1
|
Herbert A, Russell FM, Ferre RM, Wilcox J, Peterson D, Davis J, Zakeri B, Hays M, Wallach PM. Two-week intensive medical student point-of-care ultrasound training impact on long term utilization. BMC MEDICAL EDUCATION 2024; 24:884. [PMID: 39152440 PMCID: PMC11330062 DOI: 10.1186/s12909-024-05866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND There is little to no data evaluating long term usage of point of care ultrasound (POCUS) after a training intervention for medical students. The purpose of this study was to examine the impact of an intensive POCUS training program on medical student's usage at 9-months post-program. METHODS This was a prospective cross-sectional study of rising second year medical students who participated in a 2-week summer POCUS training program. Instruction consisted of 8 h of asynchronous online didactic material, 2-4 h of daily hands-on instructor-led and independent scanning, and instruction on how to teach POCUS. Students were assessed pre- and post-program, and again at 9 months post-program to evaluate POCUS usage. RESULTS A total of 56 students participated in the program over 2 summers; 52 (92.9%) responded to the 9-month post-program survey. At 9 months, 49 (94.2%) of students taught POCUS after the program to peers or faculty. Students reported serving as a POCUS instructor in 283 subsequent teaching sessions accounting for 849 h of POCUS instruction time. Six (11.5%) students were involved in the creation of a POCUS interest group on their regional campus, 7 (13%) created a POCUS curriculum for their student interest group, and 4 (7.7%) created an opt-in co-curricular POCUS program for students at their regional campus. Three (5.8%) students did not serve as educators after the program and only one student reported not using POCUS again after the program. CONCLUSION After a 2-week intensive POCUS training program for medical students, the majority of students demonstrated continued involvement in POCUS learning and education at 9-month follow-up including serving as peer instructors and assisting with limitations in financial resources and trained faculty.
Collapse
Affiliation(s)
- Audrey Herbert
- Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FOB, 3rd Floor, Indianapolis, IN, 46202, USA.
| | - Frances M Russell
- Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Robinson M Ferre
- Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FOB, 3rd Floor, Indianapolis, IN, 46202, USA
| | - James Wilcox
- Assistant Professor of Clinical Family Medicine, Department of Family Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Dina Peterson
- Assistant Professor of Clinical Radiologic and Imaging Sciences, Department of Radiologic and Imaging Sciences, Indiana University School of Medicine, Indianapolis, USA
| | - Jean Davis
- RT, RDMS, Point of Care Ultrasound program manager, Indiana University School of Medicine, Indianapolis, USA
| | - Bita Zakeri
- Ph.D. Director of Professional Programs, Northeastern University, Boston, USA
| | - Matthew Hays
- MS, Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, and Richard M. Fairbanks School of Public Health, Indianapolis, USA
| | - Paul M Wallach
- Professor of Medicine, Indiana University School of Medicine, Executive Associate Dean for Educational Affairs and Institutional Improvement, Indiana University School of Medicine, Indianapolis, USA
| |
Collapse
|
2
|
Alkass J, Farber E. MUSIG: An Example Highlighting the Value of Student Led POCUS Education, Influenced by the COVID-19 Pandemic. MEDICAL SCIENCE EDUCATOR 2024; 34:299-301. [PMID: 38686163 PMCID: PMC11055807 DOI: 10.1007/s40670-023-01955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
There has been a recent push for more formal ultrasound teaching in medical school curricula. Faculty availability, however, presents a significant barrier to its implementation. Medical student interest groups such as the McGill Ultrasound Interest Group (MUSIG), aimed to address this barrier by using near-peer instruction (NPI) to teach ultrasound to other students. MUSIG has helped teach hundreds of students about the fundamentals of ultrasound and its applicability in clinical practice by creating ultrasound conferences, friendly ultrasound competitions, virtual lectures, and educational resources. This paper aims to use MUSIG as an example to highlight the important role students can play in changing the landscape of medical education.
Collapse
Affiliation(s)
- Jad Alkass
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Eadan Farber
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| |
Collapse
|
3
|
Hari R, Kälin K, Birrenbach T, Tal K, Roumet M, Limacher A, Huwendiek S, Serra A, Walter R. Near-peer compared to faculty teaching of abdominal ultrasound for medical students - A randomized-controlled trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:77-83. [PMID: 37257839 DOI: 10.1055/a-2103-4787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Medical schools increasingly rely on near-peer tutors for ultrasound teaching. We set out to compare the efficacy of a blended near-peer ultrasound teaching program to that of a faculty course in a randomized controlled trial. METHODS 152 medical students received 21 hours of ultrasound teaching either by near-peer teachers or medical doctors. The near-peer course consisted of blended learning that included spaced repetition. The faculty-led course was the European common course for abdominal sonography. The primary outcome measurement was the students' ultrasound knowledge at month 6, assessed by structured examination (score 0 to 50). Secondary outcomes included scores at month 0 and changes in scores after the course. RESULTS Students in the near-peer group scored 37 points, and students in the faculty group scored 31 points six months after course completion. The difference of 5.99 points (95% CI 4.48;7.49) in favor of the near-peer group was significant (p<0.001). Scores immediately after the course were 3.8 points higher in the near-peer group (2.35; 5.25, p<0.001). Ultrasound skills decreased significantly in the six months after course completion in the faculty group (-2.41 points, [-3.39; -1.42], p<0.001]) but barely decreased in the near-peer group (-0.22 points, [-1.19; 0.75, p=0.66]). CONCLUSION The near-peer course that combined blended learning and spaced repetition outperformed standard faculty teaching in basic ultrasound education. This study encourages medical schools to use peer teaching combined with e-learning and spaced repetition as an effective means to meet the increasing demand for ultrasound training.
