiveness of Lung Ultrasound Training Utilizing a High-Fidelity Simulator. ATS Sch 2024; 5:133-141. [PMID: 38628301 PMCID: PMC11019766 DOI: 10.34197/ats-scholar.2023-0084oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 11/15/2023] [Indexed: 04/19/2024] Open
Abstract
Background The usefulness of lung ultrasound (LUS) has been demonstrated. However, it is unclear whether diagnostic techniques using LUS are accepted by all physicians. A simple simulation-based educational program may improve the LUS skills of beginners, but it has not been fully assessed. Objective This prospective study was conducted to assess the educational outcomes of LUS training using a high-fidelity simulator. Methods A simulator-based program for LUS was conducted. All clerkship students at the Department of Respirology at Chiba University Hospital participated in the program from December 2022 to April 2023. The participants watched a 30 minute teaching video on demand before a hands-on session lasting for 1 hour during the first week of the clinical clerkship. The readiness of the participants to learn LUS and the usefulness of the program were assessed using questionnaires administered before and after the program. The LUS skills were assessed using simulator-based tests during Weeks 1 and 4. Data on the accuracy and time required to answer the questions were collected during the tests. Results Forty clerkship students participated in this study. Thirty-three (82.5%) had received other ultrasound education; however, only two (5.0%) had experience with LUS. Based on the questionnaire responses, the participants perceived LUS as useful (preprogram: 4.6 vs. postprogram: 4.8; P = 0.010; a 5-point Likert scale was used [1: not useful to 5: useful]). The simulator-based tests showed comparable accuracies at Weeks 1 and 4 for pneumothorax (Week 1: 47.5% vs. Week 4: 52.5%; P = 0.623), pulmonary edema (Week 1: 100% vs. Week 4: 100%; P = 1.000), and pleural effusion (Week 1: 37.5% vs. Week 4: 40.0%; P = 0.800). The time required for scanning was the same for each question. In addition, the test results did not differ with prior learning, previous knowledge, or experience during clinical clerkships on LUS. Conclusion A short educational program consisting of on-demand learning and hands-on sessions with a high-fidelity simulator would be effective in equipping clerkship students with basic LUS skills. However, to increase its educational effectiveness to a practical degree, the program should be improved, and more opportunities for training using simulators should be provided.
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Affiliation(s)
- Kenichiro Takeda
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Tajima
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nami Hayama
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mikihito Saito
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Chiaki Kawame
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Frantz AM, Fahy BG. POCUS focus: Dilemmas of the technologically advanced device. J Clin Anesth 2024; 92:111305. [PMID: 37919164 DOI: 10.1016/j.jclinane.2023.111305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Amanda M Frantz
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA
| | - Brenda G Fahy
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610-0254, USA.
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Breunig M, Hanson A, Huckabee M. Learning curves for point-of-care ultrasound image acquisition for novice learners in a longitudinal curriculum. Ultrasound J 2023; 15:31. [PMID: 37402989 DOI: 10.1186/s13089-023-00329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND A learning curve is graphical representation of the relationship between effort, such as repetitive practice or time spent, and the resultant learning based on specific outcomes. Group learning curves provide information for designing educational interventions or assessments. Little is known regarding the learning curves for Point-of-Care Ultrasound (POCUS) psychomotor skill acquisition of novice learners. As POCUS inclusion in education increases, a more thorough understanding of this topic is needed to allow educators to make informed decisions regarding curriculum design. The purpose of this research study is to: (A) define the psychomotor skill acquisition learning curves of novice Physician Assistant students, and (B) analyze the learning curves for the individual image quality components of depth, gain and tomographic axis. RESULTS A total of 2695 examinations were completed and reviewed. On group-level learning curves, plateau points were noted to be similar for abdominal, lung, and renal systems around 17 examinations. Bladder scores were consistently good across all exam components from the start of the curriculum. For cardiac exams, students improved even after 25 exams. Learning curves for tomographic axis (angle of intersection of the ultrasound with the structure of interest) were longer than those for depth and gain. Learning curves for axis were longer than those for depth and gain. CONCLUSION Bladder POCUS skills can be rapidly acquired and have the shortest learning curve. Abdominal aorta, kidney, and lung POCUS have similar learning curves, while cardiac POCUS has the longest learning curve. Analysis of learning curves for depth, axis, and gain demonstrates that axis has the longest learner curve of the three components of image quality. This finding has previously not been reported and provides a more nuanced understanding of psychomotor skill learning for novices. Learners might benefit from educators paying particular attention to optimizing the unique tomographic axis for each organ system.
