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Breunig M, Kingsley R, Fischer K, Huckabee M. Physician Assistant Student Preceptors and Point-of-Care Ultrasound: Perceptions and Readiness to Teach. J Physician Assist Educ 2023; 34:344-349. [PMID: 37678810 DOI: 10.1097/jpa.0000000000000533] [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: 09/09/2023]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) inclusion in medical education is increasing, and understanding of clinical educators' perceptions and use patterns is needed. The purpose of this research project was to explore current use, interest, knowledge, perceptions, and readiness to teach POCUS from the perspectives of clinical preceptors for physician assistant (PA) students. METHODS A survey research study was completed on previously identified preceptors. Descriptive statistics outlined the frequencies of responses. Bivariate analysis with Chi-Square or Fischer Exact Testing was used to identify statistically significant differences between groupings. RESULTS Most preceptors (87.1%) believe POCUS adds clinical value, but a minority received POCUS training (37%), are familiarity with its use (37.4%), and currently use POCUS (23.4%). Two-thirds (66.1%) of preceptors stated they would allow PA students to practice POCUS skills on clinical rotation; however, few (31%) felt comfortable with this and even fewer (22.6%) felt comfortable findings on POCUS into their clinical decision making. CONCLUSIONS Despite support of incorporation of POCUS into PA education, clinical preceptors' readiness to teach POCUS on clinical rotations is limited. This study shows that preceptors are neither comfortable with student use nor incorporating student findings into clinical decision making. A lack of sufficient clinical preceptors to support POCUS education has not been previously reported. PA programs attempting to incorporate POCUS into their curricula will need to be intentional providing opportunities to continue POCUS on clinical rotations.
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Affiliation(s)
- Michael Breunig
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Ryan Kingsley
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Karen Fischer
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
| | - Michael Huckabee
- Michael Breunig, PA-C, MPAS, is a clinical skills co-director, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Rochester, Minnesota
- Ryan Kingsley, PA-C, MPAS, is a co-director of evaluations, Division of Hospital Internal Medicine, Mayo PA Program Hospitalist, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
- Karen Fischer, MPH, is a senior biostatistician, Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Michael Huckabee, PA-C, PhD, is an associate director, Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
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Chenevert L, Coneybeare D, Weingart G, Truong J. The effect of a point-of-care ultrasound curriculum on PAs in emergency medicine. JAAPA 2023; 36:43-46. [PMID: 37751258 DOI: 10.1097/01.jaa.0000977716.13111.d8] [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: 09/27/2023]
Abstract
ABSTRACT To address identified learning gaps among physician associates/assistants (PAs) working with point-of-care ultrasound (POCUS) in our ED, we designed and implemented a longitudinal POCUS curriculum. This curriculum introduced the 12 main POCUS applications for emergency medicine with presession educational assignments and in-person learning sessions. We used the Kirkpatrick framework of evaluation to develop our metrics of measurement. To examine the effect of the curriculum, pre- and postcurriculum surveys were completed and use of POCUS before, during, and after the curriculum period was monitored. Our results showed the curriculum increased confidence and knowledge of POCUS applications and significantly increased the use of POCUS clinically by PAs. Formal, on-the-job POCUS education for postgraduate PAs is a vital adjunct to informal clinical learning for PAs in emergency medicine to gain POCUS skills.
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Affiliation(s)
- Laura Chenevert
- Laura Chenevert practices in neurologic surgery at the Icahn School of Medicine at Mount Sinai in New York City. Di Coneybeare is an assistant professor of emergency medicine at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital in New York City. Gabriel Weingart is an assistant professor of emergency medicine at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. Jimmy Truong is an assistant professor of emergency medicine at Columbia University Irving Medical Center/NewYork-Presbyterian Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Pelzl CE, Rula EY, Duszak R, Christensen EW. Trends in Diagnostic Imaging by Nonphysician Practitioners and Associations With Urbanicity and Scope-of-Practice Authority. Curr Probl Diagn Radiol 2023; 52:315-321. [PMID: 37455202 DOI: 10.1067/j.cpradiol.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE We aimed to assess the changing share of diagnostic imaging billed by NPPs and how such changes differ by urbanicity within the context of scope-of-practice (SOP) regulations and legislation. METHODS This retrospective cohort study used patient claims for diagnostic imaging studies spanning 2016-2020 from Optum Clinformatics Datamart datasets. Multivariable modeling determined the odds of patients receiving NPP-interpreted vs physician-interpreted imaging. Imaging rates and trends in proportions of NPP-billed claims were assessed by urbanicity and relative to other factors including SOP, imaging modality, and place of service. RESULTS Of all identified imaging claims, 3,348,881 (3.0%) were attributed to NPPs, with the highest rates of NPP interpretations per 10,000 images occurring in rural and small-town areas. From 2016 to 2020, the rate of NPP-billed imaging increased from 257 to 331 claims per 10,000 beneficiaries (P = 0.004), observed across both metropolitan (240 to 315, P = 0.001) and micropolitan (367 to 436, P = 0.020) settings. Although rates in rural and small-town areas rose, the increase was not significant (330 to 392, P = 0.363). Rises in NPP imaging in metropolitan settings occurred in states with moderately restrictive (307 to 358, P = 0.008) and least restrictive (289 to 419, P = 0.004) SOP legislation. DISCUSSION Rates of diagnostic imaging interpretation by NPPs are rising. Growth in recent years appears driven by metropolitan areas in states with less restrictive SOP regulations. Future work is necessary to assess the quality of and downstream costs related to increasing NPP-interpreted imaging.