Collapse
Affiliation(s)
- Roman Hari
- Faculty of Medicine, University of Bern Institute of Primary Health Care, Bern, Switzerland
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University School of Health Professions Education, Maastricht, Netherlands
| | - Kaspar Kälin
- Faculty of Medicine, University of Bern Institute of Primary Health Care, Bern, Switzerland
| | - Tanja Birrenbach
- Emergency Departement, Inselspital University Hospital Bern, Bern, Switzerland
| | - Kali Tal
- Faculty of Medicine, University of Bern Institute of Primary Health Care, Bern, Switzerland
| | - Marie Roumet
- Clinical Trials Unit (CTU), University of Bern, Bern, Switzerland
| | - Andreas Limacher
- Clinical Trials Unit (CTU), University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute for medical education, University of Bern Faculty of Medicine, Bern, Switzerland
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University School of Health Professions Education, Maastricht, Netherlands
| | - Andreas Serra
- Internal Medicine and Nephrology, Hirslanden Klinik Hirslanden, Zurich, Switzerland
| | - Robin Walter
- Faculty of Medicine, University of Bern Institute of Primary Health Care, Bern, Switzerland
| |
Collapse
|
4
|
Vandenbossche V, Valcke M, Steyaert A, Verstraete K, Audenaert E, Willaert W. Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition. ANATOMICAL SCIENCES EDUCATION 2023; 16:1089-1101. [PMID: 37356074 DOI: 10.1002/ase.2311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/04/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.
Collapse
Affiliation(s)
| | - Martin Valcke
- Department of Educational Studies, Ghent University, Ghent, Belgium
| | - Adelheid Steyaert
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Emmanuel Audenaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
| | - Wouter Willaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Gastrointestinal Surgery, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
5
|
Weimer JM, Widmer N, Strelow KU, Hopf P, Buggenhagen H, Dirks K, Künzel J, Börner N, Weimer AM, Lorenz LA, Rink M, Bellhäuser H, Schiestl LJ, Kloeckner R, Müller L, Weinmann-Menke J. Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study. Tomography 2023; 9:1315-1328. [PMID: 37489472 PMCID: PMC10366829 DOI: 10.3390/tomography9040104] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses. METHODS From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum". RESULTS Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills. CONCLUSIONS Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.
Collapse
Affiliation(s)
- Johannes Matthias Weimer
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Nina Widmer
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Kai-Uwe Strelow
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Paula Hopf
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Holger Buggenhagen
- Rudolf Frey Learning Clinic, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Klaus Dirks
- Department of General Internal Medicine and Geriatrics, Rems-Murr-Klinikum, 71364 Winnenden, Germany
| | - Julian Künzel
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 95053 Regensburg, Germany
| | - Norbert Börner
- Gastroenterological Medical Group Offices at the MED Specialist Centre Mainz, 55131 Mainz, Germany
| | - Andreas Michael Weimer
- Centre of Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital Heidelberg, 69118 Heidelberg, Germany
| | - Liv Annebritt Lorenz
- Department of Radiation Oncology and Radiotherapy, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Maximilian Rink
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Regensburg, 95053 Regensburg, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, 55112 Mainz, Germany
| | - Lina Judit Schiestl
- Department of Gynaecology and Obstetrics, University Medical Centre of the Johannes-Gutenberg University Mainz, 55131 Mainz, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, 23583 Lübeck, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Centre of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Julia Weinmann-Menke
- I. Department of Medicine, University Medical Centre of the Johannes Gutenberg University-Mainz, 55131 Mainz, Germany
| |
Collapse
|
6
|
Liu Z, Huang Y, Li H, Li W, Zhang F, Ouyang W, Wang S, Luo Z, Wang J, Chen Y, Xia R, Li Y, Pan X. A generalized deep learning model for heart failure diagnosis using dynamic and static ultrasound. J Transl Int Med 2023; 11:138-144. [PMID: 38025953 PMCID: PMC10680380 DOI: 10.2478/jtim-2023-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Objective Echocardiography (ECG) is the most common method used to diagnose heart failure (HF). However, its accuracy relies on the experience of the operator. Additionally, the video format of the data makes it challenging for patients to bring them to referrals and reexaminations. Therefore, this study used a deep learning approach to assist physicians in assessing cardiac function to promote the standardization of echocardiographic findings and compatibility of dynamic and static ultrasound data. Methods A deep spatio-temporal convolutional model r2plus1d-Pan (trained on dynamic data and applied to static data) was improved and trained using the idea of "regression training combined with classification application," which can be generalized to dynamic ECG and static cardiac ultrasound views to identify HF with a reduced ejection fraction (EF < 40%). Additionally, three independent datasets containing 8976 cardiac ultrasound views and 10085 cardiac ultrasound videos were established. Subsequently, a multinational, multi-center dataset of EF was labeled. Furthermore, model training and independent validation were performed. Finally, 15 registered ultrasonographers and cardiologists with different working years in three regional hospitals specialized in cardiovascular disease were recruited to compare the results. Results The proposed deep spatio-temporal convolutional model achieved an area under the receiveroperating characteristic curve (AUC) value of 0.95 (95% confidence interval [CI]: 0.947 to 0.953) on the training set of dynamic ultrasound data and an AUC of 1 (95% CI, 1 to 1) on the independent validation set. Subsequently, the model was applied to the static cardiac ultrasound view (validation set) with simultaneous input of 1, 2, 4, and 8 images of the same heart, with classification accuracies of 85%, 81%, 93%, and 92%, respectively. On the static data, the classification accuracy of the artificial intelligence (AI) model was comparable with the best performance of ultrasonographers and cardiologists with more than 3 working years (P = 0.344), but significantly better than the median level (P = 0.0000008). Conclusion A new deep spatio-temporal convolution model was constructed to identify patients with HF with reduced EF accurately (< 40%) using dynamic and static cardiac ultrasound images. The model outperformed the diagnostic performance of most senior specialists. This may be the first HF-related AI diagnostic model compatible with multi-dimensional cardiac ultrasound data, and may thereby contribute to the improvement of HF diagnosis. Additionally, the model enables patients to carry "on-the-go" static ultrasound reports for referral and reexamination, thus saving healthcare resources.
