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Pedersen MRV, Østergaard ML, Nayahangan LJ, Nielsen KR, Lucius C, Dietrich CF, Nielsen MB. Simulation-based education in ultrasound - diagnostic and interventional abdominal focus. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:348-366. [PMID: 38513687 DOI: 10.1055/a-2277-8183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Simulation-based training (SBT) is increasingly acknowledged worldwide and has become a popular tool for ultrasound education. Ultrasound simulation involves the use of technology and software to create a virtual training setting. Simulation-based training allows healthcare professionals to learn, practice, and improve their ultrasound imaging skills in a safe learning-based environment. SBT can provide a realistic and focused learning experience that creates a deep and immersive understanding of the complexity of ultrasound, including enhancing knowledge and confidence in specific areas of interest. Abdominal ultrasound simulation is a tool to increase patient safety and can be a cost-efficient training method. In this paper, we provide an overview of various types of abdominal ultrasound simulators, and the benefits, and challenges of SBT. We also provide examples of how to develop SBT programs and learning strategies including mastery learning. In conclusion, the growing demand for medical imaging increases the need for healthcare professionals to start using ultrasound simulators in order to keep up with the rising standards.
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Affiliation(s)
- Malene Roland Vils Pedersen
- Department of Radiology, Vejle Hospital - part of Lillebaelt Hospital, Vejle, Denmark
- Department of regional health research, University of Southern Denmark
| | | | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Copenhagen, Denmark
| | - Kristina Rue Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Claudia Lucius
- Outpatient Department of Gastroenterology, IBD center, Policlinic Helios Klinikum Buch, Berlin, Germany
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Nielsen AB, Dragsbæk J, Jacobsen N, Laursen CB, Farr A, Slavicky M, Konge L, Pietersen PI. Assessment of Basic Thoracic Ultrasound Skills in Immersive Virtual Reality: Gathering Validity Evidence. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:467-473. [PMID: 38185537 DOI: 10.1016/j.ultrasmedbio.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Operator skills are essential for thoracic ultrasound (TUS) to ensure diagnostic accuracy. Immersive virtual reality (IVR) has shown potential within medical education but never for assessment of TUS skills. This study was aimed at developing an IVR test for assessing TUS skills, gathering validity evidence and establishing a pass/fail score. METHODS An expert panel developed a test based on the TUS protocol by the European Respiratory Society (ERS), including a tutorial and two clinical cases (pleural effusion and interstitial syndrome), using an IVR platform (VitaSim, Odense, Denmark). Four anterior, four lateral and six posterior zones were available for examination and decision of diagnosis. Each correct examination equaled one point. The contrasting groups' method was used to set a pass/fail score. RESULTS Data were collected during the 2022 ERS Congress. We included 13 novices (N, experience: 0 TUS), 22 intermediates (I, 1-50 TUS) and 11 experienced clinicians (E, >50 TUS). Cronbach's α was 0.86. The total mean point scores in case 1 (C1) were (N) 5.0 ± 2.7, (I) 7.3 ± 2.4 and (E) 8.7 ± 1.3, and the scores in case 2 (C2) were (N) 4.5 ± 1.8, (I) 6.7 ± 2.3 and (E) 8.5 ± 2.1. Significant differences were found between N and I for C1 (p = 0.007) and C2 (p = 0.02), I and E for C1 (p = 0.04) and C2 (p = 0.019) and N and E for C1 (p < 0.001) and C2 (p < 0.001). The pass/fail score was 7 points in each case. CONCLUSION We established an IVR test that can distinguish between operators with different TUS skills. This enables a standardized, objective and evidence-based approach to assessment of TUS skills.
