1
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Thornton J, Mahdi A, Schultz L, Briscoe G. Assessing the effectiveness of a cadaveric workshop in improving resident physicians' confidence in performing ultrasound-guided joint injections. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:112-113. [PMID: 38226305 PMCID: PMC10787854 DOI: 10.36834/cmej.77293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Our study showed that an educational workshop using a cadaveric specimen is effective in improving resident physicians' confidence in performing ultrasound-guided, as well as landmark-based, joint injections. Participants also reported a strong interest in future cadaveric workshops on ultrasound-guided joint injections and believe such workshops would be a valuable educational resource for other physicians. Implementing cadaver-based ultrasound-guided joint injection workshops similar to the one discussed in this manuscript could be used to supplement training for these procedures in medical education and provide residents with the early experience they need to be able to perform these injections independently in clinic settings.
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Affiliation(s)
- Jane Thornton
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, Fowler Kennedy Sport Medicine Clinic, Ontario, Canada
| | - Ahmed Mahdi
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, Fowler Kennedy Sport Medicine Clinic, Ontario, Canada
| | - Lydia Schultz
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, Fowler Kennedy Sport Medicine Clinic, Ontario, Canada
| | - Graham Briscoe
- Schulich School of Medicine & Dentistry Department of Family Medicine, Western University, Fowler Kennedy Sport Medicine Clinic, Ontario, Canada
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2
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Federica B, Nizar Yahya B, Hevan Al-Atroushy A, Wahida Ibraheem A, Bayar Saleem H, Bijeen Fareq J, Sholker Khalid M, Shaima Shimo J, Nora Suleeman S, Saad Zebari M, Stefano M. It is possible to create a vascular access team in a middle resource country? Experience of Hevi Paediatric Teaching Hospital at DUHOK - IRAQ. J Vasc Access 2023; 24:994-999. [PMID: 34903090 DOI: 10.1177/11297298211055402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Vascular access devices are critically important for the treatment of neonates and paediatric patients. Vascular cannulation is a key clinical skill for healthcare professionals working in the neonatal and paediatric wards. The creation of specialised Teams dedicated to the positioning of Vascular Venous Accesses is increasingly used and of fundamental importance for good patients care. The aim of the study is to evaluate the effectiveness of a training intervention for the staff of the Intensive Care Units for the insertion of the short/long peripheral catheter and to create a NuVa Team (Nurse-led Vascular Access Team). METHODS At the Hevi Paediatric Teaching Hospital, a course and an on-the-job training programme were carried out for two doctors and six nurses on the insertion of the in long peripheral catheters newborns and paediatric patients admitted at the hospital. The data collected were analysed from April 2017 to December 2020. A pre and post-procedure study was designed to determine whether establishing the Nurses Vascular Accesses Team (NuVa) is associated with higher success rates and a reduced risk of catheter-related complications. RESULTS A total of 271 Leader-cath™ catheters were placed during the study period. The mean age at catheters insertion was 2.9 years, the mean residence time was 11.7 days. Most catheters were inserted by five nurses (n = 216 (80%)); the remainder was entered by two paediatricians (n = 55 (20%)), p = 0.001. General reasons for removal were home discharge (n = 103 (38%)), deceases (n = 81 (30%)), accidental causes (n = 43 (16%)), leg/arm oedema (n = 21 (8%)), mechanical problems (n = 10 (3.5%)), physician's indication (n = 9 (3%)) and skin infection (n = 4 (1.5%)), p = 0.001. CONCLUSIONS The standardisation of the procedure for inserting the catheters placement and the creation of a NuVa Team has been of fundamental importance in gaining awareness of the procedure and allows healthcare professionals to insert the catheter without complications.
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Affiliation(s)
- Buzzi Federica
- E.U.project MADAD, Italian Association for Solidarity among Peoples, Duhok, Kurdistan Region, Iraq
- Hematology and Bone Marrow Transplantation Unit and Paediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Adel Hevan Al-Atroushy
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | | | - Haji Bayar Saleem
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Jalal Bijeen Fareq
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Mohammad Sholker Khalid
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Jaafar Shaima Shimo
- Paediatric Intensive Care Unit, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | - Suleeman Nora Suleeman
- Emergency Department, Hevi Paediatric Teaching Hospital Duhok, Duhok, Kurdistan Region, Iraq
| | | | - Maiandi Stefano
- Health Professions Directorate, Research and Development, ASST di Lodi, Lodi, Italy
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3
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Shah A, Barnes RM, Rocco LE, Robinson C, Kubalak SW, Wahlquist AE, Presley BC. Measuring success: A comparison of ultrasound and landmark guidance for knee arthrocentesis in a cadaver model. Am J Emerg Med 2023; 71:157-162. [PMID: 37406477 DOI: 10.1016/j.ajem.2023.06.044] [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: 10/17/2022] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Knee arthrocentesis can be performed by landmark (LM) or ultrasound (US) guidance. The goal of performing knee arthrocentesis is to obtain synovial fluid, however, it is also important to consider the number of attempts required and accidental bone contacts that occur. This study evaluates procedural success without bone contact in knee arthrocentesis and compares both LM and US guided techniques in a cadaver model. METHODS This was a randomized crossover study comparing US vs LM guidance for arthrocentesis in a single academic center. Volunteers were randomized to perform both LM and US guided knee arthrocentesis on cadavers. The primary outcome was procedural success, defined as first attempt aspiration of synovial fluid without bone contact. Secondary outcomes included number of attempts, number of bone contacts, time to aspiration, and confidence. RESULTS Sixty-one participants completed the study with a total of 122 procedures performed. Procedural success without bone contact was greater in the US group (84% vs 64% p = 0.02). Time to aspiration was longer for US (38.75 s vs 25.54 s p = 0.004). Participants were more confident with US compared to LM both before the procedure on a Visual Analog Scale from 1 to 100 (29 vs 21 p = 0.03) as well as after the procedure (83 vs 69 p = 0.0001). Participants had a greater median increase in confidence with US following training (44 vs 26 p = 0.01). CONCLUSIONS Study participants had greater procedural success without bone contact when US guidance was used. The increase in confidence following training was greater for US guidance than the LM method. Use of US guidance may offer a benefit by allowing for better needle control and avoidance of sensitive structures for clinicians performing knee arthrocentesis.