Collapse
Affiliation(s)
- Zeye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| | - Yuan Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
| | - Hang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| | - Wenchao Li
- Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Huazhong Fuwai Hospital, Pediatric Cardiac Surgery, Zhengzhou450000, Henan Province, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| | - Wenbin Ouyang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| | - Shouzheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| | - Zhiling Luo
- Department of Echocardiography, Fuwai Yunnan Cardiovascular Hospital, Kunming650000, Yunnan Province, China
| | - Jinduo Wang
- University of Science and Technology of China, School of Cyber Science and Technology, Hefei230000, Anhui Province, China
| | - Yan Chen
- University of Science and Technology of China, School of Cyber Science and Technology, Hefei230000, Anhui Province, China
| | - Ruibing Xia
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University Munich, MunichD-80539, Germany
| | - Yakun Li
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam1105 AZ, The Netherlands
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing100037, China
- National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing100037, China
- Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing100037, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing100037, China
| |
Collapse
|
7
|
Navas de Solis C, Stefanovski D, Johnson AL, Reef VB, Underwood C. Evaluation of a Self-Driven Large Animal Point of Care Ultrasound Learning Program for Veterinary Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2023:e20230009. [PMID: 37115710 DOI: 10.3138/jvme-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Point of care ultrasound (POCUS) has the potential to improve healthcare outcomes and is increasingly used in veterinary primary care and specialty practice. The aim of this study was to evaluate a self-driven POCUS learning program during clinical rotations in a large animal teaching hospital. A randomized controlled trial of 94 students evaluated the hypotheses that access to a self-driven POCUS program would improve scores on a written test and the quality of subjective, objective, assessment and plan (SOAP) documents. Use of the POCUS devices and perceptions of veterinary students towards POCUS were analyzed. The self-driven POCUS learning program was feasible, and the perception of most students (94%) was that the program was useful for their education. Access to equipment, ability to scan individually, the hands-on learning aspect, and clinicians' help were the most valued aspects of the program. Earlier access to POCUS in the curriculum, hands-on tutorials/labs, and a more structured learning program were identified by students as aspects to improve. Access to the self-driven POCUS program resulted in significantly higher scores on the written test in a subpopulation of students with lower scores. No significant differences in results on the multiple-choice tests in the subpopulation with higher scores or in SOAP scores of the complete group or subpopulations were found. A self-driven POCUS learning program was perceived as beneficial by students, increased POCUS knowledge in students with lower test scores, and was possible to implement in a busy large animal teaching hospital.
Collapse
Affiliation(s)
- Cristobal Navas de Solis
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Darko Stefanovski
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Amy L Johnson
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Virginia B Reef
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| | - Claire Underwood
- Department of Clinical Studies New Bolton Center, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348 USA
| |
Collapse
|
8
|
Rathbun KM, Patel AN, Jackowski JR, Parrish MT, Hatfield RM, Powell TE. Incorporating ultrasound training into undergraduate medical education in a faculty-limited setting. BMC MEDICAL EDUCATION 2023; 23:263. [PMID: 37076831 PMCID: PMC10113991 DOI: 10.1186/s12909-023-04227-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Point of care ultrasound (POCUS) is becoming a major extension of patient care. From diagnostic efficacy to its widespread accessibility, POCUS has expanded beyond emergency departments to be a tool utilized by many specialties. With the expansion of its use, medical education has begun to implement ultrasound education earlier in curricula. However, at institutions without a formal ultrasound fellowship or curriculum, these students lack the fundamental knowledge of ultrasound. At our institution, we set out to incorporate an ultrasound curriculum, into undergraduate medical education utilizing a single faculty member and minimal curricular time. METHODS Our stepwise implementation began with the development of a 3-hour fourth-year (M4) Emergency Medicine clerkship ultrasound teaching session, which included pre- and post-tests as well as a survey. The success with this session progressed to the development of a designated fourth-year ultrasound elective, which was evaluated with narrative feedback. Finally, we developed six 1-hour ultrasound sessions that correlated with first-year (M1) gross anatomy and physiology. A single faculty member was responsible for this curriculum and other instructors included residents, M4 students, and second-year (M2) near-peer tutors. These sessions also included pre- and post-tests and a survey. Due to curricular time limitations, all but the M4 Emergency Medicine clerkship session were optional. RESULTS 87 students participated in the emergency medicine clerkship ultrasound session and 166 M1 students participated in the voluntary anatomy and physiology ultrasound sessions. All participants agreed or strongly agreed that they would like more ultrasound training, that ultrasound training should be integrated into all four years of undergraduate medical education. Students were in strong agreement that the ultrasound sessions helped increase understanding of anatomy and anatomical identification with ultrasound. CONCLUSION We describe the stepwise addition of ultrasound into the undergraduate medical education curriculum of an institution with limited faculty and curricular time.