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Affiliation(s)
- Casey E Pelzl
- The Harvey L. Neiman Health Policy Institute, Reston, VA.
| | | | - Richard Duszak
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Eric W Christensen
- The Harvey L. Neiman Health Policy Institute, Reston, VA; Health Services Management, University of Minnesota, St. Paul, MN
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Casey KO, Pearson T. Evaluating knowledge, confidence, and self-efficacy of NPs and PAs in the emergency department: extended focused assessment using sonography in trauma. J Am Assoc Nurse Pract 2022; 34:876-882. [PMID: 35703933 DOI: 10.1097/jxx.0000000000000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developing and translating knowledge gained in the classroom into skills that are practiced in the clinical setting is an ongoing, iterative, and dynamic process. Health care clinicians require continually evolving knowledge, ongoing education, and hands-on skills practice particular to the specialty. PURPOSE This prospective observational study was conceived based on the existing evidence demonstrating that Point of Care Ultrasound (POCUS) is not routinely taught in nurse practitioner (NP) or physician assistant (PA) graduate programs. This study examines outcomes of an educational intervention aimed at improving knowledge, self-confidence, and self-efficacy of the Extended Focused Assessment using Sonography in Trauma (E-FAST examination) for both NPs and PAs working in emergency settings. METHODOLOGY Twenty participants attended a short course including both didactic learning and hands-on learning of the E-FAST examination. Participants rated themselves using a self-assessment tool for pre- and postintervention self-evaluation. The Wilcoxon signed-rank test was used to evaluate data. A second tool used to evaluate participants' hands-on use of the E-FAST examination is the Objective Structured Assessment of Ultrasound, in which participants were evaluated by clinical experts. These data were assessed using regression analysis. RESULTS Participants showed improvement on the pre/post course self-assessment tool. Participants also showed proficiency using ultrasound and analyzing images as evaluated by experts. CONCLUSIONS A short multimodal course can improve clinicians' knowledge, confidence, and self-efficacy in the use of POCUS and the E-FAST examination. IMPLICATIONS Hands-on education is a valuable tool for ongoing learning.
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Simulation-based clinical learning for final year medical students about Focused Assessment Sonography for Trauma. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1112865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Student Ultrasound Interest Group: A Novel Method of Introducing Ultrasound to Physician Assistant Students. J Physician Assist Educ 2022; 33:131-134. [PMID: 35412518 DOI: 10.1097/jpa.0000000000000418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study describes a student ultrasound interest group (SUIG) in a resource-limited physician assistant (PA) program. The benefits of PA student attitudes and knowledge of ultrasound (US) are described. METHODS Participation in the SUIG was voluntary. Didactics included free online access medical education (FOAMed) materials. Initial scanning sessions focused on the Focused Assessment with Sonography in Trauma (FAST) exam and were led by a faculty champion with limited US experience. A survey on attitudes and a basic US knowledge test were administered before and after the first session and again 2 months later. RESULTS Thirty-seven students (76% female, mean age 26.4) participated in the initial FAST scanning sessions. All participants agreed that the SUIG session was useful. There was a slight increase in confidence after SUIG sessions (1.27 vs 2.92 on a 5-point scale), and 94% reported increased motivation to seek out ultrasound opportunities on clinical rotations. The average score on the knowledge test increased from 37% to 90% after the scanning sessions; the average score waned over time to 80% after 2 months. CONCLUSION SUIGs are a valuable way to introduce US to PA students using limited resources. Even minimal exposure can increase PA student confidence and knowledge.