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Affiliation(s)
- Aalap Shah
- Department of Emergency Medicine, Medical University of South Carolina, USA.
| | - Ryan M Barnes
- Department of Emergency Medicine, Medical University of South Carolina, USA
| | - Lauren E Rocco
- Medical University of South Carolina College of Medicine, USA
| | - Chris Robinson
- Medical University of South Carolina College of Medicine, USA
| | - Steven W Kubalak
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina College of Medicine, USA
| | - Amy E Wahlquist
- Department of Public Health Sciences, Medical University of South Carolina, USA
| | - Bradley C Presley
- Department of Emergency Medicine, Medical University of South Carolina, USA
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4
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Hoppmann RA, Mladenovic J, Melniker L, Badea R, Blaivas M, Montorfano M, Abuhamad A, Noble V, Hussain A, Prosen G, Villen T, Via G, Nogue R, Goodmurphy C, Bastos M, Nace GS, Volpicelli G, Wakefield RJ, Wilson S, Bhagra A, Kim J, Bahner D, Fox C, Riley R, Steinmetz P, Nelson BP, Pellerito J, Nazarian LN, Wilson LB, Ma IWY, Amponsah D, Barron KR, Dversdal RK, Wagner M, Dean AJ, Tierney D, Tsung JW, Nocera P, Pazeli J, Liu R, Price S, Neri L, Piccirillo B, Osman A, Lee V, Naqvi N, Petrovic T, Bornemann P, Valois M, Lanctot JF, Haddad R, Govil D, Hurtado LA, Dinh VA, DePhilip RM, Hoffmann B, Lewiss RE, Parange NA, Nishisaki A, Doniger SJ, Dallas P, Bergman K, Barahona JO, Wortsman X, Smith RS, Sisson CA, Palma J, Mallin M, Ahmed L, Mustafa H. International consensus conference recommendations on ultrasound education for undergraduate medical students. Ultrasound J 2022; 14:31. [PMID: 35895165 PMCID: PMC9329507 DOI: 10.1186/s13089-022-00279-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. METHODS 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. RESULTS A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. CONCLUSIONS The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.
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Affiliation(s)
- Richard A. Hoppmann
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, 6311 Garners Ferry Road, Bldg 3, Room 306, Columbia, SC 29209 USA
| | - Jeanette Mladenovic
- grid.414996.70000 0004 5902 8841Foundation for the Advancement of International Medical Education and Research, Philadelphia, USA
| | - Lawrence Melniker
- grid.413734.60000 0000 8499 1112Quality Emergency Department, NewYork-Presbyterian Health System, New York, USA
| | - Radu Badea
- grid.411040.00000 0004 0571 5814Internal Medicine and Gastroenterology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Blaivas
- grid.254567.70000 0000 9075 106XInternal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Miguel Montorfano
- grid.414463.00000 0004 0638 1756Ultrasound and Doppler Department, Hospital de Emergencias “Dr. Clemente Alvarez”, Rosario, Argentina
| | - Alfred Abuhamad
- grid.255414.30000 0001 2182 3733Eastern Virginia School of Medicine, Norfolk, USA
| | - Vicki Noble
- grid.443867.a0000 0000 9149 4843Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Arif Hussain
- grid.415254.30000 0004 1790 7311Cardiac Critical Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Gregor Prosen
- grid.412415.70000 0001 0685 1285Emergency Medicine, University Medical Centre Maribor, Maribor, Slovenia
| | - Tomás Villen
- grid.449795.20000 0001 2193 453XFrancisco de Vitoria University School of Medicine, Madrid, Spain
| | - Gabriele Via
- grid.469433.f0000 0004 0514 7845Department of Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Ramon Nogue
- grid.15043.330000 0001 2163 1432Emergency Medicine, University of Lleida School of Medicine, Lleida, Spain
| | - Craig Goodmurphy
- grid.240473.60000 0004 0543 9901Ultrasound Education, Penn State College of Medicine, Hershey, USA
| | - Marcus Bastos
- Ultrasound Point of Care, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - SUPREMA, Juiz de Fora, Brazil
| | - G. Stephen Nace
- grid.267301.10000 0004 0386 9246Medical Education and Medicine, University of Tennessee Health Science Center, Memphis, USA
| | - Giovanni Volpicelli
- grid.415081.90000 0004 0493 6869Internal Medicine, Emergency Medicine, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Richard J. Wakefield
- grid.9909.90000 0004 1936 8403Rheumatology, University of Leeds, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Steve Wilson
- grid.254567.70000 0000 9075 106XUniversity of South Carolina School of Medicine, Columbia, USA
| | - Anjali Bhagra
- grid.66875.3a0000 0004 0459 167XInternal Medicine, Mayo Clinic, Rochester, USA
| | - Jongyeol Kim
- grid.416992.10000 0001 2179 3554Neurology, School of Medicine Texas Tech University Health Sciences Center, Lubbock, USA
| | - David Bahner
- grid.261331.40000 0001 2285 7943Department of Emergency Medicine, The Ohio State University, Columbus, USA
| | - Chris Fox
- grid.266093.80000 0001 0668 7243Department Emergency Medicine, University of California Irvine, Irvine, USA
| | - Ruth Riley
- grid.254567.70000 0000 9075 106XLibrary Services, University of South Carolina School of Medicine, Columbia, USA
| | - Peter Steinmetz
- grid.14709.3b0000 0004 1936 8649Family Medicine, McGill University, Montreal, Canada
| | - Bret P. Nelson
- grid.59734.3c0000 0001 0670 2351Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - John Pellerito
- grid.512756.20000 0004 0370 4759Radiology and Science Education, Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, USA
| | - Levon N. Nazarian
- grid.265008.90000 0001 2166 5843Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - L. Britt Wilson
- grid.254567.70000 0000 9075 106XPhysiology, University of South Carolina School of Medicine, Columbia, USA
| | - Irene W. Y. Ma
- grid.22072.350000 0004 1936 7697Medicine, Division of General Internal Medicine, University of Calgary, Calgary, Canada
| | - David Amponsah
- grid.413103.40000 0001 2160 8953Department of Emergency Medicine, Henry Ford Hospital, Detroit, USA
| | - Keith R. Barron
- grid.254567.70000 0000 9075 106XDepartment of Internal Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Renee K. Dversdal
- grid.5288.70000 0000 9758 5690Internal Medicine, Oregon Health & Science University, Portland, USA
| | - Mike Wagner
- grid.254567.70000 0000 9075 106XMedicine, University of South Carolina School of Medicine-Greenville, Greenville, USA
| | - Anthony J. Dean
- grid.25879.310000 0004 1936 8972Emeritus Department of Emergency Medicine, Perelman University of Pennsylvania School of Medicine, Philadelphia, USA
| | - David Tierney
- grid.413195.b0000 0000 8795 611XInternal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
| | - James W. Tsung
- grid.59734.3c0000 0001 0670 2351Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Paula Nocera
- grid.413471.40000 0000 9080 8521Anesthesiologist, Hospital Sírio Libanês, São Paulo, Brazil
| | - José Pazeli
- Nephology and Critical Care, Barbacena’s School of Medicine, Barbacena, Brazil
| | - Rachel Liu
- grid.47100.320000000419368710Emergency Medicine, Yale School of Medicine, New Haven, USA
| | - Susanna Price
- grid.439338.60000 0001 1114 4366Cardiology and Intensive Care, Royal Brompton Hospital, London, England
| | - Luca Neri
- grid.415280.a0000 0004 0402 3867Emergency and Intensive Care Medicine, King Fahad Specialist Hospital Dammam, Ad Dammām, Saudi Arabia
| | - Barbara Piccirillo