Collapse
Affiliation(s)
- Kimberly M Rathbun
- Department of Emergency Medicine, Augusta University, University of Georgia Medical Partnership, Athens, GA, Greece.
| | - Arjun N Patel
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | | | | | - Ryan M Hatfield
- Department of Emergency Medicine, Prisma Health, Columbia, SC, USA
| | - Tyler E Powell
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Kern J, Scarpulla M, Finch C, Martini W, Bolch CA, Al-Nakkash L. The assessment of point-of-care-ultrasound (POCUS) in acute care settings is benefitted by early medical school integration and fellowship training. J Osteopath Med 2023; 123:65-72. [PMID: 36121935 DOI: 10.1515/jom-2021-0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 08/29/2022] [Indexed: 01/29/2023]
Abstract
CONTEXT Point-of-care ultrasound (POCUS) has widespread utilization in multiple clinical settings. It has been shown to positively influence clinician confidence in diagnosis and can help appropriately manage patients in acute care settings. There has been a growing trend of increased emphasis on incorporating POCUS training in the first 2 years of the medical school curriculum. OBJECTIVES This article aims to analyze the clinical use of POCUS in acute settings and how training early in medical school may strengthen clinician confidence and utilization. METHODS An anonymous 10-question survey on POCUS use was conducted via a secure online platform and distributed to board-certified practicing physicians (MDs and DOs) with educational agreements with Midwestern University (MWU) across acute care specialties. This included preceptors within the MWU graduate medical education clinical consortium. Survey questions were aimed at assessing frequency of use, machine type, reasons for utilizing POCUS, initial ultrasound training, confidence in performing/interpreting POCUS, and perceived impact on patient outcomes. Surveys less than 50% complete were excluded. All surveys returned were more than 50% complete and thus included in the study. Statistical analyses were conducted utilizing the statistical software R version 4.0. RESULTS Surveys were sent out to 187 participants with 68 responses (36.4% response rate). The survey results demonstrated a relationship between learning POCUS earlier in one's medical career (medical school, residency, or fellowship) to increased use in acute settings when compared to learning POCUS during clinical practice. Of the 68 respondents, 65 (95.6%) indicated that they agree or strongly agree that POCUS use improves patient care, and 64 (94.1%) indicated that they agree or strongly agree that the use of POCUS can improve patient outcomes. CONCLUSIONS Our survey of acute care physicians indicated that most respondents utilize POCUS daily or weekly (90.8%), and this was related to fewer years of practice (under 10 years from medical school graduation, 94.6%). Moreover, POCUS was utilized primarily in acute care settings for procedures (25%, n=17/68 respondents). These survey results indicate that early integration of POCUS education in osteopathic medical school curricula and throughout fellowship training could likely enhance POCUS utilization in acute care settings.
Collapse
Affiliation(s)
- Julia Kern
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Megan Scarpulla
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Charles Finch
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | - Wayne Martini
- Department of Emergency Medicine, Abrazo Health Network, Goodyear, AZ, USA
| | - Charlotte A Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
| | - Layla Al-Nakkash
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| |
Collapse
|
10
|
Robinson E, Little D. A practical guide to undergraduate radiology education. Clin Radiol 2022; 77:e826-e834. [DOI: 10.1016/j.crad.2022.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/03/2022]
|
11
|
Ultrasonography in undergraduate medical education: a comprehensive review and the education program implemented at Jichi Medical University. J Med Ultrason (2001) 2022; 49:217-230. [PMID: 35034230 PMCID: PMC8761092 DOI: 10.1007/s10396-021-01178-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
The concept of point-of-care ultrasound has been widely accepted owing to the development of portable ultrasound systems and growing body of evidence concerning its extensive utility. Thus, it is reasonable to suggest that training to use this modality be included in undergraduate medical education. Training in ultrasonography helps medical students learn basic subjects such as anatomy and physiology, improve their physical examination skills, and acquire diagnostic and procedural skills. Technological advances such as simulators, affordable handheld devices, and tele-ultrasound systems can facilitate undergraduate ultrasound education. Several reports have indicated that some medical schools have integrated ultrasound training into their undergraduate medical curricula. Jichi Medical University in Japan has been providing medical students with ultrasound education to fulfill part of its mission to provide medical care to rural areas. Vertical integration of ultrasound education into a curriculum seems reasonable to ensure skill retention and improvement. However, several issues have hampered the integration of ultrasound into medical education, including a lack of trained faculty, the need to recruit human models, requisition of ultrasound machines for training, and limited curricular space; proposed solutions include peer teaching, students as trained simulated patients, the development of more affordable handheld devices, and a flipped classroom approach with access to an e-learning platform, respectively. A curriculum should be developed through multidisciplinary and bottom-up student-initiated approaches. Formulating national and international consensuses concerning the milestones and curricula can promote the incorporation of ultrasound training into undergraduate medical education at the national level.