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Affiliation(s)
- Anders Bo Nielsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark; SimC Simulation Centre, Odense University Hospital, Odense, Denmark
| | - Jonas Dragsbæk
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Sygehus Lillebælt-Vejle, Vejle, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Amy Farr
- Educational Activities, European Respiratory Society, Lausanne, Switzerland
| | - Marek Slavicky
- Educational Activities, European Respiratory Society, Lausanne, Switzerland
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Svendborg, Denmark; UNIFY-Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Pietersen PI, Konge L, Bhatnagar R, Slavicky M, Rahman NM, Maskell N, Crombag L, Tabin N, Laursen CB, Nielsen AB. The European Respiratory Society led training programme improves self-reported competency and increases the use of thoracic ultrasound. Breathe (Sheff) 2023; 19:230160. [PMID: 38264206 PMCID: PMC10805265 DOI: 10.1183/20734735.0160-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024] Open
Abstract
Thoracic ultrasound has become a well-implemented diagnostic tool for assessment and monitoring of patients with respiratory symptoms or disease. However, ultrasound examinations are user dependent and sufficient competencies are needed. The European Respiratory Society (ERS) hosts a structured and evidence-based training programme in thoracic ultrasound. This study aimed to explore and discuss the self-reported activity and self-reported competency of the participants during the ERS course. Online surveys were sent to the training programme participants before the second part of the course (practical part of the course), and before and 3 months after the third part of the course (final certification exam). A total of 77 participants completed the surveys. The self-reported frequency of thoracic ultrasound examinations increased during the course, and in the final survey more than 90% of the participants used thoracic ultrasound on weekly basis. The self-reported competency (on technical execution of the thoracic ultrasound examination and overall competency) also increased. The ERS thoracic ultrasound training programme forms the basis of broad theoretical knowledge and sufficient practical skills that seem to lead to behavioural changes, whereby a large proportion of the participants implemented ultrasound in their clinical practice.
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Affiliation(s)
- Pia Iben Pietersen
- Department of Radiology, Odense University Hospital – Svendborg, Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
| | - Rahul Bhatnagar
- Southmead University Hospital Bristol, Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Marek Slavicky
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine, Oxford NIHR Biomedical Research Centre, Chinese Academy of Medicine Oxford Institute, Oxford, UK
| | - Nick Maskell
- Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Laurence Crombag
- Department of Respiratory Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Nathalie Tabin
- European Respiratory Society, Educational Activities, Lausanne, Switzerland
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense Respiratory Research Unit (ODIN), Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Bo Nielsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg, Denmark
- SimC Simulation Centre, Odense University Hospital, Odense, Denmark
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Schultz HHL, Davidsen JR. Thoracic Ultrasound in Lung Transplantation—Insights in the Field. Life (Basel) 2023; 13:life13030695. [PMID: 36983850 PMCID: PMC10052757 DOI: 10.3390/life13030695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/16/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
The use of thoracic ultrasound (TUS) is a novel and dynamic diagnostic and monitoring modality that has shown remarkable advances within the last decade, with several published papers investigating its role within the field of lung transplantation. The aim of this current opinion review is to review the existing literature on the role of TUS in all stages of LTx, from in-donor lung evaluation to graft assessment on ex vivo lung perfusion and in the short- and long-term follow-up after LTx.
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Affiliation(s)
- Hans Henrik Lawaetz Schultz
- Department of Cardiology, Section for Lung Transplantation, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Jesper Rømhild Davidsen
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
- Pulmo-Rheuma Frontline Center (PURE), Department of Respiratory Medicine, Odense University Hospital, 5000 Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Correspondence: ; Tel.: +45-215-712-92
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Larsen JD, Jensen RO, Pietersen PI, Jacobsen N, Falster C, Nielsen AB, Laursen CB, Konge L, Graumann O. Education in Focused Lung Ultrasound Using Gamified Immersive Virtual Reality: A Randomized Controlled Study. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:841-852. [PMID: 36535832 DOI: 10.1016/j.ultrasmedbio.2022.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 06/17/2023]
Abstract
Focused lung ultrasound (FLUS) has high diagnostic accuracy in many common conditions seen in a variety of emergency settings. Competencies are essential for diagnostic success and patient safety but can be challenging to acquire in clinical environments. Immersive virtual reality (IVR) offers an interactive risk-free learning environment and is progressing as an educational tool. First, this study explored the educational impact of novice FLUS users participating in a gamified or non-gamified IVR training module in FLUS by comparing test scores using a test with proven validity evidence. Second, the learning effect was assessed by comparing scores of each group with known test scores of novices, intermediates and experienced users in FLUS. A total of 48 participants were included: 24 received gamified and 24 received non-gamified IVR training. No significant difference was found between gamified (mean = 15.5 points) and non-gamified (mean = 15.2 points), indicating that chosen gamification elements for our setup did not affect learning outcome (p = 0.66). The mean scores of both groups did not significantly differ from those of known intermediate users in FLUS (gamified p = 0.63, non-gamified p = 0.24), indicating that both IVR modules could be used as unsupervised out-of-hospital training for novice trainees in FLUS.