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Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) has rapidly emerged as a valuable tool in the bedside assessment of patients. This scoping review summarizes existing literature covering clinical use and educational integration of POCUS by physician assistants (PAs), with the overall goal of identifying gaps in POCUS research involving the PA profession. METHODS Keyword searches of PubMed, EMBASE, Medline, and Google Scholar were conducted. Studies assessing PA POCUS use or accuracy; those evaluating extent, method, or value of POCUS educational integration; and those assessing the effect of POCUS training interventions were included. RESULTS Of the 717 studies retrieved, 30 met inclusion criteria. Studies generally demonstrated that PAs can use a fairly wide range of POCUS applications with high accuracy, but that POCUS integration into PA programs remains limited because of a number of identified barriers. CONCLUSIONS Machine availability and insufficient POCUS training and education opportunities limit widespread clinical use of POCUS by PAs.
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Affiliation(s)
- Courtney L Zak
- At the time this article was written, Courtney L. Zak was a student in the PA program at Red Rocks Community College in Lakewood, Colo. She now practices in orthopedics at New Mexico Orthopedic's Department of Physical Medicine and Rehabilitation in Albuquerque, N.M. Jonathan D. Monti is an employee of the Geneva Foundation, an associate professor of the US Army/Baylor EMPA Fellowship Program, and a clinical research scientific advisor and grant/technical writer with Madigan Army Medical Center's Department of Clinical Investigation in Tacoma, Wash. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Mesin L, Albani S, Policastro P, Pasquero P, Porta M, Melchiorri C, Leonardi G, Albera C, Scacciatella P, Pellicori P, Stolfo D, Grillo A, Fabris B, Bini R, Giannoni A, Pepe A, Ermini L, Seddone S, Sinagra G, Antonini-Canterin F, Roatta S. Assessment of Phasic Changes of Vascular Size by Automated Edge Tracking-State of the Art and Clinical Perspectives. Front Cardiovasc Med 2022; 8:775635. [PMID: 35127855 PMCID: PMC8814097 DOI: 10.3389/fcvm.2021.775635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/14/2021] [Indexed: 12/25/2022] Open
Abstract
Assessment of vascular size and of its phasic changes by ultrasound is important for the management of many clinical conditions. For example, a dilated and stiff inferior vena cava reflects increased intravascular volume and identifies patients with heart failure at greater risk of an early death. However, lack of standardization and sub-optimal intra- and inter- operator reproducibility limit the use of these techniques. To overcome these limitations, we developed two image-processing algorithms that quantify phasic vascular deformation by tracking wall movements, either in long or in short axis. Prospective studies will verify the clinical applicability and utility of these methods in different settings, vessels and medical conditions.
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Affiliation(s)
- Luca Mesin
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
- *Correspondence: Luca Mesin
| | - Stefano Albani
- SC Cardiologia Ospedale Regionale U. Parini, Aosta, Italy
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Piero Policastro
- Mathematical Biology and Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Paolo Pasquero
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | - Massimo Porta
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | | | | | - Carlo Albera
- Department of Medical Sciences, Universitá di Torino, Turin, Italy
| | | | - Pierpaolo Pellicori
- Robertson Centre for Biostatistics, Research Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Davide Stolfo
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Andrea Grillo
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Bruno Fabris
- Department of Medical, Surgical and Health Sciences, Universitá di Trieste, Trieste, Italy
| | - Roberto Bini
- Chirurgia Generale e Trauma Team GOM Niguarda, Milan, Italy
| | - Alberto Giannoni
- Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Antonio Pepe
- Highly Specialized in Rehabilitation Hospital-ORAS S.p.A., Motta di Livenza, Italy
- Ospedale Unico di Santorso, AULSS7 Pedemontana, Italy
| | - Leonardo Ermini
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
| | - Stefano Seddone
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
| | - Gianfranco Sinagra
- Robertson Centre for Biostatistics, Research Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, Universitá di Torino, Turin, Italy
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Blaivas M, Blaivas L, Philips G, Merchant R, Levy M, Abbasi A, Eickhoff C, Shapiro N, Corl K. Development of a Deep Learning Network to Classify Inferior Vena Cava Collapse to Predict Fluid Responsiveness. