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Lüdke T, Paliege A, Kluge A, Olesch FT, Hilger G, Beleites T, Kemper M. Low-cost simulation model for ultrasound-guided punch biopsy and puncture: Construction manual and photo examples. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38513702 DOI: 10.1055/a-2292-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE Ultrasound-guided puncture and punch biopsy pose a particular challenge in ultrasound examination training. These techniques should be learned and performed several times using a simulation model that is as realistic as possible before being applied to patients. While the use of agar-agar-based models is extensively documented in the literature, there is a discernible gap in publications specifically addressing their use in punch biopsy and puncture. The aim was to develop a cost-effective model for the simulation of ultrasound-guided interventions. MATERIALS AND METHODS The developed simulation model is based on the vegetable gelatine agar-agar. The agar-agar powder is boiled in water and colored. Various objects are added to the mass. Blueberries, olives, tomatoes, and cornichons imitate solid structures. Liquid-filled balloons are used to simulate cystic structures. Adding stones can make the exercises more difficult due to hyperechoic reflexes with distal shadowing. RESULTS With the model, ultrasound-guided puncture and punch biopsies could be successfully simulated, and ultrasound images can be generated for this purpose. The cost of a single model is about 2 euros. Production takes less than 2 hours, including cooling. The pure processing time is 30 minutes. The durability of the models is limited by mold, which occurs after 5 days when stored at room temperature and after 5 weeks in the refrigerator. CONCLUSION It was shown that it is possible to produce an inexpensive agar-agar-based ultrasound model in a short time and with easily available ingredients to learn ultrasound-guided puncture and punch biopsies.
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Affiliation(s)
- Theresa Lüdke
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University Hospital, Dresden, Germany
| | - Alexander Paliege
- Department of Internal Medicine III, Nephrology, Dresden University Hospital, Dresden, Germany
| | - Anne Kluge
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University Hospital, Dresden, Germany
| | - Falk-Tony Olesch
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University Hospital, Dresden, Germany
| | - Gregor Hilger
- Department of Otorhinolaryngology, Head and Neck Surgery, Kreiskrankenhaus Stollberg gGmbH, Stollberg, Germany
| | - Thomas Beleites
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University Hospital, Dresden, Germany
| | - Max Kemper
- Department of Otorhinolaryngology, Head and Neck Surgery, Dresden University Hospital, Dresden, Germany
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Rappaport C, Schwartz A, McConomy B, Choice S, Ten Eyck P, Smock J. Implementing a 3 year, longitudinal point of care ultrasound curriculum in an internal medicine residency program. J Ultrasound 2024; 27:123-127. [PMID: 37973677 PMCID: PMC10908930 DOI: 10.1007/s40477-023-00838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. METHODS The POCUS instruction was delivered as a combination of pre-workshop self-study learning materials (monthly textbook chapters, online modules etc.), with short didactic sessions, and hands-on-scanning of healthy, male volunteers at 10-week intervals. RESULTS A total of 62 residents (23 Post-Graduate Year 1 (PGY), 24 PGY2, 15 PGY3) participated in the year-long curriculum. When pretest and post test data were analyzed at the end of the curriculum, we calculated the odds ratio for acquiring the correct image (score of 1) vs partial/incorrect acquisition (scores of 2 and 3). Significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86-20.74, p < 0.001), Inferior vena cava (IVC) (OR 5.05, 95% CI 1.91-13.35, p = 0.001) and bladder (OR 5.06, 95% CI 1.76-14.55, p = 0.003). Non-significant differences were found in acquisition of apical 4 chamber, pl (A-Line) and internal jugular vein (IJV). CONCLUSION We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper-level residents to include quantitative left ventricular and right ventricular function analysis, and including more case based pathologic image review.
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Affiliation(s)
- Charles Rappaport
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Andrei Schwartz
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Bryan McConomy
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Samuel Choice
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA.
| | - Patrick Ten Eyck
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA
| | - Justin Smock
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Kut C, Kao T, Morcos M, Kim Y, Boctor E, Viswanathan AN. 3D-printed Magnetic Resonance (MR)-based gynecological phantom for image-guided brachytherapy training. Brachytherapy 2022; 21:799-805. [PMID: 36050143 PMCID: PMC10810234 DOI: 10.1016/j.brachy.2022.07.005] [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: 02/15/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE/OBJECTIVES There is a clinical need to develop anatomic phantoms for simulation-based learning in gynecological brachytherapy. Here, we provide a step-by-step approach to build a life-sized gynecological training phantom based on magnetic resonance imaging (MRI) of an individual patient. Our hypothesis is that this phantom can generate convincing ultrasound (US) images that are similar to patient scans. METHODS Organs-at-risk were manually segmented using patient scans (MRI). The gynecological phantom was constructed using positive molds from 3D printing and polyvinyl chloride (PVC) plastisol. Tissue texture/acoustic properties were simulated using different plastic softener/hardener ratios and microbead densities. Nine readers (residents) were asked to evaluate 10 cases (1 ultrasound image per case) and categorize each as a "patient" or "phantom" image. To evaluate whether the phantom and patient images were equivalent, we used a multireader, multicase equivalence study design with two composite null hypotheses with proportion (pr) at H01: pr ≤ 0.35 and H02: pr ≥ 0.65. Readers were also asked to review US videos and identify the insertion of an interstitial needle into the pelvic phantom. Computed Tomography (CT) and magnetic resonance (MR) images of the phantom were acquired for a feasibility study. RESULTS Readers correctly classified "patient" and "phantom" scans at pr = 53.3% ± 6.2% (p values 0.013 for H01 and 0.054 for H02, df = 5.96). Readers reviewed US videos and identified the interstitial needle 100% of the time in transabdominal view, and 78% in transrectal view. The phantom was CT and MR safe. CONCLUSIONS We have outlined a manufacturing process to create a life-sized, gynecological phantom that is compatible with multi-modality imaging and can be used to simulate clinical scenarios in image-guided brachytherapy procedures.
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Affiliation(s)
- Carmen Kut
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tracy Kao
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL
| | - Marc Morcos
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Younsu Kim
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Emad Boctor
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
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Samargandy S, Philteos J, Manojlovic Kolarski M, Xu J, Monteiro E, Vescan A. Battle of the axes: simulation-based assessment of fine needle aspiration biopsies for thyroid nodules. J Otolaryngol Head Neck Surg 2022; 51:32. [PMID: 35986428 PMCID: PMC9392298 DOI: 10.1186/s40463-022-00587-5] [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: 02/08/2021] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Importance Ultrasound-guided fine-needle aspiration biopsies (UGFNA) play a crucial role in the diagnosis of thyroid nodules. There are two techniques for performing an UGFNA: short-axis technique and long-axis technique. There is sparsity in the literature regarding the differences between these two techniques. Objective To compare the efficiency between long-axis and short-axis thyroid UGFNA techniques in trainees. Our secondary outcomes were to define the comfort level and learning curves of trainees. Design A longitudinal prospective cohort study, completed from December 2018 to November 2019, using the Blue Phantom Thyroid Model© for UGFNA. Face and construct validity of the model were verified. Residents completed UGFNA on an assigned nodule using both long-axis and short-axis techniques, the order of which was sequentially allocated. The rate and time to successful biopsy were obtained for both techniques. Biopsy attempts were repeated to establish learning curves. Setting Single-center study. Participants Fourteen Otolaryngology—Head & Neck Surgery residents at the University of Toronto. Main outcome measure Biopsy success and efficiency for novice learners completing UGFNA on a simulated thyroid model using long-axis and short-axis techniques. Results A trend towards higher odds of successful biopsy using the long-axis technique with no difference in procedure duration was observed (OR = 2.2, p = 0.095, CI = 0.87–5.39). Learning curve graphs appeared heterogenous according to trainee level. Trainees found the long-axis technique easier to perform (10/14, 71%), and the simulator valuable for learning (12/14, 86%). Conclusion Thyroid UGFNA using the long-axis technique may have an increased success rate and is generally favored by trainees for being easier to perform. Thyroid simulators have the potential to increase learner comfort and efficiency with UGFNA. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-022-00587-5.