- grid.260914.80000 0001 2322 1832New York Institute of Technology, Bellmore, USA
| | - Adi Osman
- Emergency Physician & ED Critical Care, Trauma & Emergency Department, Hospital Raja Permaisuri, Ipoh, Perak Malaysia
| | - Vaughan Lee
- grid.267153.40000 0000 9552 1255Medical Education, University of South Alabama College of Medicine, Mobile, USA
| | - Nitha Naqvi
- grid.420545.20000 0004 0489 3985Royal Brompton Hospital Part of Guy’s and St Thomas’ NHS Foundation Trust, London, England
| | | | - Paul Bornemann
- grid.254567.70000 0000 9075 106XDepartment of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, USA
| | - Maxime Valois
- Medicine, McGill and Sherbrooke Universities, Montreal, Canada
| | | | - Robert Haddad
- grid.254567.70000 0000 9075 106XUltrasound Education - Ultrasound Institute, University of South Carolina School of Medicine, Columbia, USA
| | - Deepak Govil
- grid.429252.a0000 0004 1764 4857Critical Care Medicine, Medanta - The Medicity, Gurgaon, India
| | - Laura A. Hurtado
- grid.7345.50000 0001 0056 1981Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Vi Am Dinh
- grid.411390.e0000 0000 9340 4063Emergency Medicine and Internal Medicine, Loma Linda University Medical Center, Loma Linda, USA
| | - Robert M. DePhilip
- grid.261331.40000 0001 2285 7943Emeritus Biomedical Education and Anatomy, The Ohio State University, Columbus, USA
| | - Beatrice Hoffmann
- grid.38142.3c000000041936754XDepartment of Emergency Medicine, Harvard Medical School, Boston, USA
| | - Resa E. Lewiss
- grid.265008.90000 0001 2166 5843Emergency Medicine and Radiology, Thomas Jefferson University, Philadelphia, USA
| | - Nayana A. Parange
- grid.1026.50000 0000 8994 5086Medical Sonography, University of South Australia Allied Health and Human Performance, Adelaide, Australia
| | - Akira Nishisaki
- grid.25879.310000 0004 1936 8972Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Stephanie J. Doniger
- Pediatric Emergency Medicine, Children’s Hospital in Orange California, Orange, USA
| | - Paul Dallas
- grid.438526.e0000 0001 0694 4940Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Kevin Bergman
- grid.266102.10000 0001 2297 6811Family and Community Medicine, University of California - San Francisco, Martinez, USA
| | - J. Oscar Barahona
- grid.423309.f0000 0000 8901 8514Greenwich Ultrasound Services, Greenwich Ultrasound Associates, PC, Greenwich, USA
| | - Ximena Wortsman
- grid.443909.30000 0004 0385 4466Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - R. Stephen Smith
- grid.15276.370000 0004 1936 8091Surgery, University of Florida College of Medicine, Gainesville, USA
| | - Craig A. Sisson
- grid.267309.90000 0001 0629 5880Emergency Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - James Palma
- grid.265436.00000 0001 0421 5525Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA
| | | | - Liju Ahmed
- King Faisal Specialist Hospital and Research Center, Madinah, Kingdom of Saudi Arabia
| | - Hassan Mustafa
- grid.21613.370000 0004 1936 9609Internal Medicine, University of Manitoba, Manitoba, Canada
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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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6
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Bushi S, Kirshblum S, Ezepue T, Ma R. Perceived Benefits of a Cadaver-Based Ultrasound Procedure Workshop for Physical Medicine and Rehabilitation Trainees. Am J Phys Med Rehabil 2022; 101:e18-e21. [PMID: 34091463 DOI: 10.1097/phm.0000000000001814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ultrasound-guided musculoskeletal and spasticity injections have become common procedures in physical medicine and rehabilitation practices, but there are currently no guidelines for teaching these procedures in residency and fellowship training programs. As part of a quality improvement initiative, the authors aimed to assess the educational value of a hands-on cadaver-based workshop for enhancing these skills in residents and fellows. Twenty-seven physical medicine and rehabilitation trainees in a single institution were asked to complete surveys before and after the workshop to assess self-perceived benefits. After the workshop, the overwhelming majority felt improvement in their overall knowledge of ultrasound-guided musculoskeletal (93%) and spasticity (78%) procedures. In addition, the workshop improved the level of comfort of trainees both in planning (70%) and performing (59%) the procedures independently. Improving these skills is especially important considering most trainees plan to incorporate ultrasound-guided musculoskeletal (81%) and spasticity (74%) procedures into their future practices. The framework for this workshop can serve as a template for other programs to incorporate into their own training.
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Affiliation(s)
- Sharon Bushi
- From the Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey (SB, SK, RM); Kessler Institute for Rehabilitation, West Orange, New Jersey (SB); Kessler Foundation, East Hanover, New Jersey (SK); New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey (TE); and Department of Physical Medicine and Rehabilitation, VA Health System, East Orange, New Jersey (RM)
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7
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Li L, Li L, Zuo Y. A Hands-On Organ-Slicing Activity to Teach the Cross-Sectional Anatomy. ANATOMICAL SCIENCES EDUCATION 2020; 13:732-742. [PMID: 32034876 DOI: 10.1002/ase.1947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 01/22/2020] [Accepted: 02/05/2020] [Indexed: 06/10/2023]
Abstract
The presentation of pre-sliced specimens is a frequently used method in the laboratory teaching of cross-sectional anatomy. In the present study, a new teaching method based on a hands-on slicing activity was introduced into the teaching of brain, heart, and liver cross-sectional anatomy. A randomized, controlled trial was performed. A total of 182 third-year medical students were randomized into a control group taught with the prosection mode (pre-sliced organ viewing) and an experimental group taught with the dissection mode (hands-on organ slicing). These teaching methods were assessed by testing the students' knowledge of cross-sectional specimens and cross-sectional radiological images, and analyzing students' feedback. Using a specimen test on three organs (brain, heart, and liver), significant differences were observed in the mean scores of the control and experimental groups: for brain 59.6% (±14.2) vs. 70.1% (±15.5), (P < 0.001, Cohen's d = 0.17); for heart: 57.6% (±12.5) vs. 75.6% (±15.3), (P < 0.001, d = 0.30); and for liver: 60.4% (±14.5) vs. 81.7% (±14.2), (P < 0.001, d = 0.46). In a cross-sectional radiological image test, better performance was also found in the experimental group (P < 0.001). The mean scores of the control vs. experimental groups were as follows: for brain imaging 63.9% (±15.1) vs. 71.1% (±16.1); for heart imaging 64.7% (±14.5) vs. 75.2% (±15.5); and for liver imaging 61.1% (±15.5) vs. 81.2% (±14.6), respectively. The effect sizes (Cohen's d) were 0.05, 0.23, and 0.52, respectively. Students in the lower tertile benefited the most from the slicing experiences. Students' feedback was generally positive. Hands-on slicing activity can increase the effectiveness of anatomy teaching and increase students' ability to interpret radiological images.