Collapse
|
12
|
Pade KH, Niknam KR, Lobo VE, Anderson KL. The Efficacy of a Brief Educational Training Session in Point-of-Care Pediatric Hip Ultrasound. Pediatr Emerg Care 2022; 38:1-3. [PMID: 32796351 DOI: 10.1097/pec.0000000000002202] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric limp is a common presenting complaint to emergency departments. Despite this, diagnosis can be difficult in young patients with no history of trauma. Ultrasound can be used to identify a hip effusion, which may be the etiology of limp in pediatric patients. Brief educational training sessions have successfully been used to introduce novice ultrasound users to point-of-care (POC) ultrasound; however, the education of POC hip ultrasound is underexplored, and the efficacy of educational training sessions in this domain remains unknown. OBJECTIVE To evaluate the feasibility and efficacy of using a brief educational training session to teach novice ultrasound users to identify hip anatomy and effusions. METHODS Medical and physician assistant students were enrolled during an ultrasound education conference. A pretest evaluated prior knowledge, experience, and confidence level regarding POC hip ultrasound. Students attended a brief didactic session and then completed an objective structured assessment of technical skill as well as a posttest. RESULTS Twenty-eight students naive to hip ultrasound participated in this study. Levels of training included medical and physician assistant students. Mean test scores increased from the pretest (4.8 of 9, SD = 1.6) to the posttest (7.9 of 9, SD = 0.72) (P < 0.001). Average objective structured assessment of technical skill was 4.6 of 5 (SD, 0.75; 95% confidence interval, 4.3-4.9). After the sessions, confidence levels in identifying landmarks, joint space, and a joint effusion significantly increased (P < 0.001). CONCLUSIONS Pediatric hip ultrasound knowledge, performance, skills, and confidence improved as demonstrated by novice ultrasound users after a brief educational training session. Our study shows that a brief, targeted educational intervention was a feasible and effective method of introducing pediatric POC hip ultrasound to novices.
Collapse
Affiliation(s)
- Kathryn H Pade
- From the Department of Emergency Medicine, Rady Children's Hospital, San Diego
| | - Kian R Niknam
- Department of Emergency Medicine, Stanford University Hospital, Palo Alto, CA
| | - Viveta E Lobo
- Department of Emergency Medicine, Stanford University Hospital, Palo Alto, CA
| | - Kenton L Anderson
- Department of Emergency Medicine, Stanford University Hospital, Palo Alto, CA
| |
Collapse
|
13
|
Schott CK, LoPresti CM, Boyd JS, Core M, Haro EK, Mader MJ, Pascual S, Finley EP, Lucas BP, Colon-Molero A, Restrepo MI, Pugh J, Soni NJ. Retention of Point-of-Care Ultrasound Skills Among Practicing Physicians: Findings of the VA National POCUS Training Program. Am J Med 2021; 134:391-399.e8. [PMID: 32931765 DOI: 10.1016/j.amjmed.2020.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. METHODS Course participants' POCUS knowledge and hands-on technical skills were tested pre-course using an online, 30-question knowledge test and a directly observed skills test, respectively. The same knowledge and skills tests were repeated immediately post-course and after 6-9 months using remote tele-ultrasound software. Course participants completed a survey on their POCUS use pre-course and after 6-9 months post-course. RESULTS There were 127 providers who completed the POCUS training course from October 2016 to November 2017. Knowledge test scores increased from a median of 60% to 90% immediately post-course followed by a slight decrease to 87% after 8 months post-course. Median skills test scores for 4 common POCUS applications (heart, lung, abdomen, vascular access) increased 36-74 points from pre-course to immediately post-course with a 2-7-point decrease after 8 months. Providers reported more frequent POCUS use post-course, which suggests application of their POCUS knowledge and skills in clinical practice. More frequent use of cardiac POCUS applications was associated with significantly greater retention of cardiac skills at 8 months. CONCLUSIONS Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
Collapse
Affiliation(s)
- Christopher K Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care System, Pittsburgh, Pa; Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center (UPMC), Pa.
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Boyd
- Department of Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville; Department of Emergency Medicine, Vanderbilt University, Nashville, Tenn
| | - Megan Core
- Department of Emergency Medicine Service, Orlando Veterans Affairs Medical Center, Fla; Department of Medicine, University of Central Florida College of Medicine, Orlando
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Michael J Mader
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | | | - Erin P Finley
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vt; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Angel Colon-Molero
- VHA Specialty Care Service, Veterans Affairs Central Office (VACO), Washington, DC
| | - Marcos I Restrepo
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Jacqueline Pugh
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| |
Collapse
|
14
|
Amaral CB, Ralston DC, Becker TK. Prehospital point-of-care ultrasound: A transformative technology. SAGE Open Med 2020; 8:2050312120932706. [PMID: 32782792 PMCID: PMC7383635 DOI: 10.1177/2050312120932706] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Point-of-care ultrasound at the bedside has evolved into an essential component of emergency patient care. Current evidence supports its use across a wide spectrum of medical and traumatic diseases in a variety of settings. The prehospital use of ultrasound has evolved from a niche technology to impending widespread adoption across emergency medical services systems internationally. Recent technological advances and a growing evidence base support this trend. However, concerns regarding feasibility, education, and quality assurance must be addressed proactively. This topical review describes the history of prehospital ultrasound, initial training needs, ongoing skill maintenance, quality assurance and improvement requirements, available devices, and indications for prehospital ultrasound.