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Höhne E, Recker F, Dietrich CF, Schäfer VS. Assessment Methods in Medical Ultrasound Education. Front Med (Lausanne) 2022; 9:871957. [PMID: 35755059 PMCID: PMC9218354 DOI: 10.3389/fmed.2022.871957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Medical schools are increasingly incorporating ultrasound into undergraduate medical education. The global integration of ultrasound into teaching curricula and physical examination necessitates a strict evaluation of the technology's benefit and the reporting of results. Course structures and assessment instruments vary and there are no national or worldwide standards yet. This systematic literature review aims to provide an up-to-date overview of the various formats for assessing ultrasound skills. The key questions were framed in the PICO format (Population, Intervention, Comparator, and Outcome). A review of literature using Embase, PubMed, Medline, Cochrane and Google Scholar was performed up to May 2021, while keywords were predetermined by the authors. Inclusion criteria were as follows: prospective as well as retrospective studies, observational or intervention studies, and studies outlining how medical students learn ultrasound. In this study, 101 articles from the literature search matched the inclusion criteria and were investigated. The most frequently used methods were objective structured clinical examinations (OSCE), multiple choice questions, and self-assessments via questionnaires while frequently more than one assessment method was applied. Determining which assessment method or combination is ideal to measure ultrasound competency remains a difficult task for the future, as does the development of an equitable education approach leading to reduced heterogeneity in curriculum design and students attaining equivalent skills.
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Affiliation(s)
- Elena Höhne
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- *Correspondence: Florian Recker
| | | | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Bonn, Germany
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Chen YT, Chou R, Kohler M, Eng C, Borg-Stein J. In-person versus virtual musculoskeletal ultrasound education during the coronavirus disease 2019 pandemic: A single-center study. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/jisprm.jisprm-000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Meuwly JY, Mandralis K, Tenisch E, Gullo G, Frossard P, Morend L. Use of an Online Ultrasound Simulator to Teach Basic Psychomotor Skills to Medical Students During the Initial COVID-19 Lockdown: Quality Control Study. JMIR MEDICAL EDUCATION 2021; 7:e31132. [PMID: 34723818 PMCID: PMC8593817 DOI: 10.2196/31132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/11/2021] [Accepted: 09/27/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Teaching medical ultrasound has increased in popularity in medical schools with hands-on workshops as an essential part of teaching. However, the lockdown due to COVID-19 kept medical schools from conducting these workshops. OBJECTIVE The aim of this paper is to describe an alternative method used by our medical school to allow our students to acquire the essential psychomotor skills to produce ultrasound images. METHODS Our students took online ultrasound courses. Consequently, they had to practice ultrasound exercises on a virtual simulator, using the mouse of their computer to control a simulated transducer. Our team measured the precision reached at the completion of simulation exercises. Before and after completion of the courses and simulator's exercises, students had to complete a questionnaire dedicated to psychomotor skills. A general evaluation questionnaire was also submitted. RESULTS A total of 193 students returned the precourse questionnaire. A total of 184 performed all the simulator exercises and 181 answered the postcourse questionnaire. Of the 180 general evaluation questionnaires that were sent out, 136 (76%) were returned. The average precourse score was 4.23 (SD 2.14). After exercising, the average postcourse score was 6.36 (SD 1.82), with a significant improvement (P<.001). The postcourse score was related to the accuracy with which the simulator exercises were performed (Spearman rho 0.2664; P<.001). Nearly two-thirds (n=84, 62.6%) of the students said they enjoyed working on the simulator. A total of 79 (58.0%) students felt that they had achieved the course's objective of reproducing ultrasound images. Inadequate connection speed had been a problem for 40.2% (n=54) of students. CONCLUSIONS The integration of an online simulator for the practical learning of ultrasound in remote learning situations has allowed for substantial acquisitions in the psychomotor field of ultrasound diagnosis. Despite the absence of workshops, the students were able to learn and practice how to handle an ultrasound probe to reproduce standard images. This study enhances the value of online programs in medical education, even for practical skills.
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Affiliation(s)
- Jean-Yves Meuwly
- Department of Radiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Katerina Mandralis
- Department of Radiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Estelle Tenisch
- Department of Radiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Giuseppe Gullo
- Department of Radiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Pierre Frossard
- Department of Radiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Laura Morend
- Medical Pedagogy Unit, University of Lausanne, Lausanne, Switzerland
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Buesing J, Weng Y, Kugler J, Wang L, Blaha O, Hom J, Ahuja N, Kumar A. Handheld Ultrasound Device Usage and Image Acquisition Ability Among Internal Medicine Trainees: A Randomized Trial. J Grad Med Educ 2021; 13:76-82. [PMID: 33680304 PMCID: PMC7901629 DOI: 10.4300/jgme-d-20-00355.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is insufficient knowledge about how personal access to handheld ultrasound devices (HUDs) improves trainee learning with point-of-care ultrasound (POCUS). OBJECTIVE To assess whether HUDs, alongside a yearlong lecture series, improved trainee POCUS usage and ability to acquire images. METHODS Internal medicine intern physicians (n = 47) at a single institution from 2017 to 2018 were randomized 1:1 to receive personal HUDs (n = 24) for patient care/self-directed learning vs no-HUDs (n = 23). All interns received a repeated lecture series on cardiac, thoracic, and abdominal POCUS. Main outcome measures included self-reported HUD usage rates and post-intervention assessment scores using the Rapid Assessment of Competency in Echocardiography (RACE) scale between HUD and no-HUD groups. RESULTS HUD interns reported performing POCUS assessments on patients a mean 6.8 (SD 2.2) times per week vs 6.4 (SD 2.9) times per week in non-HUD arm (P = .66). There was no relationship between the number of self-reported examinations per week and a trainee's post-intervention RACE score (rho = 0.022, P = .95). HUD interns did not have significantly higher post-intervention RACE scores (median HUD score 17.0 vs no-HUD score 17.8; P = .72). Trainee confidence with cardiac POCUS did not correlate with RACE scores. CONCLUSIONS Personal HUDs without direct supervision did not increase the amount of POCUS usage or improve interns' acquisition abilities. Interns who reported performing more examinations per week did not have higher RACE scores. Improved HUD access and lectures without additional feedback may not improve POCUS mastery.
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Gopal D, Baston C, Adusumalli S, Jagasia D, Prenner S. Focused Cardiac Ultrasound Curriculum for Internal Medicine Residents. POCUS JOURNAL 2021; 6:29-32. [PMID: 36895500 PMCID: PMC9979930 DOI: 10.24908/pocus.v6i1.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Focused cardiac ultrasound (FCU) is a safe and efficient diagnostic intervention for internal medicine physicians. FCU is a highly teachable skill, but is used in routine cardiac assessment in only 20% of surveyed training programs.We developed an FCU curriculum for internal medicine residents and an assessment tool to evaluate the impact of the curriculum on trainee knowledge and confidence. Methods: Internal medicine residents rotating through clinical cardiology services underwent 30 minutes of didactic and 60 minutes of hands-on teaching on acquisition and interpretation of FCU. A 20 item pre and post-curriculum online survey was administered (November 2018-December 2019) to assess confidence and knowledge in FCU. Results: 79 of 116 (68%) residents completed the pre-survey and 50 completed the post-survey, of whom 34 received the curriculum. The mean change in confidence score in those who received versus did not receive the curriculum was 0.99 versus 0.39 (p=0.046) on a 5-point Likert scale. Among 33 residents who had paired pre- and post-surveys the mean change in confidence score was 1.2 versus 0.85 (p<0.001) in those who received versus did not receive the curriculum. The mean increase in knowledge score was 13% versus 7% respectively (p<0.0001). Conclusions: We instituted a novel curriculum for internal medicine residents to gain experience in image acquisition and interpretation. Both confidence and knowledge in FCU improved following the curriculum, indicating that this is a highly teachable skill. Additional analysis of the of the FCU study images will be useful for informing future interventions.