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1495-1504. [PMID: 33038035 DOI: 10.1002/jum.15527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To create a deep learning algorithm capable of video classification, using a long short-term memory (LSTM) network, to analyze collapsibility of the inferior vena cava (IVC) to predict fluid responsiveness in critically ill patients. METHODS We used a data set of IVC ultrasound (US) videos to train the LSTM network. The data set was created from IVC US videos of spontaneously breathing critically ill patients undergoing intravenous fluid resuscitation as part of 2 prior prospective studies. We randomly selected 90% of the IVC videos to train the LSTM network and 10% of the videos to test the LSTM network's ability to predict fluid responsiveness. Fluid responsiveness was defined as a greater than 10% increase in the cardiac index after a 500-mL fluid bolus, as measured by bioreactance. RESULTS We analyzed 211 videos from 175 critically ill patients: 191 to train the LSTM network and 20 to test it. Using standard data augmentation techniques, we increased our sample size from 191 to 3820 videos. Of the 175 patients, 91 (52%) were fluid responders. The LSTM network was able to predict fluid responsiveness moderately well, with an area under the receiver operating characteristic curve of 0.70 (95% confidence interval [CI], 0.43-1.00), a positive likelihood ratio of infinity, and a negative likelihood ratio of 0.3 (95% CI, 0.12-0.77). In comparison, point-of-care US experts using video review offline and manual diameter measurement via software caliper tools achieved an area under the receiver operating characteristic curve of 0.94 (95% CI, 0.83-0.99). CONCLUSIONS We demonstrated that an LSTM network can be trained by using videos of IVC US to classify IVC collapse to predict fluid responsiveness. Our LSTM network performed moderately well given the small training cohort but worse than point-of-care US experts. Further training and testing of the LSTM network with a larger data sets is warranted.
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Affiliation(s)
- Michael Blaivas
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
- Department of Emergency Medicine, St Francis Hospital, Columbus, Georgia, USA
| | - Laura Blaivas
- Michigan State University, East Lansing, Michigan, USA
| | - Gary Philips
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Roland Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell Levy
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adeel Abbasi
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
| | - Carsten Eickhoff
- Brown Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | - Nathan Shapiro
- Department of Emergency Medicine, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Keith Corl
- Department of Medicine, Division of Pulmonary Critical Care and Sleep, Warren Alert Medical School of Brown University, Providence, Rhode Island, USA
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Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) is integral to bedside evaluation of ED patients. This study examines POCUS exposure for physician assistants (PAs) before ED employment. METHODS A retrospective cross-sectional survey was distributed electronically to PAs employed in 13 EDs across a healthcare system. Participants were queried on POCUS education during PA training. Findings were reported as percentages of total respondents, using descriptive statistics. RESULTS The response rate was 70.1%. Only 14.9% of respondents received POCUS exposure in PA school. Of those who received training, most (66.7%) received 5 or fewer hours and 94.1% strongly agree or agree that POCUS education should be integrated into PA education. CONCLUSION In this survey, most PAs practicing in the ED did not receive POCUS education during training. Practice location and year of graduation may contribute to this finding. Healthcare systems should consider additional training for PAs working in EDs to bridge gaps in knowledge.
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Affiliation(s)
- Courtney M Smalley
- Courtney M. Smalley practices emergency medicine at Cleveland (Ohio) Clinic Health System, and is director of emergency ultrasound for the Emergency Services Institute. She also is an assistant professor in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland. The author has disclosed no potential conflicts of interest, financial or otherwise
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The role of point of care ultrasound in radiology department: update and prospective. A statement of Italian college ultrasound. Radiol Med 2020; 126:636-641. [PMID: 33146845 DOI: 10.1007/s11547-020-01301-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Ultrasound, in its new point-of-care conception, has been called the stethoscope of the future. Goal-directed bedside ultrasound examination, performed by a healthcare provider to answer a specific diagnostic question or guide an invasive procedure, is currently revolutionizing medical practice. It is used by various specialties in multiple clinical contexts for procedural, diagnostic, and screening applications. Point-of-care ultrasound is also a strategic technique in clinical radiology; it brings the radiologist closer to the patient (in interaction and understanding) like interventional and angiography procedures and, as an integrative imaging modality, is a vital radiological tool for decision-making in many situations. In this commentary, we present our observations on the use of ultrasound, in a sincere appeal to refrain from omitting ultrasound as a diagnostic technique in this era of deep professional change, in which radiologists must return to being a true clinical semiologist.
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Akinlade FT, Akinlade OM, Aremu AA. Spleen-left kidney ratio and liver-right kidney ratio: novel measures of normal liver, spleen, and kidney dimensions in Southwestern Nigerian children. J Ultrasound 2020; 24:297-302. [PMID: 32915401 DOI: 10.1007/s40477-020-00521-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased. METHODS This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20. RESULTS The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337). CONCLUSION The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.