Collapse
Affiliation(s)
- Colton B Amaral
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Daniel C Ralston
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| |
Collapse
|
15
|
Renberg M, Kilhamn N, Lund K, Hertzberg D, Rimes-Stigare C, Bell M. Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population. Ultrasound J 2020; 12:28. [PMID: 32430724 PMCID: PMC7237552 DOI: 10.1186/s13089-020-00175-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/11/2020] [Indexed: 01/13/2023] Open
Abstract
Background The Doppler-derived renal resistive index (RRI) is emerging as a promising bedside tool for assessing renal perfusion and risk of developing acute kidney injury in critically ill patients. It is not known what level of ultrasonography competence is needed to obtain reliable RRI values. Objective The aim of this study was to evaluate the feasibility of RRI measurements by an intermediate and novice sonographer in a volunteer population. Methods After a focused teaching session, an intermediate (resident), novice (medical student) and expert sonographer performed RRI measurements in 23 volunteers consecutively and blinded to the results of one another. Intraclass correlation coefficients and Bland–Altman plots were used to evaluate interobserver reliability, bias and precision. Results Both non-experts were able to obtain RRI values in all volunteers. Median RRI in the population measured by the expert was 0.58 (interquartile range 0.52–0.62). The intraclass correlation coefficient was 0.96 (95% confidence interval 0.90–0.98) for the intermediate and expert, and 0.85 (95% confidence interval 0.69–0.94) for the novice and expert. In relation to the measurements of the expert, both non-experts showed negligible bias (mean difference 0.002 [95% confidence interval − 0.005 to 0.009, p = 0.597] between intermediate and expert, mean difference 0.002 [95% confidence interval − 0.011 to 0.015, p = 0.752] between novice and expert) and clinically acceptable precision (95% limits of agreement − 0.031 to 0.035 for the intermediate, 95% limits of agreement − 0.056 to 0.060 for the novice). Conclusions RRI measurements by both an intermediate and novice sonographer in a volunteer population were reliable, accurate and precise after a brief course. RRI is easy to learn and feasible within the scope of point-of-care ultrasound.
Collapse
Affiliation(s)
- Mårten Renberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
| | - Naima Kilhamn
- Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Kent Lund
- Department of Clinical Physiology, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Daniel Hertzberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Claire Rimes-Stigare
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Strøm M, Rasmussen JL, Nayahangan LJ, de la Motte L, Vogt K, Konge L, Eiberg J. Learn EVAR sizing from scratch: The results of a one-day intensive course in EVAR sizing and stent graft selection for vascular trainees. Vascular 2020; 28:342-347. [DOI: 10.1177/1708538120913719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aim Recognition of structured training in endovascular aortic repair (EVAR) for vascular trainees is increasing. Nevertheless, how trainees can achieve sufficient skills in EVAR sizing and graft selection is sparsely described. The aim of this study was to investigate the effect of systematic training in basic EVAR sizing and graft selection on vascular surgery trainees using a validated assessment tool. Methods Sixteen vascular surgery trainees were included in an intensive 6-h hands-on workshop in aortic sizing and stent graft selection for EVAR with a trainer-to-trainee ratio of 1:2. After 1-h lecture, participants did 5 h of supervised training on increasingly complex cases. Finally, the participants were tested using a validated assessment tool. Results All participants were able to size the test-case and select a stent graft combination in 24:35 (13:30–48:20) min (median and range). The participants’ overall test scores (lower is better) were in median 17.9 (11.9–28.4). This did not differ from the scores of experienced EVAR operators 14.7 (11.7–25.2) (<200 EVAR’s) ( p = .32) but was inferior to the score of EVAR experts 11.2 (9.8 –18.7) (≥200 EVAR’s) ( p = .01). The sub-score for anatomical measurements was 10.6 (3.9–18.8) and comparable with the experienced group 9.7 (8.1–12.8) ( p = .83) but inferior to the expert operators 6.5 (5.2–10.2) ( p = .04). The sub-score for stent graft selection was 7.5 (4.9–14.1) and comparable with experienced operators scoring 4.5 (3.6–12.3) ( p = .09) but inferior to the expert operators score of 5.0 (3.6–8.4) ( p = .01). Conclusion This study presents the results of a standardised one-day basic EVAR sizing and graft selection workshop. Vascular surgery trainees with no prior EVAR experience learned to size and select stent grafts for a simple infra-renal AAA on par with experienced EVAR operators.
Collapse
Affiliation(s)
- Michael Strøm
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Vascular Surgery, Roskilde University Hospital, Roskilde, Denmark
| | - Jonathan Lawaetz Rasmussen
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
| | - Louise de la Motte
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katja Vogt
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Eiberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
17
|
Khoury M, Fotsing S, Jalali A, Chagnon N, Malherbe S, Youssef N. Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943615. [PMID: 32754649 PMCID: PMC7378712 DOI: 10.1177/2382120520943615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.
Collapse
Affiliation(s)
- Michel Khoury
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Salomon Fotsing
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| | - Alireza Jalali
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Nicolas Chagnon
- Department of Emergency Medicine,
Montfort Hospital, Ottawa, ON, Canada
| | | | - Nermine Youssef
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Affaires Francophones, University of
Ottawa, Ottawa, ON, Canada
| |
Collapse
|
18
|
Swamy V, Brainin P, Biering-Sørensen T, Platz E. Ability of non-physicians to perform and interpret lung ultrasound: A systematic review. Eur J Cardiovasc Nurs 2019; 18:474-483. [PMID: 31018658 DOI: 10.1177/1474515119845972] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. AIMS To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. METHODS AND RESULTS We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0-12 h of didactic training and 58-62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79-98% and a specificity of 70-99%. In image adequacy studies, medical students with 2-9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50-100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. CONCLUSIONS Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.