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Affiliation(s)
- Dipika Gopal
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Cameron Baston
- Division of Pulmonary & Critical Care, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Dinesh Jagasia
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
| | - Stuart Prenner
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania
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A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound. Crit Care Med 2020; 47:e948-e952. [PMID: 31569139 DOI: 10.1097/ccm.0000000000004002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners. SETTING The University of Iowa Hospitals and Clinics. SUBJECTS Twenty-four subjects (23 first-year medical students and one first-year physician assistant student). DESIGN The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills. INTERVENTIONS Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session. MEASUREMENTS AND MAIN RESULTS For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008). CONCLUSIONS Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.
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Dhanani M, Hou A, Moll M, Schembri F. Introduction of an academic medical center's point-of-care ultrasound curriculum to internal medicine residents at a community-based teaching hospital. J Community Hosp Intern Med Perspect 2020; 10:93-98. [PMID: 32850043 PMCID: PMC7425611 DOI: 10.1080/20009666.2020.1742483] [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] [Indexed: 11/19/2022] Open
Abstract
Background Despite its proven utility, integration of point-of-care ultrasound (POCUS) into internal medicine (IM) residency training has been inconsistent. Due to their unique constraints, community-based teaching hospitals may face particular challenges in providing POCUS training to IM residents. Objectives To evaluate short-term educational outcomes of an academic center’s POCUS curriculum following its adaptation and delivery to IM residents at a community-based teaching hospital. Methods A needs assessment (NA) regarding POCUS training was distributed to PGY-2 and PGY-3 IM residents at a community-based teaching hospital in 2017. Based on the NA results, a POCUS curriculum from an academic center was modified and a revised course was offered to the same residents. Participants completed cognitive assessments before and after three of the four didactic sessions. Observed placement of an ultrasound-guided peripheral IV before and after the training program comprised the skills assessment. Results 17 of 28 (61%) residents completed the NA; eleven participated in the course. Of 33 possible quiz pairs, 15 (45%) were completed. Average quiz scores rose after the first and third sessions. Skills assessment scores increased after course completion. Conclusion Adaptation of POCUS curricula from academic centers may be a feasible instructional strategy for community-based IM residency programs.
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Affiliation(s)
- Muhammad Dhanani
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Amy Hou
- Clinical Fellow in Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA
| | - Matthew Moll
- Clinical Fellow in Medicine, Harvard Medical School, Boston, MA, USA.,Division of Pulmonary & Critical Care Medicine, Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
| | - Frank Schembri
- Adjunct Assistant Professor of Medicine, Boston University School of Medicine, Boston, MA, USA.,Department of Intensive Care Medicine, South Shore Hospital, Weymouth, MA, USA
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Sepulveda-Ortiz V, Warkentine F, Starr-Seal R, Rominger A. The effectiveness of a longitudinal ultrasound curriculum for general pediatricians working in a Puerto Rican emergency department: a pilot study. Ultrasound J 2020; 12:20. [PMID: 32318889 PMCID: PMC7174469 DOI: 10.1186/s13089-020-00169-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/13/2020] [Indexed: 01/17/2023] Open
Abstract
Background The Hospital Pediatrico Universitario (HOPU) is the principal institution in Puerto Rico offering medical services to the children of the island and the Caribbean. There is limited use of point-of-care ultrasound (PoCUS) in their emergency department (ED) and obtaining an ultrasound through radiology is prohibitively time consuming. The objective of this study is to increase PoCUS knowledge and comfort by the ED physicians in the HOPU pediatric emergency department. Results Thirteen general pediatricians completed the entire PoCUS course, but only 10 completed both the pre- and post-tests and therefore included in the analysis (N = 10). Pretest scores ranged from 30 to 63.3% with a mean of 41.6% [standard deviation (SD) 9.95]. The posttest scores ranged from 55 to 96%, with a mean of 66.1% (SD 12.26). The mean difference in scores was 24.42% (95% confidence interval 17.9, 30.9) with a significance of p < 0.05 and range of 8.3–36.6%. Physician experience and confidence with each topic improved from baseline. After the course, the majority of the participants (> 70%) had at least some confidence in 5 of the 6 topics. Conclusions In EDs with limited resources, a longitudinal PoCUS educational curriculum is effective in improving the knowledge and comfort of physicians with limited PoCUS experience. The effectiveness of scheduled, repeated courses to refresh and refocus participants was highlighted following the unexpected challenges encountered during the course, including multiple natural disasters.
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Affiliation(s)
- Veronica Sepulveda-Ortiz
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA
| | - Fred Warkentine
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA
| | - Rebecca Starr-Seal
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA
| | - Anna Rominger
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Louisville, 571 S. Floyd Street, Suite 412, Louisville, KY, 40202, USA.
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Kumar A, Weng Y, Wang L, Bentley J, Almli M, Hom J, Witteles R, Ahuja N, Kugler J. Portable Ultrasound Device Usage and Learning Outcomes Among Internal Medicine Trainees: A Parallel-Group Randomized Trial. J Hosp Med 2020; 15:e1-e6. [PMID: 32118565 DOI: 10.12788/jhm.3351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 11/03/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about how to effectively train residents with point-of-care ultrasonography (POCUS) despite increasing usage. OBJECTIVE This study aimed to assess whether handheld ultrasound devices (HUDs), alongside a year-long lecture series, improved trainee image interpretation skills with POCUS. METHODS Internal medicine intern physicians (N = 149) at a single academic institution from 2016 to 2018 participated in the study. The 2017 interns (n = 47) were randomized 1:1 to receive personal HUDs (n = 24) for patient care vs no-HUDs (n = 23). All 2017 interns received a repeated lecture series regarding cardiac, thoracic, and abdominal POCUS. Interns were assessed on their ability to interpret POCUS images of normal/abnormal findings. The primary outcome was the difference in end-of-the-year assessment scores between interns randomized to receive HUDs vs not. Secondary outcomes included trainee scores after repeating lectures and confidence with POCUS. Intern scores were also compared with historical (2016, N = 50) and contemporaneous (2018, N = 52) controls who received no lectures. RESULTS Interns randomized to HUDs did not have significantly higher image interpretation scores (median HUD score: 0.84 vs no-HUD score: 0.84; P = .86). However, HUD interns felt more confident in their abilities. The 2017 cohort had higher scores (median 0.84), compared with the 2016 historical control (median 0.71; P = .001) and 2018 contemporaneous control (median 0.48; P < .001). Assessment scores improved after first-time exposure to the lecture series, while repeated lectures did not improve scores. CONCLUSIONS Despite feeling more confident, personalized HUDs did not improve interns' POCUS-related knowledge or interpretive ability. Repeated lecture exposure without further opportunities for deliberate practice may not be beneficial for mastering POCUS.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yingjie Weng
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Libo Wang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Bentley
- Quantitative Science Unit, Stanford University School of Medicine, Stanford, California
| | - Marta Almli
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ronald Witteles
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Neera Ahuja
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, Robison SW, Edwards GG, Lewis MD, Maniaci MJ. A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:935-942. [PMID: 31807108 PMCID: PMC6839571 DOI: 10.2147/amep.s220153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 05/29/2023]
Abstract
PURPOSE Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program. PATIENTS AND METHODS This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment. RESULTS In total, 42 residents consented for participation. The residents' monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not. CONCLUSION A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.