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Affiliation(s)
- F T Akinlade
- Department of Radiology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria.
| | - O M Akinlade
- Department of Internal Medicine, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
| | - A A Aremu
- Department of Radiology, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Monti JD, Perreault MD. Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics. Mil Med 2020; 185:e601-e608. [PMID: 32060506 DOI: 10.1093/milmed/usaa014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Advances in the portability of ultrasound have allowed it to be increasingly employed at the point of care in austere settings. Battlefield constraints often limit the availability of medical officers throughout the operational environment, leading to increased interest in whether highly portable ultrasound devices can be employed by military medics to enhance their provision of combat casualty care. Data evaluating optimal training for effective medic employment of ultrasound is limited however. This prospective observational cohort study's primary objective was to assess the impact of a 4-hour introductory training intervention on ultrasound-naïve military medic participants' knowledge/performance of the eFAST application. MATERIALS AND METHODS Conventional U.S. Army Medics, all naïve to ultrasound, were recruited from across JBLM. Volunteer participants underwent baseline eFAST knowledge assessment via a 50-question multiple-choice exam. Participants were then randomized to receive either conventional, expert-led classroom didactic training or didactic training via an online, asynchronously available platform. All participants then underwent expert-led, small group hands-on training and practice. Participants' eFAST performance was then assessed with both live and phantom models, followed by a post-course knowledge exam. Concurrently, emergency medicine (EM) resident physician volunteers, serving as standard criterion for trained personnel, underwent the same OSCE assessments, followed by a written exam to assess their baseline eFAST knowledge. Primary outcome measures included (1) post-course knowledge improvement, (2) eFAST exam technical adequacy, and (3) eFAST exam OSCE score. Secondary outcome measures were time to exam completion and diagnostic accuracy rate for hemoperitoneum and hemopericardium. These outcome measures were then compared across medic cohorts and to those of the EM resident physician cohort. RESULTS A total of 34 medics completed the study. After 4 hours of ultrasound training, overall eFAST knowledge among the 34 medics improved from a baseline mean of 27% on the pretest to 83% post-test. For eFAST exam performance, the medics scored an average of 20.8 out of a maximum of 22 points on the OSCE. There were no statistically significant differences between the medics who received asynchronous learning versus traditional classroom-based learning, and the medics demonstrated comparable performance to previously trained EM resident physicians. CONCLUSIONS A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Online, asynchronously available platforms may effectively mitigate some of the resource requirement burden associated with point-of-care ultrasound training. Future studies evaluating medic eFAST performance on real-world battlefield trauma patients are needed. Skill and knowledge retention must also be assessed for this degradable skill to determine frequency of refresher training when not regularly performed.
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Affiliation(s)
- Jonathan D Monti
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
| | - Michael D Perreault
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Jackson Avenue, Joint Base Lewis-McChord, Washington 98431
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Abstract
PURPOSE This study evaluated the benefits and challenges of implementing point-of-care ultrasound (POCUS) training in a physician assistant program curriculum. METHODS Physician assistant students were introduced to POCUS during 2 semesters of Physical Diagnosis. The students were assessed for understanding of applications, effectiveness in obtaining images of target anatomy, and the time required to obtain those images. Student attitudes and the cost of implementation were also recorded. RESULTS After 13 hours of training, the 24 students were able to obtain all the target anatomy images and describe the associated structures with an average accuracy rating of 97%. Understanding of POCUS in clinical applications, including recognition of abnormal scan images, was assessed at an average of 85%. Student attitudes toward POCUS were assessed with 88.69% affirming "strongly agree." Although the costs associated with implementation might vary depending on the setting, they were feasible in our program. CONCLUSION Our study confirmed that POCUS training can be effectively implemented with faculty time burdens and costs that are not prohibitive.