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Affiliation(s)
- Lei Li
- Department of Anatomy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Lin Li
- Department of Anatomy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yizhi Zuo
- Department of Anatomy, Nanjing Medical University, Nanjing, People's Republic of China
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8
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Ma IWY, Steinmetz P, Weerdenburg K, Woo MY, Olszynski P, Heslop CL, Miller S, Sheppard G, Daniels V, Desy J, Valois M, Devine L, Curtis H, Romano MJ, Martel P, Jelic T, Topping C, Thompson D, Power B, Profetto J, Tonseth P. The Canadian Medical Student Ultrasound Curriculum: A Statement From the Canadian Ultrasound Consensus for Undergraduate Medical Education Group. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1279-1287. [PMID: 31943311 PMCID: PMC7317450 DOI: 10.1002/jum.15218] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/09/2019] [Accepted: 12/11/2019] [Indexed: 05/03/2023]
Abstract
OBJECTIVES This study sought to establish by expert review a consensus-based, focused ultrasound curriculum, consisting of a foundational set of focused ultrasound skills that all Canadian medical students would be expected to attain at the end of the medical school program. METHODS An expert panel of 21 point-of-care ultrasound and educational leaders representing 15 of 17 (88%) Canadian medical schools was formed and participated in a modified Delphi consensus method. Experts anonymously rated 195 curricular elements on their appropriateness to include in a medical school curriculum using a 5-point Likert scale. The group defined consensus as 70% or more experts agreeing to include or exclude an element. We determined a priori that no more than 3 rounds of voting would be performed. RESULTS Of the 195 curricular elements considered in the first round of voting, the group reached consensus to include 78 and exclude 24. In the second round, consensus was reached to include 4 and exclude 63 elements. In our final round, with 1 additional item added to the survey, the group reached consensus to include an additional 3 and exclude 8 elements. A total of 85 curricular elements reached consensus to be included, with 95 to be excluded. Sixteen elements did not reach consensus to be included or excluded. CONCLUSIONS By expert opinion-based consensus, the Canadian Ultrasound Consensus for Undergraduate Medical Education Group recommends that 85 curricular elements be considered for inclusion for teaching in the Canadian medical school focused ultrasound curricula.
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Affiliation(s)
- Irene W. Y. Ma
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Peter Steinmetz
- Department of Family MedicineMcGill UniversityMontrealQuebecCanada
| | - Kirstin Weerdenburg
- Department of Pediatric Emergency MedicineIWK Health Center and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael Y. Woo
- Department of Emergency MedicineUniversity of Ottawa and Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Paul Olszynski
- Department of Emergency MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Claire L. Heslop
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Stephen Miller
- Department of Emergency Medicine, Skilled Clinician Program, Undergraduate Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Gillian Sheppard
- Department of Emergency MedicineMemorial University of NewfoundlandSt John'sNewfoundlandCanada
| | - Vijay Daniels
- Division of General Internal MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Janeve Desy
- Division of General Internal MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Maxime Valois
- Department of Emergency MedicineMcGill UniversityMontrealQuebecCanada
- Department of Emergency MedicineSherbrooke UniversitySherbrookeQuebecCanada
| | - Luke Devine
- Division of General Internal MedicineUniversity of TorontoTorontoOntarioCanada
| | - Heather Curtis
- Department of Diagnostic ImagingDalhousie UniversityHalifaxNova ScotiaCanada
| | - Michael J. Romano
- Division of Emergency Medicine, Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Patrick Martel
- Department of Emergency Medicine, Thunder Bay Regional Health Sciences CenterNorth Ontario School of MedicineThunder BayOntarioCanada
| | - Tomislav Jelic
- Department of Emergency MedicineUniversity of ManitobaWinnipegManitobaCanada
| | - Claude Topping
- Departments of Family Medicine and Emergency MedicineLaval University, QuebecQuebecCanada
| | - Drew Thompson
- Department of Emergency MedicineWestern UniversityLondonOntarioCanada
| | - Barbara Power
- Department of Medicine, EducationUniversity of OttawaOttawaOntarioCanada
| | - Jason Profetto
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Pete Tonseth
- Department of RadiologyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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9
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Engberg M, Taudorf M, Rasmussen NK, Russell L, Lönn L, Konge L. Training and assessment of competence in resuscitative endovascular balloon occlusion of the aorta (REBOA) - a systematic review. Injury 2020; 51:147-156. [PMID: 31810637 DOI: 10.1016/j.injury.2019.11.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving but high-risk emergency procedure in patients with haemorrhagic shock. Lack of physicians with competence in the procedure is a barrier to implementation of REBOA. It is currently unclear how training and assessment of competence should be done. OBJECTIVES To report and evaluate research in training and assessment of competence in REBOA and femoral arterial access with the aim to investigate the effect of simulation-based training in the procedure and to provide suggestions for the future design of training programs and assessment tools. METHODS Following PRISMA guidelines, PubMed, Embase, and Cochrane Library databases were searched for studies on training or assessment of competence in REBOA and femoral arterial access. Bias assessment was done using the Medical Education Research Study Quality Instrument. Evidence level was assessed using GRADE. RESULTS Sixteen studies were included, six of them published as abstracts. Full-text studies included 189 trainees ranging in experience level from military medics to surgical specialists. Outcome measures were heterogenous; the most used were rater checklists, knowledge testing, and procedure time. All studies confirmed an effect of training of REBOA on procedural competence in a simulation setting but had a high degree of bias. No study developed or used an assessment tool supported by validity evidence and no study investigated mid and long-term outcomes. CONCLUSION Simulation-based training of REBOA improves skills, however, the evidence level is very low and data cannot answer important questions on effect size, skill transfer and retention, and optimal course design. To advance research and training programmes, an assessment tool supported by validity evidence with broad applicability is needed.
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Affiliation(s)
- Morten Engberg
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | - Mikkel Taudorf
- Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niklas Kahr Rasmussen
- Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark; Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
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10
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Pedigo R, Tolles J, Watcha D, Kaji AH, Lewis RJ, Stark E, Jordan J. Teaching Endotracheal Intubation Using a Cadaver Versus a Manikin-based Model: a Randomized Controlled Trial. West J Emerg Med 2019; 21:108-114. [PMID: 31913829 PMCID: PMC6948684 DOI: 10.5811/westjem.2019.10.44522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The optimal method to train novice learners to perform endotracheal intubation (ETI) is unknown. The study objective was to compare two models: unembalmed cadaver vs simulation manikin. METHODS Fourth-year medical students, stratified by baseline ETI experience, were randomized 1:1 to train on a cadaver or simulation manikin. Students were tested and video recorded on a separate cadaver; two reviewers, blinded to the intervention, assessed the videos. Primary outcome was time to successful ETI, analyzed with a Cox proportional hazards model. Authors also compared percentage of glottic opening (POGO), number of ETI attempts, learner confidence, and satisfaction. RESULTS Of 97 students randomized, 78 were included in the final analysis. Median time to ETI did not differ significantly (hazard ratio [HR] 1.1; 95% CI [confidence interval], 0.7-1.8): cadaver group = 34.5 seconds (interquartile ratio [IQR]: 23.3-55.8) vs manikin group = 35.5 seconds (IQR: 23.8-80.5), with no difference in first-pass success (odds ratio [OR] = 1; 95% CI, 0.1-7.5) or median POGO: 80% cadaver vs 90% manikin (95% CI, -14-34%). Satisfaction was higher for cadavers (median difference = 0.5; p = 0.002; 95% CI, 0-1) as was change in student confidence (median difference = 0.5; p = 0.03; 95% CI, 0-1). Students rating their confidence a 5 ("extremely confident") demonstrated decreased time to ETI (HR = 4.2; 95% CI, 1.0-17.2). CONCLUSION Manikin and cadaver training models for ETI produced similar time to ETI, POGO, and first-pass success. Cadaver training was associated with increased student satisfaction and confidence; subjects with the highest confidence level demonstrated decreased time to ETI.