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Affiliation(s)
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jed C Cowdell
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brett T Hiroto
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Monia E Werlang
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah W Robison
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Grace G Edwards
- Department of Education, Mayo Clinic, Jacksonville, FL, USA
- The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michele D Lewis
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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15
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Abstract
The Accreditation Council for Graduate Medical Education and the American Board of Physical Medicine and Rehabilitation developed milestones for evaluation of resident physicians that include proper musculoskeletal ultrasound examination of major joints. To date, there have been no published data demonstrating acquisition and retention of these skills and correlation with the milestone evaluation. The investigators developed and implemented a curriculum in musculoskeletal ultrasound examination for Physical Medicine and Rehabilitation residents at a large academic medical center. The investigators chose the following six joints for training and evaluation: ankle, elbow, hip, knee, shoulder, and wrist/hand. The program included: (1) didactic lectures on anatomy and ultrasound technique; (2) peer-led demonstrations of the procedure on a standardized patient (SP); (3) individual practice on standardized patients; (4) faculty observation and feedback; (5) review sessions and additional practice; and (6) assessment of skills in an objective structured clinical examination. From 2013 to 2017, 30 physical medicine and rehabilitation residents were trained and evaluated. The results, based on objective structured clinical examination scores, showed that most residents achieved the appropriate level of competency for their year. A blended, standardized curriculum in musculoskeletal ultrasound instruction with assessment by an objective structured clinical examination can be used to evaluate musculoskeletal ultrasound skills and can help align this education with residency milestones.
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16
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LoPresti CM, Schnobrich DJ, Dversdal RK, Schembri F. A road map for point-of-care ultrasound training in internal medicine residency. Ultrasound J 2019; 11:10. [PMID: 31359161 PMCID: PMC6638610 DOI: 10.1186/s13089-019-0124-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 03/28/2019] [Indexed: 01/13/2023] Open
Abstract
Background Ever-expanding uses have been developed for ultrasound, including its focused use at the bedside, often referred to as point-of-care ultrasound (POCUS). POCUS has been well developed and integrated into training in numerous fields, but remains relatively undefined in internal medicine training. This training has been shown to be desirable to both educators and trainees, but has proven difficult to implement. We sought to create a road map for internal medicine residency programs looking to create a POCUS program. Results Four internal medicine residency programs that have successfully integrated POCUS training describe their programs, as well as the principles and concepts underlying program development and execution. Review of educational teaching and assessment methods is outlined, as well as suggestions for integration into an already busy residency curriculum. Commonly reported barriers to POCUS implementation such as faculty development, equipment purchasing, resident supervision and quality assurance are addressed. Specific POCUS applications to target are touched upon, and a comparison of applications taught within these four programs suggest that there may be enough similarities to suggest a common curriculum. Finally, future needs are discussed. Conclusions POCUS can be successfully taught to internal medicine residents as a part of internal medicine training. Many common elements and principles are evident on review of these four described successful programs. Future support, in the form of endorsed medical society guidelines, will be needed before POCUS is universally incorporated across internal medicine residency training programs.
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Affiliation(s)
- Charles M LoPresti
- Division of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA.,Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106, USA
| | - Daniel J Schnobrich
- Department of Medicine, University of Minnesota, 401 East River Parkway, Variety Club Research Center, Suite 131, Minneapolis, MN, 55455, USA
| | - Renee K Dversdal
- Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
| | - Frank Schembri
- Department of Medicine, Boston Medical Center, 715 Albany St. E-113, Boston, MA, 02118, USA
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17
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Fortuna RJ, Marston B, Messing S, Wagoner G, Pulcino TL, Bingemann T, Caiola E, Scofield S, Nead K, Robbins BW. Ambulatory Training Program to Expand Procedural Skills in Primary Care. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519859298. [PMID: 31309160 PMCID: PMC6607565 DOI: 10.1177/2382120519859298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/31/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Outpatient procedures are an important component of primary care, yet few programs incorporate procedural training into their curriculum. We examined a 4-year procedural curriculum to improve understanding of ambulatory procedures and increase the number of procedures performed. METHODS A total of 56 resident and 8 faculty physicians participated in a procedural curriculum directed at joint injections (knee, shoulder, elbow, trochanteric bursa, carpal tunnel, wrist, and ankle), subdermal contraceptive insertion/removal, skin biopsies, and ultrasound use in primary care. We administered annual surveys and used generalized estimating equations to model changes. RESULTS Across the 4 years, there was an average 96% response rate. Mean comfort level with the indications for procedures increased for both resident (62.5 to 78.8; P < .0001) and faculty physicians (61.5 to 94.8; P < .0001). Similarly, mean comfort with performing procedures increased for both resident (32.1 to 62.3; P < .0001) and faculty physicians (42.2 to 85.4; P < .0001). Residents' comfort level performing procedures increased for all individual procedures measured. The mean number of procedures performed per year increased for resident (1.9 to 8.2; P < .0001) and faculty physicians (14.7 to 25.2; P = .087). CONCLUSIONS A longitudinal ambulatory-based procedural curriculum can increase resident and faculty physician understanding and comfort performing primary-care-based procedures. This, in turn, increased the total number of procedures performed.
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Affiliation(s)
- Robert J. Fortuna
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Bethany Marston
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
- Department of Internal Medicine,
Allergy/Immunology and Rheumatology, University of Rochester Medical Center,
Rochester, NY, USA
| | - Susan Messing
- Department of Biostatistics and
Computational Biology, University of Rochester Medical Center, Rochester, NY,
USA
| | - Gunnar Wagoner
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Tiffany L. Pulcino
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Todd Bingemann
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Enrico Caiola
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Steven Scofield
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Karen Nead
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
| | - Brett W Robbins
- Department of Internal Medicine,
University of Rochester Medical Center, Rochester, NY, USA
- Department of Pediatrics,University of
Rochester Medical Center, Rochester, NY, USA
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18
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Anstey JE, Jensen TP, Afshar N. Point-of-Care Ultrasound Needs Assessment, Curriculum Design, and Curriculum Assessment in a Large Academic Internal Medicine Residency Program. South Med J 2018; 111:444-448. [DOI: 10.14423/smj.0000000000000831] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Soffler MI, Hayes MM, Smith CC. Central venous catheterization training: current perspectives on the role of simulation. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:395-403. [PMID: 29872360 PMCID: PMC5973312 DOI: 10.2147/amep.s142605] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Simulation is a popular and effective training modality in medical education across a variety of domains. Central venous catheterization (CVC) is commonly undertaken by trainees, and carries significant risk for patient harm when carried out incorrectly. Multiple studies have evaluated the efficacy of simulation-based training programs, in comparison with traditional training modalities, on learner and patient outcomes. In this review, we discuss relevant adult learning principles that support simulation-based CVC training, review the literature on simulation-based CVC training, and highlight the use of simulation-based CVC training programs at various institutions.
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Affiliation(s)
- Morgan I Soffler
- Harvard Combined Pulmonary and Critical Care Fellowship at Massachusetts General Hospital and Beth Israel Deaconess Medical Center, Boston, MA, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Internal Medicine Residency Program, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - C Christopher Smith
- Internal Medicine Residency Program, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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20
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Dancel R, Schnobrich D, Puri N, Franco-Sadud R, Cho J, Grikis L, Lucas BP, El-Barbary M, Soni NJ. Recommendations on the Use of Ultrasound Guidance for Adult Thoracentesis: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2018; 13:126-135. [PMID: 29377972 DOI: 10.12788/jhm.2940] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Executive Summary: 1) We recommend that ultrasound should be used to guide thoracentesis to reduce the risk of complications, the most common being pneumothorax. 2) We recommend that ultrasound guidance should be used to increase the success rate of thoracentesis. 3) We recommend that ultrasound-guided thoracentesis should be performed or closely supervised by experienced operators. 4) We suggest that ultrasound guidance be used to reduce the risk of complications from thoracentesis in mechanically ventilated patients. 5) We recommend that ultrasound should be used to identify the chest wall, pleura, diaphragm, lung, and subdiaphragmatic organs throughout the respiratory cycle before selecting a needle insertion site. 6) We recommend that ultrasound should be used to detect the presence or absence of an effusion and approximate the volume of pleural fluid to guide clinical decision-making. 7) We recommend that ultrasound should be used to detect complex sonographic features, such as septations, to guide clinical decision-making regarding the timing and method of pleural drainage. 8) We suggest that ultrasound be used to measure the depth from the skin surface to the parietal pleura to help select an appropriate length needle and determine the maximum needle insertion depth. 9) We suggest that ultrasound be used to evaluate normal lung sliding pre- and postprocedure to rule out pneumothorax. 10) We suggest avoiding delay or interval change in patient position from the time of marking the needle insertion site to performing the thoracentesis. 11) We recommend against performing routine postprocedure chest radiographs in patients who have undergone thoracentesis successfully with ultrasound guidance and are asymptomatic with normal lung sliding postprocedure. 12) We recommend that novices who use ultrasound guidance for thoracentesis should receive focused training in lung and pleural ultrasonography and hands-on practice in procedural technique. 13) We suggest that novices undergo simulation-based training prior to performing ultrasound-guided thoracentesis on patients. 14) Learning curves for novices to become competent in lung ultrasound and ultrasound-guided thoracentesis are not completely understood, and we recommend that training should be tailored to the skill acquisition of the learner and the resources of the institution.