Collapse
Affiliation(s)
- Varsha Swamy
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA
| | - Philip Brainin
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Tor Biering-Sørensen
- 2 Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Elke Platz
- 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, USA.,3 Harvard Medical School, Boston, USA
| |
Collapse
|
19
|
Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in Undergraduate Medical Education: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2667-2679. [PMID: 29708268 DOI: 10.1002/jum.14628] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/18/2018] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The purpose of this study was to conduct a systematic review of the evidence of educational outcomes associated with teaching ultrasonography (US) to medical students. METHODS A review of databases through 2016 was conducted for research studies that reported data on teaching US to medical students. Each title and abstract were reviewed by teams of 2 independent abstractors to determine whether the article would be ordered for full-text review and subsequently by 2 independent authors for inclusion. Data were abstracted with a form developed a priori by the authors. RESULTS Ninety-five relevant unique articles were included (of 6936 identified in the databases). Survey data showed that students enjoyed the US courses and desired more US training. Of the studies that assessed US-related knowledge and skill, most of the results were either positive (16 of 25 for knowledge and 24 of 58 for skill) or lacked a control (8 of 25 for knowledge and 27 of 58 for skill). The limited evidence (14 of 95 studies) of the effect of US training on non-US knowledge and skill (eg, anatomy knowledge or physical examination skill) was mixed. CONCLUSIONS There is ample evidence that students can learn US knowledge and skills and that they enjoy and want US training in medical school. The evidence for the effect of US on external outcomes is limited, and there is insufficient evidence to recommend it for this purpose at this time.
Collapse
Affiliation(s)
- Joshua J Davis
- Department of Emergency Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Jacqueline Potts
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Arthur K Au
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Charles A Pohl
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Matthew Fields
- Department of Emergency Medicine, Kaiser Permanente San Diego, San Diego, California, USA
| |
Collapse
|
20
|
Steinmetz P, Oleskevich S, Dyachenko A, McCusker J, Lewis J. Accuracy of Medical Students in Detecting Pleural Effusion Using Lung Ultrasound as an Adjunct to the Physical Examination. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2545-2552. [PMID: 29574857 DOI: 10.1002/jum.14612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study compared the accuracy of medical students in identifying pleural effusion in hospitalized patients using the physical examination versus lung ultrasound (US). METHODS Fourth-year medical students (n = 14) received 20 hours of general practical US training (including 2 hours of specialized lung US training) plus theoretical and video documentation. The students used the physical examination alone versus the physical examination plus lung US to document the presence or absence of pleural effusion in the right and left hemithoraces of hospitalized patients (n = 11 patients; 22 hemithoraces examined 544 times in total). The reference standard for identification of pleural effusion was a lung US examination by 2 expert point-of-care sonographers. RESULTS The odds of correctly identifying the presence versus absence of pleural effusion was 5 times greater with lung US as an adjunct to the physical examination compared to the physical examination alone (odds ratio [OR], 5.1 from multivariate logistic regression; 95% confidence interval, 3.3-8.0). The addition of lung US to the physical examination resulted in an increase in sensitivity from 48% to 90%, in specificity from 73% to 86%, and in accuracy from 60% to 88%. The benefits of using US were greater when pleural effusion was present versus absent (OR, 10.8 versus 2.4) and when examining older versus younger patients (OR, 10.2 versus 2.8). CONCLUSIONS These results demonstrate that medical students' ability to detect the presence or absence of pleural effusion is superior when using lung US as an adjunct to the physical examination than when using the physical examination alone.
Collapse
Affiliation(s)
- Peter Steinmetz
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St Mary's Hospital Center, Montreal, Quebec, Canada
| | - Sharon Oleskevich
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Alina Dyachenko
- St Mary's Research Center, McGill University, Montreal, Quebec, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- St Mary's Hospital Center, Montreal, Quebec, Canada
- St Mary's Research Center, McGill University, Montreal, Quebec, Canada
| | - John Lewis
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St Mary's Hospital Center, Montreal, Quebec, Canada
| |
Collapse
|
21
|
Safavi AH, Shi Q, Ding M, Kotait M, Profetto J, Mohialdin V, Shali A. Structured, Small-group Hands-on Teaching Sessions Improve Pre-clerk Knowledge and Confidence in Point-of-care Ultrasound Use and Interpretation. Cureus 2018; 10:e3484. [PMID: 30613446 PMCID: PMC6314823 DOI: 10.7759/cureus.3484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Many undergraduate medical education (UME) programs have begun adopting point-of-care ultrasound (PoCUS) curricula, reflecting the increasing ubiquity of this technique across medical specialties. The structures of international PoCUS curricula have been extensively studied. However, the efficacy of these curricula to increase knowledge and confidence in PoCUS is less well-studied. We investigated whether a structured, small-group PoCUS teaching session consisting of pre-defined learning objectives, an introductory presentation, and a mandatory hands-on scanning component would increase pre-clerk knowledge of and confidence in PoCUS theory, use, and interpretation. Methods A pre-post study was designed to assess changes in pre-clerk knowledge and confidence in PoCUS theory, use, and interpretation. Pre-clerks were recruited from the Hamilton campus of the Michael G. DeGroote School of Medicine at McMaster University. Pre-clerks were organized into four groups, with an average group size of seven learners. Two preceptors each taught two groups. Sessions included an introductory PowerPoint presentation and one-on-one preceptor-guided practice in identifying abdominal and genitourinary structures using