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Affiliation(s)
- Ryan Pedigo
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.,Los Angeles Biomedical Research Institute, Torrance, California.,David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, California
| | - Juliana Tolles
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.,Los Angeles Biomedical Research Institute, Torrance, California.,David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, California
| | - Daena Watcha
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.,Los Angeles Biomedical Research Institute, Torrance, California
| | - Amy H Kaji
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.,Los Angeles Biomedical Research Institute, Torrance, California.,David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, California
| | - Roger J Lewis
- Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.,Los Angeles Biomedical Research Institute, Torrance, California.,David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, California
| | - Elena Stark
- David Geffen School of Medicine at UCLA, Department of Pathology and Laboratory Medicine, Los Angeles, California
| | - Jaime Jordan
- Los Angeles Biomedical Research Institute, Torrance, California.,David Geffen School of Medicine at UCLA, Department of Emergency Medicine, Los Angeles, California
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11
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Wampler K, Bartenhagen L, Sayles H, Michael K. Lightly Embalmed Cadavers in Sonography Education: A Novel Approach to Improving Students’ Perceived Competence in Renal Biopsy Procedures. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319875451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine if a simulation lab using lightly embalmed cadavers would improve diagnostic medical sonography (DMS) students’ perceived competence in ultrasound-guided native renal biopsy examinations. Methods: Subjects included DMS students (n = 49) enrolled in academic years 2012 to 2018. Each DMS student performed a native renal biopsy with a nephrology fellow. Skills practiced included machine setup, inferior renal pole localization, biopsy guide preparation, needle visualization, and communication skills. Pre- and postlab surveys assessed DMS students’ perceived competence. Results: Prelab, 12% (n = 6) of students felt competent to assist in the procedure. Postlab, 61% (n = 35) of students felt competent, a statistically significant ( P < .001) change. All students viewed the lab as a valuable experience. Hands-on experience (53%), student/physician collaboration (33%), and low-stress environment (13%) were reported themes. Additional resources (50%) and scheduling (22%) were areas for improvement. Conclusion: A renal biopsy simulation lab using lightly embalmed cadavers is an effective method to improve DMS students’ perceived competence in this procedure.
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Affiliation(s)
- Kathryn Wampler
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lisa Bartenhagen
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Harlan Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kimberly Michael
- Department of Medical Imaging and Therapeutic Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
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12
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Done AJ, Fairres MJ, Heiler JC, Smith CJ, Rappaport W. A low-cost high-fidelity model for abscess simulation. Am J Surg 2019; 219:628-631. [PMID: 31253352 DOI: 10.1016/j.amjsurg.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of a subcutaneous abscess is a commonly encountered scenario across multiple specialties. Prior simulation models for abscess incision and drainage have been limited by their cost and reproducibility. METHODS We developed a realistic abscess model with commonly available materials that can be utilized in fresh cadaver labs at a cost of less than $1 USD per use. The model was evaluated for content validity with pre- and post-measures by 25 pre-clinical medical students. RESULTS The model described herein successfully simulates commonly encountered subcutaneous abscesses. Pre and post-training surveys demonstrated a significant increase in all outcomes measures. CONCLUSIONS The model presented in this manuscript can be easily incorporated into training programs that utilize a fresh cadaver lab for multi-procedural resident training. It provides a realistic abscess that can be placed in almost any anatomical location at a fraction of the cost, and significantly reduced preparation time compared to previously described models.
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Affiliation(s)
- Aaron J Done
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | | | - Joseph C Heiler
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | - Cody J Smith
- College of Medicine, The University of Arizona, Tucson, AZ, USA.
| | - William Rappaport
- Department of Surgery, The University of Arizona, Tucson, AZ, USA; College of Medicine, The University of Arizona, Tucson, AZ, USA.
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13
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Chilstrom M, Beck S. Impact of one-day course on medical student knowledge, attitudes and comfort with point-of-care ultrasound-guided procedures. Australas J Ultrasound Med 2019; 22:200-205. [PMID: 34760557 DOI: 10.1002/ajum.12137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Given the ubiquity of procedural ultrasound in clinical practice, the importance of exposing medical students to the topic is increasingly relevant. We examined final-year medical student knowledge, attitudes and comfort level with procedural ultrasound before and after a one-day course. Methods This was a prospective cross-sectional survey of final-year students at a single university. We collected data regarding ultrasound experience, career goals and knowledge of procedural ultrasound, as well as attitudes and comfort (each assessed with three questions using a Likert scale). All students were sent a pre- and post-test survey, and we compared pre- and post-test results using the chi-square test, with a two-tailed P-value < 0.05 considered statistically significant. Results All of the 94 course participants completed both the pre- and post-tests. Of the 23 non-participants, 16 (70%) completed both pre- and post-tests. Almost all (99%) respondents reported some prior ultrasound exposure, but only 34% had previously performed at least one core procedure with ultrasound guidance. Among participants, we found a 13% average increase in knowledge score (P < 0.05) between pre- and post-tests; there was no significant change in knowledge score among non-participants. Among participants, we also found an increase in positive attitudes (P < 0.05 for two of three questions) and an increased comfort level with procedural ultrasound (P < 0.05 for all three questions). Discussion A one-day course can impact medical student knowledge, attitudes and comfort with the use of ultrasound for procedural guidance. Conclusion Further research is needed to assess long-term outcomes and explore alternative educational modalities.
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Affiliation(s)
- Mikaela Chilstrom
- Department of Emergency Medicine Emory University 531 Asbury Circle, Suite N340 Atlanta Georgia 30322 USA
| | - Sierra Beck
- Department of Emergency Medicine Emory University 531 Asbury Circle, Suite N340 Atlanta Georgia 30322 USA
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14
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Liu RB, Suwondo DN, Donroe JH, Encandela JA, Weisenthal KS, Moore CL. Point-of-Care Ultrasound: Does it Affect Scores on Standardized Assessment Tests Used Within the Preclinical Curriculum? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:433-440. [PMID: 30058124 DOI: 10.1002/jum.14709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES An increasing number of medical schools are incorporating point-of-care ultrasound (POCUS) into preclinical and clinical curricula. The ultimate effect of this teaching is unclear, and there has been no distinct link between ultrasound (US) learning and existing standardized student assessments. Additionally, neither optimal timing nor methods of POCUS integration have been established. We aimed to demonstrate the effect of US teaching on standardized objective assessments that already exist within the curriculum and, in doing so, discern a route for POCUS curricular integration. METHODS A longitudinal POCUS pilot curriculum was started in 2013, with the class of 2017. We collected basic science course results, standardized objective structured clinical examination scores, and United States Medical Licensing Examination step 1 scores from both the pilot group (n = 34) and matched control participants (n = 34) from the classes of 2017 and 2018. Scores between POCUS students and controls were analyzed by Student t tests. RESULTS Students participating in the longitudinal POCUS program scored significantly higher on the physical examination portion of their clinical skill objective structured clinical examination assessment than the control group (mean score, 89.2 versus 85.7; P < .05). This parameter was the only area with a statistically significant difference. CONCLUSIONS Point-of-care US program implementation may improve students' overall physical examination understanding and performance, even when US performance itself is not being tested. Introducing a POCUS curriculum may work best when designed in conjunction with the physical examination thread of a medical school curriculum.