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Affiliation(s)
- Ria Dancel
- Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
- Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Schnobrich
- Division of General Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nitin Puri
- Division of Critical Care Medicine Services, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ricardo Franco-Sadud
- Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA
| | - Loretta Grikis
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Mahmoud El-Barbary
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | | | - Nilam J Soni
- Division of General & Hospital Medicine, The University of Texas School of Medicine at San Antonio, San Antonio, Texas, USA
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
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21
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Central Line Proficiency Test Outcomes after Simulation Training versus Traditional Training to Competence. Ann Am Thorac Soc 2018; 14:550-554. [PMID: 28145736 DOI: 10.1513/annalsats.201612-987oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Studies have shown the importance of simulation-based training on the outcomes of central venous catheter (CVC) insertion by trainees. OBJECTIVES To compare the performance of internal medicine trainees who underwent standardized simulation training of CVC insertion with that of internal medicine trainees who had traditional CVC training and were already deemed competent to perform the procedure during a proficiency evaluation using a training mannequin. METHODS Trainees who perform CVC insertion were enrolled in the institutional Central Line Workshop, which includes both an online and an experiential simulation component. The training is followed by a certification station proficiency assessment. Residents and fellows previously certified competent to perform CVC placement without supervision completed the online module, but they could opt out of the experiential component and proceed directly to the evaluation. RESULTS Forty-eight trainees participated in the study. Twenty-one (44%), 15 (31%), 6 (13%), 1 (2%), 2 (4%), and 3 (6%) were in postgraduate year 1 (PGY1), PGY2, PGY3, PGY4, PGY5, and PGY6, respectively. Twenty-nine completed the hands-on instruction, 28 (97%) of whom successfully passed the simulation-based assessment on their first attempt. Nineteen trainees previously credentialed to perform CVC placement without supervision opted out of the simulation-based experiential training. Of these, five (26%) failed in their first attempt (P = 0.02 vs. trainees who completed the simulation training). CONCLUSIONS Standardized simulation-based training can improve CVC insertion proficiency, even among trainees with previous experience sufficient to have been deemed competent in the procedure. Improved performance at simulation-based testing may translate to improved outcomes of CVC placement by trainees.
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22
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Tomasi R, Aichner J, Heim M, Edrich T, Hinzmann D, Kochs E, Zwißler B, Scheiermann P. [Current status of teaching in lung ultrasound : Query of knowledge, utilization, need, and preferred teaching method]. Med Klin Intensivmed Notfmed 2017; 113:202-207. [PMID: 28497206 DOI: 10.1007/s00063-017-0307-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/23/2017] [Accepted: 04/09/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) is a point-of-care technique which can quickly identify or rule out pathological findings. To date, it is unclear if knowledge about the use of LUS is readily available. OBJECTIVES We aimed to identify how much knowledge about the use of LUS is present, if there is a need for teaching in LUS, as well as the preferred teaching method in LUS. MATERIALS AND METHODS A total of 54 participants from two university departments of anesthesiology were randomized into the groups Online, Classroom, and Control. The Online group was taught by videos, the Classroom group by a traditional lecture with hands-on training, and the Control group was not taught at all. We conducted a pre- and posttest as well as a retention test 4 weeks after the end of the study by means of a survey (comparison with Mann-Whitney U test or t‑test, respectively, with p < 0.05 considered to be significant). RESULTS LUS is used "rarely" or "never", and mainly if there is a suspicion for pleural effusion (41.3%). There is a need for LUS (Online: 21.7%; Classroom: 60.9%; Control: 62.5%, p < 0.05). Hybrid teaching consisting of classroom-based and online-based teaching is preferred by the users (Online: 52.2%; Classroom: 56.5%; Control: 62.5%). At the end of the study, 32.6% of the participants of the intervention groups had used LUS in the diagnosis of a pneumothorax. Of the participants, 93.5% planned to use LUS more often in the future. CONCLUSIONS LUS is rarely used. There is a considerable need for teaching of LUS. Internet-based teaching and traditional lectures are considered equal. Both teaching methods improve the knowledge about LUS and lead to increased use of LUS in daily practice. The participants prefer hybrid teaching incorporating both teaching methods.
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Affiliation(s)
- R Tomasi
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - J Aichner
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, Bavariaring 19, 80336, München, Deutschland
| | - M Heim
- Klinik für Anästhesiologie am Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - T Edrich
- Abteilung für Anästhesie, Klinikum Landkreis Erding, Bajuwarenstraße 5, 85435, Erding, Deutschland
| | - D Hinzmann
- Klinik für Anästhesiologie am Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - E Kochs
- Klinik für Anästhesiologie am Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, München, Deutschland
| | - B Zwißler
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland
| | - P Scheiermann
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München, Deutschland.
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23
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Interrigi MC, Trovato FM, Catalano D, Trovato GM. Emergency thoracic ultrasound and clinical risk management. Ther Clin Risk Manag 2017; 13:151-160. [PMID: 28223817 PMCID: PMC5308587 DOI: 10.2147/tcrm.s126770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Thoracic ultrasound (TUS) has been proposed as an easy-option replacement for chest X-ray (CXR) in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. PATIENTS AND METHODS This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. RESULTS Three hundred and seventy emergency TUS scans (excluding trauma patients) were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion); in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed tomography (CT). In seven patients, even if chest disease was identified by CXR, such diagnoses were significantly modified by ultrasound, and CT confirmed that TUS was more appropriate. The overall respective individual performances of CXR and TUS for the diagnosis of a pleural-pulmonary disease in emergency are good, with accuracy >95%. CONCLUSION About 20% of pneumonia cases were detectable only by CXR and 20% only by TUS and not by CXR; ie, about 40% of patients may have been misdiagnosed if, by chance, only one of the two tools had been used. The concurrent use of TUS and CXR increases the overall sensitivity and specificity. The contribution of expert telementoring and final reappraisal is a valuable and sustainable element for emergency physicians' training and performance, contributing reasonably to mitigation of clinical risks.
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Affiliation(s)
| | - Francesca M Trovato
- Accident and Emergency Department, Ospedale Civile, Ragusa
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
| | - Daniela Catalano
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania
| | - Guglielmo M Trovato
- Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania
- Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy
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24
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Town JA, Bergl PA, Narang A, McConville JF. Internal Medicine Residents' Retention of Knowledge and Skills in Bedside Ultrasound. J Grad Med Educ 2016; 8:553-557. [PMID: 27777666 PMCID: PMC5058588 DOI: 10.4300/jgme-d-15-00383.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The long-term retention of knowledge and skills in bedside ultrasound by internal medicine residents after ultrasound training is not well understood. OBJECTIVE We sought to determine whether knowledge and skills acquired from focused training in bedside ultrasound are retained over time, and whether retention is related to independent practice. METHODS We conducted a prospective observational trial of 101 internal medicine residents at an academic medical center who participated in a bedside ultrasound workshop followed by 12 months of independent practice. Performance was measured on image-based knowledge and skills assessment using direct observation, both before the workshop and 12 months later. Individual usage data were obtained along with a survey on attitudes toward bedside ultrasound. RESULTS Participants' mean knowledge assessment score increased from a baseline of 63.7% to 84.5% immediately after training (P < .001). At 12 months, mean knowledge score fell to 73.0%, significantly different from both prior assessments (P < .001). Despite knowledge decline, the mean skills assessment score improved from a baseline of 30.5% to 50.4% at 12 months (P < .001). Residents reporting more ultrasound use (> 25 examinations) had higher scores in baseline knowledge and skills assessments than those with lower usage (< 25 examinations). Change in knowledge and image acquisition skills between assessments was equal in both subgroups. CONCLUSIONS Residents' knowledge of ultrasound improved after brief training but decayed over time, whereas skills showed marginal improvement over the study, with minimal support. Growth and retention of ultrasound abilities were not impacted by usage rates.