PoCUS. Student responses on pre- and post-intervention surveys were analyzed to identify changes in knowledge and confidence. Student satisfaction with the teaching session was assessed from self-reported levels of agreement with satisfaction statements. The strengths and areas of improvement for the teaching sessions were identified from open-ended survey responses. Results Data from 27 students indicated a significant improvement in knowledge test scores (p < .05), with no significant differences between groups (F(3,23) = 0.64, p = n.s.) or between students with different preceptors (p = n.s.). Students’ confidence in PoCUS use and interpretation improved significantly (p < .05 for both), with no significant differences between groups (F(3,23) = 0.70, p = n.s. and F(3,23) = 0.32, p = n.s., respectively) or between students with different preceptors (p = n.s. for both). Improvements in knowledge of and confidence in PoCUS use were significantly correlated (r = .44, p < .05). All of the students agreed that they liked the instruction, content, and structure of the teaching session. The most frequently cited strengths of the teaching sessions were the mandatory individual practice time per student, individualized instruction from and interactions with preceptors, and the small group structure of the sessions. Conclusion This study provides novel evidence that a structured, small-group teaching session featuring a didactic presentation, defined learning objectives, and mandatory hands-on learning can effectively teach introductory PoCUS knowledge and skills to pre-clerks and increase student confidence. Future studies will investigate the retention and application of PoCUS knowledge and skill throughout clerkship and early residency training to determine if this teaching model can facilitate longitudinal PoCUS learning and competency as well as improved diagnostic capabilities as students advance through undergraduate medical training.
Collapse
Affiliation(s)
- Amir H Safavi
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Qian Shi
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Maylynn Ding
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | - Maryam Kotait
- Medical Education and Simulation, McMaster University, Hamilton, CAN
| | | | - Vian Mohialdin
- Pathology and Molecular Medicine, McMaster University, Hamilton, CAN
| | - Ari Shali
- Pathology and Molecular Medicine, McMaster University, Hamilton, CAN
| |
Collapse
|
22
|
See KC, Chua JW, Verstegen D, Van Merrienboer JJG, Van Mook WN. Focused echocardiography: Dyad versus individual training in an authentic clinical context. J Crit Care 2018; 49:50-55. [PMID: 30366250 DOI: 10.1016/j.jcrc.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context. MATERIALS AND METHODS We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017. For supervised practice, residents were divided into individual versus dyad training groups. Residents then performed at least five FSE examinations, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure was the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8). RESULTS 16 residents received individual training and 17 residents received dyad training. The mean composite score did not differ between the individual and dyad training groups (6.0 ± 0.4 versus 5.9 ± 0.4, 95% CI of difference - 0.2 to 0.4). CONCLUSIONS Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.
Collapse
Affiliation(s)
- Kay Choong See
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Joo Wei Chua
- Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Danielle Verstegen
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Jeroen J G Van Merrienboer
- Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Walther N Van Mook
- Department of Intensive Care Medicine, Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands; School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| |
Collapse
|
23
|
|
24
|
Arias Felipe A, Doménech García J, Sánchez Los Arcos I, Luordo D, García Sánchez FJ, Villanueva Martínez J, Forero de la Sotilla A, Villena Garrido V, Torres Macho J, García de Casasola Sánchez G. Teaching the basics of echocardiography in the undergraduate: Students as mentors. Rev Clin Esp 2017; 217:245-251. [PMID: 28318521 DOI: 10.1016/j.rce.2017.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/21/2017] [Accepted: 02/05/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse the ability of medical students to incorporate the practical teaching of basic echocardiography planes using a peer mentoring design. METHODOLOGY Thirty-six medical students previously trained in obtaining echocardiography planes (mentors) taught the other 5th-year students (n=126). The teaching methodology included three stages: theory (online course), basic training (three 15h sessions of practical experience in ultrasound and at least 20 echocardiographic studies per mentor) and objective structured clinical assessment (OSCA), which scored the appropriateness of the basic ultrasound planes and the correct identification of 16 cardiac structures. RESULTS The students' weighted mean score in the OSCA was 8.66±1.98 points (out of 10). Only 10 students (8.4%) scored less than 5, and 15 (12.6%) scored less than 7. Fifty students (42%) scored 10 points. The most easily identified structure was the left ventricle in the short-axis parasternal plane, with 89.9% of correct answers. The most poorly identified structure was the mitral valve in the subxiphoid plane, with 69.7% of correct answers. CONCLUSIONS Peer mentoring-based teaching achieves an appropriate level of training in obtaining basic echocardiography planes. The training period is relatively short. The peer mentoring system can facilitate the implementation of teaching on basic aspects of ultrasound to a large number of undergraduate students.
Collapse
Affiliation(s)
- A Arias Felipe
- Facultad de Medicina, Universidad Complutense, Madrid, España
| | | | | | - D Luordo
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - F J García Sánchez
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - J Villanueva Martínez
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - A Forero de la Sotilla
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - V Villena Garrido
- Facultad de Medicina, Universidad Complutense, Madrid, España; Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España; CIBERES, España
| | - J Torres Macho
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España
| | - G García de Casasola Sánchez
- Facultad de Medicina, Universidad Complutense, Madrid, España; Grupo de Trabajo de Ecografía Clínica de la Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, España.
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|