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Affiliation(s)
- Jonas D Larsen
- Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.
| | - Rune O Jensen
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Pia I Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
| | - Niels Jacobsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Regional Center for Technical Simulation (SimC), Odense University Hospital, Odense, Denmark
| | - Casper Falster
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders B Nielsen
- Regional Center for Technical Simulation (SimC), Odense University Hospital, Odense, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark; Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Konge
- Regional Center for Technical Simulation (SimC), Odense University Hospital, Odense, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Center for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Pietersen PI, Mikkelsen S, Lassen AT, Helmerik S, Jørgensen G, Nadim G, Christensen HM, Wittrock D, Laursen CB. Quality of focused thoracic ultrasound performed by emergency medical technicians and paramedics in a prehospital setting: a feasibility study. Scand J Trauma Resusc Emerg Med 2021; 29:40. [PMID: 33632276 PMCID: PMC7908705 DOI: 10.1186/s13049-021-00856-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In a prehospital setting, the severity of respiratory symptoms in patients calling for an ambulance differ. The initial evaluation, diagnosing, and thereby management can be challenging because respiratory symptoms can be caused by disease in many organs. Ultrasound examinations can contribute with important information and support the clinical decision-making. However, ultrasound is user-dependent and requires sufficient knowledge and training. The aim of this study was to explore the quality of thoracic ultrasound examinations performed on patients by emergency medical technicians and paramedics in a prehospital, clinical setting. METHODS From November 2018 - April 2020, Danish emergency medical technicians and paramedics (n = 100) performed thoracic ultrasound examinations on patients with respiratory symptoms using a portable ultrasound device. The ultrasound examinations were stored and retrospectively assessed by a reviewer blinded to the patients' symptoms and history, as well as the emergency medical technicians' and paramedics' findings. The image quality was scored from 1 to 5. The findings determined by the reviewer was then correlated with a questionnaire filled out by the emergency medical technicians and paramedics regarding ultrasonic findings and potential change in treatment or management of the patient. The agreement in percentage and as Cohen's kappa was explored. RESULTS A total of 590 ultrasound examinations were assessed, resulting in a median image quality score of 3 (IQ1 = 4, IQ3 = 3). The overall agreement in percentage between the emergency medical technicians and paramedics and reviewer was high (87.7% for a normal scan, 89.9% for interstitial syndrome, 97.3% for possible pneumothorax, and 96.3% for pleural effusion). Cohen's kappa varied from 0.01 for possible pneumothorax to 0.69 for pleural effusion. Based on the questionnaires (n = 406), the ultrasound examination entailed a change in treatment or visitation in 48 cases (11.7%) which in this study population encompasses a number-needed-to-scan of 8.5. CONCLUSION Emergency medical technicians and paramedics perform focused thoracic ultrasound examinations with adequate image quality sufficient to determine if pathology is present or not. The emergency medical technicians' and paramedics' assessment correlates to some extent with an experienced reviewer and their findings are most reliable for the inclusion of a normal scan or inclusion of pleural effusion. Implementation could possibly impact the number of patients receiving correct prehospital treatment and optimal choice of receiving facility.
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Affiliation(s)
- Pia Iben Pietersen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark.
- Regional Center for Technical Simulation, Odense University Hospital, 5000, Odense C, Denmark.
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense C, Denmark
| | - Annmarie T Lassen
- Department of Emergency Medicine, Odense University Hospital, 5000, Odense C, Denmark
| | - Simon Helmerik
- Department of Quality & Education, Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Gitte Jørgensen
- Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Giti Nadim
- Department of Emergency Medicine, Odense University Hospital, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark
| | - Helle Marie Christensen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark
- Department of Respiratory Medicine, Odense University Hospital, 5000, Odense C, Denmark
| | - Daniel Wittrock
- Department of Quality & Education, Ambulance Syd, Region of Southern Denmark, 5220, Odense SØ, Denmark
| | - Christian B Laursen
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, entrance 87, 1st floor, 5000, Odense C, Denmark
- Department of Respiratory Medicine, Odense University Hospital, 5000, Odense C, Denmark
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