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Inspiring the Future of Physician Assistant Ultrasound Education: Lessons Learned From the Inaugural Yes, iScan Event. J Physician Assist Educ 2020; 31:28-32. [PMID: 32011422 DOI: 10.1097/jpa.0000000000000289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Point-of-care ultrasound (POCUS), despite its rapid integration into undergraduate medical education curriculum, remains underutilized among physician assistant (PA) programs, with a resultant training gap between PAs and their physician collaborators. Herein, we present the Yes, iScan Ultrasound event, piloted at the 2018 American Academy of PAs (AAPA) conference, as a means to generate PA student interest in, and introductory engagement with, the emerging clinical adjunct of POCUS. METHODS Physician assistant students and instructors were recruited to voluntarily participate. Student participants received pre-event online training access. They then competed in a team-based 8-hour competition covering core POCUS concepts of image acquisition, interpretation, and clinical implementation. Student participants' pre- and post-event self-assessments of their knowledge of how ultrasound could be implemented into clinical practice were analyzed using a 2-tailed t-test. RESULTS A total of 62 students participated in the competition, with a post-event response rate of 53%. Surveys demonstrated a statistically significant post-event increase in knowledge of how ultrasound integrates into clinical practice from 3.9 to 6 (7-point Likert scale, P-value < .01, 95% confidence interval -2.51 to -1.76). Seventy-nine percentage of students reported being highly engaged throughout the event, with 95% of students recommending recurring incorporation into future AAPA conferences. CONCLUSIONS Students reported high engagement and a significant increase in their knowledge of how POCUS may integrate into clinical practice following their participation. Although these data suggest that such events are successful at generating enthusiasm for this emerging clinical adjunct, further studies on the impact of the event toward increased POCUS integration into PA education are recommended.
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Khan MAB, Abu-Zidan FM. Point-of-care ultrasound for the acute abdomen in the primary health care. Turk J Emerg Med 2020; 20:1-11. [PMID: 32355895 PMCID: PMC7189821 DOI: 10.4103/2452-2473.276384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 01/07/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is a focused examination, which is performed and interpreted at the bedside by the treating physician answering a specific clinical question. It is currently utilized as an essential adjunct to physical examination in many medical specialties. Recent advances in technology have made POCUS machines portable, affordable, and could be used with minimal training even by nonradiologists. This review aims to cover the fundamental physics of POCUS and its applications for diagnosing the acute abdomen in the primary health care including the most common causes encountered by family physicians. These are acute appendicitis, acute cholecystitis, renal colic, ectopic pregnancy, acute diverticulitis, bowel obstruction, and abdominal aortic aneurysm. We hope to encourage primary care physicians to incorporate POCUS in their routine clinical practice. We also highlight challenges encountered when using POCUS in the primary health care including limited availability and the need for proper training. Furthermore, we review the POCUS results when performed by primary health-care physicians. Integrating POCUS in primary health care empowers primary health-care physicians to provide high-quality, safe, and cost-effective care to the patients.
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Affiliation(s)
- Moien A B Khan
- Department of Family Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Effectiveness of a Brief Course in Bedside Ultrasound for Physician Assistant Students. J Physician Assist Educ 2019; 30:72-75. [PMID: 30801560 DOI: 10.1097/jpa.0000000000000242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Ultrasound (US) is an important imaging tool and the most commonly used imaging modality worldwide. Although US requires expertise to be performed at the highest quality levels, basic US exams can be learned by most physicians and medical technologists with knowledge of human anatomy and with physical examination skills. The full potential of US is achieved when it is more than a pure “imaging modality”, but instead an integrated clinical, physical, and imaging assessment in which the examiner interacts directly and personally with the patient. Specific diagnostic US knowledge is strongly encouraged for specialist training in clinical disciplines.
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Informing the Revolution: A Needs Assessment of Ultrasound Knowledge and Skills Among Graduating Physician Assistant Students. J Physician Assist Educ 2018; 29:173-176. [PMID: 30086123 DOI: 10.1097/jpa.0000000000000210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We performed a needs assessment to understand how existing physician assistant (PA) program curricula and clinical training affect students' ultrasound knowledge, skills, and competence and prepare students for performing ultrasound techniques in clinical practice. METHODS Students graduating from a PA program completed a 23-item questionnaire examining their ultrasound training experiences, their self-assessment of competency, and their demographics. Students also completed a 15-item ultrasound knowledge assessment. RESULTS Thirty-eight of 39 students (97%) completed the survey. Students received little hands-on ultrasound training, with the most hands-on training being offered during emergency medicine (44.7%), obstetrics and gynecology (42.1%), and inpatient internal medicine (39.5%) rotations. This lack of preparedness was reflected in a mean score of 47.1% (±16.4%) on the ultrasound knowledge assessment. Most students (84.2%) indicated that the ultrasound instruction they received during clinical rotations was insufficient to prepare them for clinical practice, and 84.2% desired a formal ultrasound training program in the PA program curriculum. CONCLUSIONS Existing PA program curricula are insufficient for developing critical skills related to ultrasonography.
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