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Affiliation(s)
- James A. Town
- Corresponding author: James A. Town, MD, University of Washington, Medicine, 1959 NE Pacific Street, Box 356522, Seattle, WA 98195, 206.616.8378,
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Ailon J, Mourad O, Nadjafi M, Cavalcanti R. Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada. CANADIAN MEDICAL EDUCATION JOURNAL 2016; 7:e51-e69. [PMID: 28344693 DOI: 10.1145/3130800.3130828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly used on General Internal Medicine (GIM) inpatient services, creating a need for defined competencies and formalized training. We evaluated the extent of training in POCUS and the clinical use of POCUS among Canadian GIM residency programs. METHOD Internal Medicine trainees and GIM Faculty at the University of Toronto were surveyed on their clinical use of POCUS and the extent of their training. We separately surveyed Canadian IM Program Directors and Division Directors on the extent of POCUS training in their programs, barriers in the implementation of POCUS curricula, and recommendations for POCUS competencies in IM. RESULTS A majority of IM trainees (90/118, 76%) and GIM Faculty (15/29, 52%) used POCUS clinically. However, the vast majority of resident (111/117, 95%) and GIM Faculty (18/28, 64%) had received limited training. Of the Program Leaders surveyed, half (9/17, 53%) reported POCUS clinical use by their trainees; however only one quarter (4/16, 25%) reported offering formal curricula. Most respondents agreed that POCUS training should be incorporated into IM residency curricula, specifically for procedural guidance. CONCLUSIONS A considerable discrepancy exists between the clinical use of POCUS and the extent of formal training among Canadian IM residents and GIM Faculty. We propose that formalized POCUS training should be incorporated into IM residency programs, GIM fellowships, and Faculty development sessions, and identify POCUS skills that could be incorporated into future IM curricula.
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Affiliation(s)
- Jonathan Ailon
- General Internal Medicine & Palliative Care, Saint Michael's Hospital, Toronto, ON
| | - Ophyr Mourad
- General Internal Medicine, Saint Michael's Hospital, Toronto, ON
| | - Maral Nadjafi
- General Internal Medicine, North York General Hospital, Toronto, ON
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Trovato FM, Catalano D, Trovato GM. Thoracic ultrasound: An adjunctive and valuable imaging tool in emergency, resource-limited settings and for a sustainable monitoring of patients. World J Radiol 2016; 8:775-784. [PMID: 27721940 PMCID: PMC5039673 DOI: 10.4329/wjr.v8.i9.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Imaging workup of patients referred for elective assessment of chest disease requires an articulated approach: Imaging is asked for achieving timely diagnosis. The concurrent or subsequent use of thoracic ultrasound (TUS) with conventional (chest X-rays-) and more advanced imaging procedures (computed tomography and magnetic resonance imaging) implies advantages, limitations and actual problems. Indeed, despite TUS may provide useful imaging of pleura, lung and heart disease, emergency scenarios are currently the most warranted field of application of TUS: Pleural effusion, pneumothorax, lung consolidation. This stems from its role in limited resources subsets; actually, ultrasound is an excellent risk reducing tool, which acts by: (1) increasing diagnostic certainty; (2) shortening time to definitive therapy; and (3) decreasing problems from blind procedures that carry an inherent level of complications. In addition, paediatric and newborn disease are particularly suitable for TUS investigation, aimed at the detection of congenital or acquired chest disease avoiding, limiting or postponing radiological exposure. TUS improves the effectiveness of elective medical practice, in resource-limited settings, in small point of care facilities and particularly in poorer countries. Quality and information provided by the procedure are increased avoiding whenever possible artefacts that can prevent or mislead the achievement of the correct diagnosis. Reliable monitoring of patients is possible, taking into consideration that appropriate expertise, knowledge, skills, training, and even adequate equipment’s suitability are not always and everywhere affordable or accessible. TUS is complementary imaging procedure for the radiologist and an excellent basic diagnostic tool suitable to be shared with pneumologists, cardiologists and emergency physicians.
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Clay RD, Lee EC, Kurtzman MF, Dversdal RK. Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents. Crit Ultrasound J 2016; 8:11. [PMID: 27515967 PMCID: PMC4980845 DOI: 10.1186/s13089-016-0047-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background A growing body of evidence supports the use of bedside ultrasound for core Internal Medicine procedures and increasingly as augmentation of the physical exam. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on training approach. Aim To implement and study the effectiveness of a high-yield and expedited curriculum to train internal medicine interns to use bedside ultrasound for physical examination and procedures. Setting The study was conducted at a metropolitan, academic medical center and included 33 Internal Medicine interns. Program description This was a prospective cohort study of a new educational intervention consisting of a single-day intensive bedside ultrasound workshop followed by two optional hour-long workshops later in the year. The investigation was conducted at Oregon Health & Science University in Portland, Oregon. The intensive day consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions and ultrasound simulations. A 30-question assessment was used to assess ultrasound interpretation knowledge prior to, immediately post, and 6 months post intervention. Results Thirty-three interns served as their own historical controls. Assessment performance significantly increased after the intervention from a mean pre-test score of 18.3 (60.9 % correct) to a mean post-test score 25.5 (85.0 % correct), P value of <0.0001. This performance remained significantly better at 6 months with a mean score of 23.8 (79.3 % correct), P value <0.0001. There was significant knowledge attrition compared to the immediate post-assessment, P value 0.0099. Conclusions A single-day ultrasound training session followed by two optional noon conference sessions yielded significantly improved ultrasound interpretation skills in internal medicine interns.
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Affiliation(s)
- Ryan D Clay
- Department of Medicine, Oregon Health & Science University, Portland, USA.,Mayo Clinic Minnesota, 200 First Street SW, Rochester, MN, USA
| | - Elizabeth C Lee
- Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Marc F Kurtzman
- Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Renee K Dversdal
- Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, OP-30, Portland, OR, 97239, USA.
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Favot M, Courage C, Mantouffel J, Amponsah D. Ultrasound Training in the Emergency Medicine Clerkship. West J Emerg Med 2015; 16:938-42. [PMID: 26594295 PMCID: PMC4651599 DOI: 10.5811/westjem.2015.9.27290] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 09/07/2015] [Accepted: 09/26/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction The curriculum in most emergency medicine (EM) clerkships includes very little formalized training in point-of-care ultrasound. Medical schools have begun to implement ultrasound training in the pre-clinical curriculum, and the EM clerkship is an appropriate place to build upon this training. The objectives are (1) to evaluate the effectiveness of implementing a focused ultrasound curriculum within an established EM clerkship and (2) to obtain feedback from medical students regarding the program. Methods We conducted a prospective cohort study of medical students during an EM clerkship year from July 1, 2011, to June 30, 2012. Participants included fourth-year medical students (n=45) enrolled in the EM clerkship at our institution. The students underwent a structured program focused on the focused assessment with sonography for trauma exam and ultrasound-guided vascular access. At the conclusion of the rotation, they took a 10-item multiple choice test assessing knowledge and image interpretation skills. A cohort of EM residents (n=20) also took the multiple choice test but did not participate in the training with the students. We used an independent samples t-test to examine differences in test scores between the groups. Results The medical students in the ultrasound training program scored significantly higher on the multiple-choice test than the EM residents, t(63)=2.3, p<0.05. The feedback from the students indicated that 82.8% were using ultrasound on their current rotations and the majority (55.2%) felt that the one-on-one scanning shift was the most valuable aspect of the curriculum. Discussion Our study demonstrates support for an ultrasound training program for medical students in the EM clerkship. After completing the training, students were able to perform similarly to EM residents on a knowledge-based exam.