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Affiliation(s)
- Rachel B Liu
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - David N Suwondo
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Joseph H Donroe
- Department General Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John A Encandela
- Department Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karrin S Weisenthal
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher L Moore
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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15
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Kalivoda EJ, Sullivan A, Bunting L. A Cost-Effective, Rapidly Constructed Simulation Model for Ultrasound-Guided Pericardiocentesis Procedural Training. J Emerg Med 2019; 56:74-79. [DOI: 10.1016/j.jemermed.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/15/2018] [Accepted: 09/01/2018] [Indexed: 11/17/2022]
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16
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Amini R, Camacho LD, Valenzuela J, Ringleberg JK, Patanwala AE, Stearns J, Situ-LaCasse EH, Acuña J, Adhikari S. Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519885638. [PMID: 31799406 PMCID: PMC6864035 DOI: 10.1177/2382120519885638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity. OBJECTIVES The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks. METHODS This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations. RESULTS A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures. CONCLUSIONS This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
| | - Luis D Camacho
- College of Medicine, The University of
Arizona, Tucson, AZ, USA
| | | | | | - Asad E Patanwala
- Sydney Pharmacy School, The University
of Sydney, Sydney, NSW, Australia
| | - Jack Stearns
- Department of Molecular and Cellular
Biology, The University of Arizona, Tucson, AZ, USA
| | | | - Josie Acuña
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, The
University of Arizona, Tucson, AZ, USA
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17
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Greenstein J, Das D, Acuna J, Kapoor M, Brown C, Husain A, Lally B, Hahn B. The use of cadaver models to diagnose rib fractures: A pilot study. Am J Emerg Med 2018; 37:313-316. [PMID: 30551938 DOI: 10.1016/j.ajem.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In the emergency department, rib fractures are a common finding in patients who sustain chest trauma. Rib fractures may be a sign of significant, underlying pathology, especially in the elderly patients where rib fractures are associated with significant morbidity and mortality. To date, no studies have evaluated the ability of ultrasound to detect rib fractures using cadaver models and subsequently use this model as a teaching tool. OBJECTIVES The purpose of this study was to determine if it is possible to generate rib fractures on cadaver models which could be accurately identified using ultrasound. METHODS This was a cross-sectional study performed during one session at a cadaver lab. A single hemithorax from four adult cadavers were used as models. Single rib fractures on each of rib five through eight were created. Four subjects, blinded to the normal versus fractured ribs, were asked to identify the presence of a fracture on each rib. RESULTS A total of 8 of 16 potential ribs had fractured induced by study staff. Mean accuracy was 55% for all subjects. The overall sensitivity and specificity for detecting rib fractures was 50% (CI: 31.89-68.11) and 59.38% (CI: 35.69-73.55) respectively. The overall PPV and NPV was 55.17% and 54.29% respectively. CONCLUSIONS In this pilot study, subjects were not able to detect induced rib fractures using ultrasound on cadaver models. The use of this model as a teaching tool in the detection of rib fractures requires further investigation.
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Affiliation(s)
- Josh Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America.
| | - Devjani Das
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Josie Acuna
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Monica Kapoor
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Cara Brown
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Abbas Husain
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Brendan Lally
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY, United States of America
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18
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Breslin R, Collins K, Cupitt J. The use of ultrasound as an adjunct to peripheral venous cannulation by junior doctors in clinical practice. MEDICAL TEACHER 2018; 40:1275-1280. [PMID: 29385869 DOI: 10.1080/0142159x.2018.1428737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE There is little consensus on the role of training in bedside ultrasound skills for medical students or junior doctors early in their careers. METHODS We trained 20 Foundation Year 1 doctors in the use of ultrasound as an adjunct to peripheral venous cannulation and following an assessment of competence gave them access to an ultrasound machine to assist with difficult cannulations in their clinical practice. Self-reported confidence and competence were assessed using pre- and post-training questionnaires, with competence objectively assessed immediately post-training and at one and three months follow up. Clinical use of ultrasound was studied over three months. RESULTS Improvements in self-reported confidence and competence were observed post-training and retained at three months. 85% (17/20) of participants were objectively assessed as competent immediately post-training, with retention of competence demonstrated in 80% (16/20) and 75% (15/20) at one and three months, respectively. There were 33 separate uses of ultrasound during the three month study period with a 73% (24/33) success rate and no adverse incidents. CONCLUSIONS We suggest that doctors in their first post-graduate year can be trained in the use of ultrasound as an adjunct to peripheral venous cannulation, retain the skill over time and use it safely in their clinical practice.
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Affiliation(s)
- Ryan Breslin
- a Department of Intensive Care , Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK
| | - Karen Collins
- a Department of Intensive Care , Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK
| | - Jason Cupitt
- a Department of Intensive Care , Blackpool Teaching Hospitals NHS Foundation Trust , Blackpool , UK
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19
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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: 23] [Impact Index Per Article: 3.8] [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.
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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
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Theodoulou I, Nicolaides M, Athanasiou T, Papalois A, Sideris M. Simulation-Based Learning Strategies to Teach Undergraduate Students Basic Surgical Skills: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2018; 75:1374-1388. [PMID: 29422405 DOI: 10.1016/j.jsurg.2018.01.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/19/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We aimed to identify and critically appraise all literature surrounding simulation-based learning (SBL) courses, to assess their relevance as tools for undergraduate surgical education, and create a design framework targeted at standardizing future SBL. METHODS We performed a systematic review of the literature using a specific keyword strategy to search at MEDLINE database. RESULTS Of the 2371 potentially eligible titles, 472 were shortlisted and only 40 explored active interventions in undergraduate medical education. Of those, 20 were conducted in the United States, 9 in Europe and 11 in the rest of the world. Nineteen studies assessed the effectiveness of SBL by comparing students' attributes before and after interventions, 1 study assessed a new tool of surgical assessment and 16 studies evaluated SBL courses from the students' perspectives. Of those 40 studies, 12 used dry laboratory, 7 wet laboratory, 12 mixed, and 9 cadaveric SBL interventions. The extent to which positive results were obtained from dry, wet, mixed, and cadaveric laboratories were 75%, 57%, 92%, and 100%, respectively. Consequently, the SBL design framework was devised, providing a foundation upon which future SBL interventions can be designed such that learning outcomes are optimized. CONCLUSIONS SBL is an important step in surgical education, investing in a safer and more efficient generation of surgeons. Standardization of these efforts can be accelerated with SBL design framework, a comprehensive guide to designing future interventions for basic surgical training at the undergraduate level.
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Affiliation(s)
- Iakovos Theodoulou
- Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital Great Maze Pond, London, United Kingdom.
| | - Marios Nicolaides
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, London, United Kingdom
| | | | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, United Kingdom
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Fürst RVDC, Polimanti AC, Galego SJ, Bicudo MC, Montagna E, Corrêa JA. Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model. World J Surg 2017; 41:681-686. [PMID: 27766394 DOI: 10.1007/s00268-016-3757-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To present a simple and affordable model able to properly simulate an ultrasound-guided venous access. DESIGN The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones. RESULTS The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible. CONCLUSION The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.