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Affiliation(s)
- Mike Breunig
- Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Andrew Hanson
- Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael Huckabee
- Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, 200 First Street SW, Rochester, MN, 55905, USA
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Murray S, Trinder K, Kolbenson L, Katulka J, Olszynski P. Virtual Supervision of Third Year Medical Students Using Handheld POCUS Devices and Cloud-based Image Archiving Provides Opportunity for Feedback and Skill Improvement. POCUS JOURNAL 2023; 8:60-64. [PMID: 37152344 PMCID: PMC10155719 DOI: 10.24908/pocus.v8i1.16195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Background : Feedback on Point of Care Ultrasound (POCUS) skills is essential for skill development. Providing feedback can be difficult in a large province with several distributed medical education sites. Use of handheld POCUS devices and a cloud-based image archiving enables virtual supervision. We evaluated the quality of uploaded images as well as feedback provided to students. Methods: Volunteer third year students were given access to handheld POCUS devices at various training sites. Students were encouraged to upload educational POCUS scans to their accounts where they would then receive feedback from faculty. Subsequently, images that met inclusion criteria were randomized and reviewed by a blinded expert using a global rating scale. Feedback was also analyzed. Finally, students completed a questionnaire on their technology-enhanced POCUS learning experience. Results: An independent-sampled t-test comparing mean ratings for initial images submitted prior to any feedback with those submitted after three rounds of feedback showed significant effect on image scores (2.60 vs 3.50, p = .040, d = .93). Feedback included 4 performance domains (indications, image generation, interpretation, and integration). Students found the technology easy to use and felt feedback was tailored to their learning needs. Conclusions: We observed that virtual feedback provided to medical students through a cloud-based work platform can be effective for enhancing POCUS skills.
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Affiliation(s)
- Sydney Murray
- College of Medicine, University of SaskatchewanSaskatoon, SKCanada
| | - Krista Trinder
- College of Medicine, University of SaskatchewanSaskatoon, SKCanada
| | - Linden Kolbenson
- Department of Medicine, University of SaskatchewanSaskatoon, SKCanada
| | - Jeremy Katulka
- Department of Medicine, University of SaskatchewanSaskatoon, SKCanada
| | - Paul Olszynski
- Department of Emergency Medicine, University of SaskatchewanSaskatoon, SKCanada
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Mayo PH, Chew M, Douflé G, Mekontso-Dessap A, Narasimhan M, Vieillard-Baron A. Machines that save lives in the intensive care unit: the ultrasonography machine. Intensive Care Med 2022; 48:1429-1438. [PMID: 35941260 PMCID: PMC9360728 DOI: 10.1007/s00134-022-06804-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 02/04/2023]
Abstract
This article highlights the ultrasonography machine as a machine that saves lives in the intensive care unit. We review its utility in the limited resource intensive care unit and some elements of machine design that are relevant to both the constrained operating environment and the well-resourced intensive care unit. As the ultrasonography machine can only save lives, if is operated by a competent intensivist; we discuss the challenges of training the frontline clinician to become competent in critical care ultrasonography followed by a review of research that supports its use.
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Affiliation(s)
- Paul H. Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Michelle Chew
- Department of Anaesthesiology and Intensive Care Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ghislaine Douflé
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Armand Mekontso-Dessap
- AP-HP Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010 Créteil, France ,Univ Paris Est Créteil, CARMAS, 94010 Créteil, France ,Univ Paris Est Créteil, INSERM, IMRB, 94010 Créteil, France
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY USA
| | - Antoine Vieillard-Baron
- Intensive Care Medicine, University Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, 92100 Boulogne-Billancourt, France
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