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Affiliation(s)
- Mark Favot
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Cheryl Courage
- Wayne State University School of Medicine, Department of Emergency Medicine, Detroit, Michigan
| | - Jacob Mantouffel
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
| | - David Amponsah
- Henry Ford Health System, Department of Emergency Medicine, Detroit, Michigan
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Kelm DJ, Ratelle JT, Azeem N, Bonnes SL, Halvorsen AJ, Oxentenko AS, Bhagra A. Longitudinal Ultrasound Curriculum Improves Long-Term Retention Among Internal Medicine Residents. J Grad Med Educ 2015; 7:454-7. [PMID: 26457155 PMCID: PMC4597960 DOI: 10.4300/jgme-14-00284.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound is a rapidly evolving component of internal medicine (IM) residency training. The optimal approach for teaching this skill remains unclear. OBJECTIVE We sought to determine whether the addition of a longitudinal ultrasound curriculum to a stand-alone workshop for ultrasound training improved knowledge retention in IM residents. METHODS We conducted an observational cohort study from July to December 2013. All postgraduate year (PGY)-1 IM residents attended an ultrasound workshop during orientation. Ability to identify static images of ascites, kidney, thyroid, pleural fluid, inferior vena cava, and internal jugular vein was assessed immediately after the workshop. An ultrasound curriculum, including morning report and ultrasound rounds, was initiated during the inpatient medicine rotation. PGY-1 residents were randomly assigned to participate in the longitudinal curriculum. Six months later, we conducted a follow-up survey with all PGY-1 residents. RESULTS Forty-eight PGY-1 residents (67%) completed the postworkshop test and the 6-month follow-up test. Of these, 50% (24 of 48) had participated in the ultrasound curriculum. Residents not exposed to the curriculum showed a decline in the identification of ascites, pleural effusion, and internal jugular vein at 6 months (P < .05), whereas those who participated in the curriculum maintained their performance (P < .05). CONCLUSIONS Six months after exposure to a longitudinal ultrasound curriculum, residents were more likely to correctly identify ultrasound images of ascites, kidney, and pleural effusion. The addition of a longitudinal ultrasound curriculum may result in improved knowledge retention in IM residents.
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Affiliation(s)
- Diana J. Kelm
- Corresponding author: Diana J. Kelm, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, 507.284.2416, fax 507.266.4372,
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Bernard S, Richardson C, Hamann CR, Lee S, Dinh VA. Head and Neck Ultrasound Education-A Multimodal Educational Approach in the Predoctoral Setting: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015. [PMID: 26206830 DOI: 10.7863/ultra.34.8.1437] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVES With the increased implementation of ultrasound in medical education, it is important to continually improve instructional methods. In this study, we demonstrate that by augmenting the traditional methods of instructor demonstration and student practice on a healthy volunteer with additional modalities, such as didactic presentation, simulated pathologic cases, and simulated procedures, students gain a more comprehensive understanding of and confidence in ultrasound technique and pathology. METHODS A multimodal curriculum was developed and applied to head and neck ultrasound sessions of our institution's Ultrasound Symposium. Participants were asked to fill out surveys rating each instructional modality as well as preinstructional and postinstructional confidence. The survey results were divided into a group of first- and second-year medical students who had previous ultrasound training and a group of third- and fourth-year students who were ultrasound "naïve." RESULTS The survey showed that the first- and second-year student group (n = 8) had an average preinstructional confidence of 4.14/10 compared to 1.44/10 in the third- and fourth-year student group (n = 9) (P = .003). Following the instructional sessions, the students' confidence increased respectively to 8.14/10 and 7.78/10 (P= .53), showing a 4.00 (96%) increase in the first- and second-year group and a 6.34 (440%) increase in the third- and fourth-year group. The combined results of all student teaching modality ratings showed that instructor demonstration was rated the highest (9.47) and computerized simulation lowest (8.25). CONCLUSIONS Overall, our study shows that multimodal ultrasound instruction was beneficial in increasing both ultrasound-trained and ultrasound-naïve medical students' confidence in head and neck ultrasound.
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Affiliation(s)
- Stewart Bernard
- Loma Linda University School of Medicine, Loma Linda, California USA (S.B., C.R., C.R.H.); and Departments of Otolaryngology-Head and Neck Surgery (S.L.), Emergency Medicine (V.A.D.), and Medicine, Division of Critical Care (V.A.D.), Loma Linda University, Loma Linda, California USA.
| | - Clare Richardson
- Loma Linda University School of Medicine, Loma Linda, California USA (S.B., C.R., C.R.H.); and Departments of Otolaryngology-Head and Neck Surgery (S.L.), Emergency Medicine (V.A.D.), and Medicine, Division of Critical Care (V.A.D.), Loma Linda University, Loma Linda, California USA
| | - Carsten R Hamann
- Loma Linda University School of Medicine, Loma Linda, California USA (S.B., C.R., C.R.H.); and Departments of Otolaryngology-Head and Neck Surgery (S.L.), Emergency Medicine (V.A.D.), and Medicine, Division of Critical Care (V.A.D.), Loma Linda University, Loma Linda, California USA
| | - Steve Lee
- Loma Linda University School of Medicine, Loma Linda, California USA (S.B., C.R., C.R.H.); and Departments of Otolaryngology-Head and Neck Surgery (S.L.), Emergency Medicine (V.A.D.), and Medicine, Division of Critical Care (V.A.D.), Loma Linda University, Loma Linda, California USA
| | - Vi Am Dinh
- Loma Linda University School of Medicine, Loma Linda, California USA (S.B., C.R., C.R.H.); and Departments of Otolaryngology-Head and Neck Surgery (S.L.), Emergency Medicine (V.A.D.), and Medicine, Division of Critical Care (V.A.D.), Loma Linda University, Loma Linda, California USA
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Dulohery MM, Stoven S, Kurklinsky AK, Halvorsen A, McDonald FS, Bhagra A. Ultrasound for internal medicine physicians: the future of the physical examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1005-11. [PMID: 24866607 DOI: 10.7863/ultra.33.6.1005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians' baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. METHODS Training was performed at the Mayo Clinic in June 2010 and June 2011. The participants consisted of internal medicine residents. The workshop included didactics and hands-on US experiences with human and cadaver models in a simulation center. Pretests and posttests of residents' knowledge, attitudes, and skills with US were completed. We reassessed the 2010 group in the spring of 2012 with a long-term retention survey for knowledge and confidence in viewing images. RESULTS A total of 136 interns completed the workshop. Thirty-nine residents completed the long-term retention survey. Posttest assessments showed a statistically significant improvement in the knowledge of US imaging, confidence in identifying structures, image identification, and image acquisition (P < .0001). In the long-term retention study, knowledge of US imaging and confidence in identifying structures did decline. CONCLUSIONS This educational intervention resulted in improvement in US knowledge and image acquisition. However, the knowledge diminished over time, suggesting that further education is needed if US is to become an important component of internal medicine training and practice.