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Affiliation(s)
| | - Afonso César Polimanti
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Sidnei José Galego
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Maria Claudia Bicudo
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Erik Montagna
- Laboratory of Research in Health Sciences Teaching, Faculdade de Medicina do ABC, Av Principe de Gales, 821, Santo André, SP, CEP 09060-650, Brazil.
| | - João Antônio Corrêa
- Department of Angiology and Vascular Surgery, Faculdade de Medicina do ABC, Santo André, SP, Brazil
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Amini R, Stolz LA, Breshears E, Patanwala AE, Stea N, Hawbaker N, Thompson M, Sanders AB, Adhikari S. Assessment of ultrasound-guided procedures in preclinical years. Intern Emerg Med 2017; 12:1025-1031. [PMID: 27565985 DOI: 10.1007/s11739-016-1525-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p < 0.05). Students' overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p < 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p < 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students' confidence and technical skill at performing US-guided procedures.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA.
| | - Lori Ann Stolz
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Asad E Patanwala
- Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA
| | - Nicholas Stea
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Nicolaus Hawbaker
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | - Matthew Thompson
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA
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Reply to Letter to the Editor by Crocoli A, et al. J Pediatr Surg 2017. [PMID: 28648879 DOI: 10.1016/j.jpedsurg.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Doucet G, Ryan S, Bartellas M, Parsons M, Dubrowski A, Renouf T. Modelling and Manufacturing of a 3D Printed Trachea for Cricothyroidotomy Simulation. Cureus 2017; 9:e1575. [PMID: 29057187 PMCID: PMC5647136 DOI: 10.7759/cureus.1575] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. In doing so, emergency cricothyroidotomy simulation can be made accessible, accurate, cost-effective and reproducible. Three-dimensional modelling software was used in conjunction with a desktop three-dimensional (3D) printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies of tracheal anatomical configuration. This ensured that the landmarking necessary for emergency cricothyroidotomies was designed appropriately. Several revisions of the original model were made based on informal opinion from medical professionals to establish appropriate anatomical accuracy of the model for use in rural/remote cricothyroidotomy simulation. Using an entry-level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in less than three hours for only $1.70 Canadian dollars (CAD). Due to its anatomical accuracy, flexibility and durability, this model is great for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments. Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.
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Affiliation(s)
- Gregory Doucet
- Faculty of Engineering and Applied Science, Memorial University of Newfoundland
| | - Stephen Ryan
- Faculty of Medicine, Memorial University of Newfoundland
| | | | | | - Adam Dubrowski
- Emergency Medicine, Pediatrics, Memorial University of Newfoundland
| | - Tia Renouf
- Emergency Medicine, Memorial University of Newfoundland
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Hefler J, Ramnanan CJ. Can CanMEDS competencies be developed in medical school anatomy laboratories? A literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8. [PMID: 28650843 PMCID: PMC5511744 DOI: 10.5116/ijme.5929.4381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The purpose of this literature review was to identify potential ways in which undergraduate medical anatomy education may be relevant to the CanMEDS Roles, a competency-based framework used throughout Canadian medical training. METHODS A scoping review of medical education literature was conducted in March 2017 for English language publications that included key words related to anatomy education and to key competencies formally described for each of the Roles in the CanMEDS 2015 framework. Indicated benefits were then collated, characterized, and synthesized for each CanMEDS Role. RESULTS There were 71 studies identified describing original findings. Perceived benefits of anatomy education were most often identified for competencies related to the Medical Expert Role. Multiple studies also cited benefits related to the Scholar, Professional and Collaborator Roles. There was a lack of literature related to the Health Advocate, Communicator, and Leader Roles. The majority of benefits defined in the literature were limited to student perceptions rather than objectively measured outcomes. CONCLUSIONS There is some evidence to suggest that anatomy education can facilitate the development of core competencies related to several CanMEDS Roles, outside of simply developing medical knowledge in the Medical Expert Role. Future studies need to develop methods to objectively assess outcomes related to these competencies.
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Affiliation(s)
- Joshua Hefler
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
| | - Christopher J. Ramnanan
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
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Ghosh SK. Cadaveric dissection as an educational tool for anatomical sciences in the 21st century. ANATOMICAL SCIENCES EDUCATION 2017; 10:286-299. [PMID: 27574911 DOI: 10.1002/ase.1649] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/12/2016] [Accepted: 08/14/2016] [Indexed: 05/20/2023]
Abstract
Anatomical education has been undergoing reforms in line with the demands of medical profession. The aim of the present study is to assess the impact of a traditional method like cadaveric dissection in teaching/learning anatomy at present times when medical schools are inclining towards student-centered, integrated, clinical application models. The article undertakes a review of literature and analyzes the observations made therein reflecting on the relevance of cadaveric dissection in anatomical education of 21st century. Despite the advent of modern technology and evolved teaching methods, dissection continues to remain a cornerstone of anatomy curriculum. Medical professionals of all levels believe that dissection enables learning anatomy with relevant clinical correlates. Moreover dissection helps to build discipline independent skills which are essential requirements of modern health care setup. It has been supplemented by other teaching/learning methods due to limited availability of cadavers in some countries. However, in the developing world due to good access to cadavers, dissection based teaching is central to anatomy education till date. Its utility is also reflected in the perception of students who are of the opinion that dissection provides them with a foundation critical to development of clinical skills. Researchers have even suggested that time has come to reinstate dissection as the core method of teaching gross anatomy to ensure safe medical practice. Nevertheless, as dissection alone cannot provide uniform learning experience hence needs to be complemented with other innovative learning methods in the future education model of anatomy. Anat Sci Educ 10: 286-299. © 2016 American Association of Anatomists.
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Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, Employees' State Insurance, Post Graduate Institute of Medical Sciences and Research (ESI-PGIMSR), Employees' State Insurance Corporation Medical College, Joka, Kolkata, West Bengal, India
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Amini R, Wyman MT, Hernandez NC, Guisto JA, Adhikari S. Use of Emergency Ultrasound in Arizona Community Emergency Departments. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:913-921. [PMID: 28150328 DOI: 10.7863/ultra.16.05064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/13/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Despite the increased educational exposure to point-of-care ultrasound (US) at all levels of medical training, there are utilization gaps between academic and nonacademic emergency department (ED) settings. The purpose of this study was to assess the current practices and potential barriers to the use of point-of-care US in nonacademic EDs throughout the state of Arizona. METHODS We conducted a cross-sectional study. An online questionnaire was electronically sent to all nonacademic EDs in Arizona. The survey consisted of questions regarding demographics, current practice patterns, policies, interdepartmental agreements, and perceptions regarding the use of point-of-care US. RESULTS Seventy nonacademic EDs were identified for inclusion in our study, and 58 EDs completed the survey, which represented an 83% response rate. Seventy-eight percent (95% confidence interval [CI], 67%-89%) perform or interpret point-of-care US examinations for patient care. The 3 most common applications of point-of-care US reported by respondents were focused assessment with sonography for trauma, cardiac US examinations, and line placement, and 36% (95% CI, 22%-50%) bill for point-of-care US examinations. At 75% (95% CI, 62%-88%) of EDs, no one is specifically responsible for reviewing point-of-care US examinations for quality assurance, and at 50% (95% CI, 35%-65%), no mechanism exists to archive images. Eighty-three percent (95% CI, 72%-94%) of EDs think that their groups will benefit from the American College of Emergency Physicians Clinical Ultrasound Accreditation Program. CONCLUSIONS Ultrasound equipment is available in nearly all nonacademic EDs in Arizona. However, it appears that most providers lack US training, credentialing, quality assurance, and reimbursement mechanisms.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA
| | - Michael T Wyman
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | - John A Guisto
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona, USA
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Mohty KM, Cravens MG, Adamas-Rappaport WJ, Amini-Shervin B, Irving SC, Stea N, Adhikari S, Amini R. Cadaver-based Necrotizing Fasciitis Model for Medical Training. Cureus 2017; 9:e1168. [PMID: 28507840 PMCID: PMC5429149 DOI: 10.7759/cureus.1168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Necrotizing fasciitis is a devastating infectious disease process that is characterized by extensive soft tissue necrosis along deep fascial planes, systemic toxicity, and high mortality. Ultrasound imaging is a rapid and non-invasive tool that can be used to help make the diagnosis of necrotizing fasciitis by identifying several distinctive sonographic findings. The purpose of this study is to describe the construction of a realistic diagnostic training model for necrotizing fasciitis using fresh frozen cadavers and common, affordable materials. Presently, fresh non-embalmed cadavers have been used at medical institutions for various educational sessions including cadaver-based ultrasound training sessions. Details for the preparation and construction of a necrotizing fasciitis cadaver model are presented here. This paper shows that the images obtained from the cadaver model closely imitate the ultrasound appearance of fluid and gas seen in actual clinical cases of necrotizing fasciitis. Therefore, it can be concluded that this cadaver-based model produces high-quality sonographic images that simulate those found in true cases of necrotizing fasciitis and is ideal for demonstrating the sonographic findings of necrotizing fasciitis.