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Affiliation(s)
- Megan M Dulohery
- Divisions of Pulmonary and Critical Care Medicine (M.M.D.), Gastroenterology (S.S.), General Internal Medicine (F.S.M., A.B.), and Hospital Internal Medicine (F.S.M), and Internal Medicine Residency Office of Educational Innovations (AH., F.S.M), Mayo Clinic, Rochester, Minnesota USA; and Division of Cardiology, Mayo Clinic, Jacksonville, Florida USA (AK.)
| | - Samantha Stoven
- Divisions of Pulmonary and Critical Care Medicine (M.M.D.), Gastroenterology (S.S.), General Internal Medicine (F.S.M., A.B.), and Hospital Internal Medicine (F.S.M), and Internal Medicine Residency Office of Educational Innovations (AH., F.S.M), Mayo Clinic, Rochester, Minnesota USA; and Division of Cardiology, Mayo Clinic, Jacksonville, Florida USA (AK.)
| | | | - Andrew Halvorsen
- Divisions of Pulmonary and Critical Care Medicine (M.M.D.), Gastroenterology (S.S.), General Internal Medicine (F.S.M., A.B.), and Hospital Internal Medicine (F.S.M), and Internal Medicine Residency Office of Educational Innovations (AH., F.S.M), Mayo Clinic, Rochester, Minnesota USA; and Division of Cardiology, Mayo Clinic, Jacksonville, Florida USA (AK.)
| | - Furman S McDonald
- Divisions of Pulmonary and Critical Care Medicine (M.M.D.), Gastroenterology (S.S.), General Internal Medicine (F.S.M., A.B.), and Hospital Internal Medicine (F.S.M), and Internal Medicine Residency Office of Educational Innovations (AH., F.S.M), Mayo Clinic, Rochester, Minnesota USA; and Division of Cardiology, Mayo Clinic, Jacksonville, Florida USA (AK.)
| | - Anjali Bhagra
- Divisions of Pulmonary and Critical Care Medicine (M.M.D.), Gastroenterology (S.S.), General Internal Medicine (F.S.M., A.B.), and Hospital Internal Medicine (F.S.M), and Internal Medicine Residency Office of Educational Innovations (AH., F.S.M), Mayo Clinic, Rochester, Minnesota USA; and Division of Cardiology, Mayo Clinic, Jacksonville, Florida USA (AK.).
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Cannella AC, Kissin EY, Torralba KD, Higgs JB, Kaeley GS. Evolution of Musculoskeletal Ultrasound in the United States: Implementation and Practice in Rheumatology. Arthritis Care Res (Hoboken) 2013; 66:7-13. [DOI: 10.1002/acr.22183] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 09/17/2013] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | - Jay B. Higgs
- Brooke Army Medical Center; Fort Sam Houston Texas
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Andrus P, Dean A. Focused Cardiac Ultrasound. Glob Heart 2013; 8:299-303. [DOI: 10.1016/j.gheart.2013.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 12/05/2013] [Indexed: 11/27/2022] Open
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Caronia J, Panagopoulos G, Devita M, Tofighi B, Mahdavi R, Levin B, Carrera L, Mina B. Focused renal sonography performed and interpreted by internal medicine residents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2007-2012. [PMID: 24154905 DOI: 10.7863/ultra.32.11.2007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Intensivist-performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings. METHODS Internal medicine residents were trained in a 5-hour module on focused renal sonography evaluating renal length, echogenicity, hydronephrosis, and cysts on a convenience sample of medical ward, intermediate care, and medical intensive care unit patients. All patients underwent comprehensive sonography within 24 hours. The primary outcome was represented by the Fleiss κ statistic, which indicated the degree of interobserver agreement between residents and radiologists. Sensitivity, specificity, and positive and negative predictive values were calculated using the comprehensive radiologist-read examination as the reference. RESULTS Seventeen internal medicine residents imaged 125 kidneys on 66 patients. The average number of studies performed was 7.3 (SD, 6.6). Residents demonstrated excellent agreement with radiologists for hydronephrosis (κ = 0.73; P < .001; SE, 0.15; sensitivity, 94%; specificity, 93%), moderate agreement for echogenic kidneys (κ = 0.43; P < .001; SE, 0.13; sensitivity, 40%; specificity, 98%), and substantial agreement for renal cysts (κ = 0.61; P < .001; SE, 0.12; sensitivity, 60%; specificity, 96%). Residents showed sensitivity of 100% and specificity of 88% for identification of atrophic kidneys, defined as length less than 8 cm. CONCLUSIONS After a 5-hour training course, medical residents accurately identified hydronephrosis and key sonographic findings of chronic kidney disease in a cohort of medical patients. Screening for hydronephrosis and renal atrophy can be performed by medical residents after adequate training.
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Affiliation(s)
- Jonathan Caronia
- Division of Pulmonary and Critical Care Medicine, Lenox Hill Hospital, 100 E 77th St, New York, NY 10075 USA.
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Alba GA, Kelmenson DA, Noble VE, Murray AF, Currier PF. Faculty staff-guided versus self-guided ultrasound training for internal medicine residents. MEDICAL EDUCATION 2013; 47:1099-108. [PMID: 24117556 DOI: 10.1111/medu.12259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/12/2013] [Accepted: 04/17/2013] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Ultrasonography is of growing importance within internal medicine (IM), but the optimal method of training doctors to use it is uncertain. In this study, the authors provide the first objective comparison of two approaches to training IM residents in ultrasonography. METHODS In this randomised trial, a simulation-based ultrasound training curriculum was implemented during IM intern orientation at a tertiary care teaching hospital. All 72 incoming interns attended a lecture and were given access to online modules. Interns were then randomly assigned to a 4-hour faculty-guided (FG) or self-guided (SG) ultrasound training session in a simulation laboratory with both human and manikin models. Interns were asked to self-assess their competence in ultrasonography and underwent an objective structured clinical examination (OSCE) to assess their competence in basic and procedurally oriented ultrasound tasks. The primary outcome was the score on the OSCE. RESULTS Faculty-guided training was superior to self-guided training based on the OSCE scores. Subjects in the FG training group achieved significantly higher OSCE scores on the two subsets of task completion (0.9-point difference, 95% confidence interval [CI] 0.27-1.54; p = 0.008) and ultrasound image quality (2.43-point difference, 95% CI 1.5-3.36; p < 0.001). Both training groups demonstrated an increase in self-assessed competence after their respective training sessions and there was little difference between the groups. Subjects rated the FG training group much more favourably than the SG training group. CONCLUSIONS Both FG and SG ultrasound training curricula can improve the self-reported competence of IM interns in ultrasonography. However, FG training was superior to SG training in both skills acquisition and intern preference. Incorporating mandatory ultrasound training into IM residencies can address the perceived need for ultrasound training, improve confidence and procedural skills, and may enhance patient safety. However, the optimal training method may require significant faculty input.
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Affiliation(s)
- George A Alba
- Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Augustine EM, Kahana M. Effect of procedure simulation workshops on resident procedural confidence and competence. J Grad Med Educ 2012; 4:479-85. [PMID: 24294425 PMCID: PMC3546578 DOI: 10.4300/jgme-d-12-00019.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 03/25/2012] [Accepted: 05/08/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatrics residents perform a limited number of some procedures in the clinical setting and may benefit from procedure simulation workshops. OBJECTIVE To examine (1) the number and types of procedures performed by pediatrics residents in the clinical setting, (2) the relationship between the number of procedures performed and self-reported procedural confidence and competence, and (3) the effect of a procedure simulation workshop on self-reported procedural confidence and competence. METHODS Pediatrics residents at Lucile Packard Children's Hospital at Stanford attended a half-day procedure workshop, rotating between 6 procedure simulation stations: vascular access, airway management, bladder catheterization, chest tube placement, lumbar puncture, and umbilical lines. Residents completed a survey immediately before and after the workshop to self-assess procedural confidence and competence. RESULTS Seventy-two residents participated in a procedure workshop. The average number of procedures performed increased significantly from intern to junior to senior year. A positive correlation was found between number of procedures performed and preworkshop confidence (P < .001, R (2) = 0.86) and competence (P < .001, R (2) = 0.88). For each procedure assessed, completion of the procedure simulation workshop resulted in a statistically significant (P < .001) increase in self-perceived confidence (14%-131%; average, 48%) and competence (12%-119%; average, 50%). Statistically significant (P < .05) increases remained when results for interns, juniors, and seniors were examined separately. CONCLUSION Procedure simulation workshops improve resident self-reported procedural confidence and competence, particularly for procedures that are least performed.
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