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Affiliation(s)
| | | | | | | | | | - Nicholas Stea
- Department of Emergency Medicine, University of Arizona
| | | | - Richard Amini
- Department of Emergency Medicine, University of Arizona
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Amini R, Amini A, Hollinger P, Rhodes SM, Schmier C. Emergency department diagnosis of a concealed pleurocutaneous fistula in a 78-year-old man using point-of-care ultrasound. World J Emerg Med 2016; 7:307-309. [PMID: 27965727 DOI: 10.5847/wjem.j.1920-8642.2016.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Richard Amini
- Emergency Medicine, University of Arizona, Tucson, Arizona 85724, USA
| | - Albert Amini
- Arizona Premier Surgery, 640 W Yellowstone Way, Chandler, Arizona 85248, USA
| | - Patrick Hollinger
- Emergency Medicine, University of Arizona, Tucson, Arizona 85724, USA
| | | | - Charles Schmier
- Emergency Medicine, University of Arizona, Tucson, Arizona 85724, USA
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DeTar LG, Alber JM, Behar-Horenstein LS, Spencer TG. A Mixed-Methods Analysis of Changing Student Confidence in an Online Shelter Medicine Course. JOURNAL OF VETERINARY MEDICAL EDUCATION 2016; 43:434-444. [PMID: 27404546 DOI: 10.3138/jvme.1115-182r] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Maddie's Shelter Medicine Program at the University of Florida College of Veterinary Medicine offers comprehensive training in shelter medicine to veterinary students based on a set of core job skills identified by the Association of Shelter Veterinarians. In 2012, this program began teaching online distance education courses to students and practicing veterinarians worldwide who sought additional training in this newly recognized specialty area. Distance learning is a novel educational strategy in veterinary medicine; most instruction at veterinary medical schools is classroom based. No previous studies have shown whether online courses can prepare veterinarians to practice shelter medicine. In this study, we investigated how an online, graduate-level course titled "Shelter Animal Physical Health" changed student self-reported confidence. First, we compared pre-course confidence regarding eight specific shelter medical practice scenarios to post-course confidence through statistical analysis. Quantitative analysis showed a significant (p<.001) increase in self-reported confidence for all eight scenarios. Next, we used open coding to identify themes within reflection papers that students were asked to write during the course and used those findings to corroborate or refute the quantitative results. Qualitative analysis of students' reflection papers identified six themes: confidence, communication, population management, outbreak management, medical care, and application. The results of this study show that distance education can be an effective method of preparing veterinarians and veterinary students to practice shelter medicine.
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Affiliation(s)
- Lawrence E Kass
- Penn State Milton S Hershey Medical Center, Hershey, PA, USA.
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Miller R, Ho H, Ng V, Tran M, Rappaport D, Rappaport WJA, Dandorf SJ, Dunleavy J, Viscusi R, Amini R. Introducing a Fresh Cadaver Model for Ultrasound-guided Central Venous Access Training in Undergraduate Medical Education. West J Emerg Med 2016; 17:362-6. [PMID: 27330672 PMCID: PMC4899071 DOI: 10.5811/westjem.2016.3.30069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/21/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Over the past decade, medical students have witnessed a decline in the opportunities to perform technical skills during their clinical years. Ultrasound-guided central venous access (USG-CVA) is a critical procedure commonly performed by emergency medicine, anesthesia, and general surgery residents, often during their first month of residency. However, the acquisition of skills required to safely perform this procedure is often deficient upon graduation from medical school. To ameliorate this lack of technical proficiency, ultrasound simulation models have been introduced into undergraduate medical education to train venous access skills. Criticisms of simulation models are the innate lack of realistic tactile qualities, as well as the lack of anatomical variances when compared to living patients. The purpose of our investigation was to design and evaluate a life-like and reproducible training model for USG-CVA using a fresh cadaver. Methods This was a cross-sectional study at an urban academic medical center. An 18-point procedural knowledge tool and an 18-point procedural skill evaluation tool were administered during a cadaver lab at the beginning and end of the surgical clerkship. During the fresh cadaver lab, procedure naïve third-year medical students were trained on how to perform ultrasound-guided central venous access of the femoral and internal jugular vessels. Preparation of the fresh cadaver model involved placement of a thin-walled latex tubing in the anatomic location of the femoral and internal jugular vein respectively. Results Fifty-six third-year medical students participated in this study during their surgical clerkship. The fresh cadaver model provided high quality and lifelike ultrasound images despite numerous cannulation attempts. Technical skill scores improved from an average score of 3 to 12 (p<0.001) and procedural knowledge scores improved from an average score of 4 to 8 (p<0.001). Conclusion The use of this novel cadaver model prevented extravasation of fluid, maintained ultrasound-imaging quality, and proved to be an effective educational model allowing third-year medical students to improve and maintain their technical skills.
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Affiliation(s)
- Ryan Miller
- College of Medicine, The University of Arizona, Tucson, Arizona
| | - Hang Ho
- College of Medicine, The University of Arizona, Tucson, Arizona
| | - Vivienne Ng
- Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
| | - Melissa Tran
- College of Medicine, The University of Arizona, Tucson, Arizona
| | - Douglas Rappaport
- Department of Emergency Medicine, Beth Israel Deaconess, Boston, Massachusetts
| | | | | | - James Dunleavy
- College of Medicine, The University of Arizona, Tucson, Arizona
| | - Rebecca Viscusi
- Department of Surgery, The University of Arizona, Tucson, Arizona
| | - Richard Amini
- Department of Emergency Medicine, The University of Arizona, Tucson, Arizona
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