Comparison of Web-versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals

Reliability Exercise of Ultrasound Salivary Glands in Sjögren's Disease: An International Web Training Initiative

INTRODUCTION

Major salivary gland ultrasonography (SGUS) demonstrated its good metric properties as an outcome measure for diagnosing primary Sjögren's disease (SD). The objective was to assess SGUS reliability among sonographers with different levels of experience, using web training.

METHODS

Sonographers from expert centers participated in the reliability exercise. Before exercises, training was done by videoconferencing. Reliability of the two most experienced sonographers (MES) was assessed and then compared to other sonographers. Intra-reader and inter-reader reliability of SGUS items were assessed by computing Cohen's κ coefficients.

RESULTS

All sets were read twice by all 14 sonographers within a 4-month interval. Intra-reader reliability of MES was almost perfect for homogeneity, substantial for Outcome Measures in Rheumatology (OMERACT) scoring system (OMERACTss). Among LES (less experienced sonographers), reliability was moderate to almost perfect for homogeneity, fair to moderate for OMERACTss, and fair to almost perfect for binary OMERACTss. Inter-reader reliability between MES was almost perfect for homogeneity, substantial for diagnosis, moderate for OMERACTss, and substantial for binary OMERACTss. Compared to MES, reliabilities of LES were moderate to almost perfect for both homogeneity and diagnosis, only fair to moderate for OMERACTss, but increased in binary OMERACTss.

CONCLUSIONS

Videoconferencing training sessions in an international reliability exercise could be an excellent tool to train experienced and less-experienced sonographers. SGUS homogeneity items is useful to distinguish normal from abnormal salivary glands parenchyma independently of diagnosis. Structural damage evaluations by OMERACT scoring system is a new comprehensive score to diagnose patients with SD and could be easily used by sonographers in a binary method.

[Virtual DEGUM-certified course in the head and neck region-a useful complement to conventional course formats?]

BACKGROUND

Training in clinical ultrasound has become highly relevant for working as an otorhinolaryngologist. While there is a high demand for standardized and certified training courses, until recently, there was no possibility to attend web-based and exclusively virtual head and neck ultrasound courses certified by the Deutsche Gesellschaft für Ultraschall in der Medizin (DEGUM; German Society for Ultrasound in Medicine).

OBJECTIVE

The aim of this study was to provide a qualitative and semi-quantitative analysis of the first purely virtual DEGUM-certified head and neck ultrasound courses.

MATERIALS AND METHODS

In 2021, three purely web-based DEGUM-certified head and neck ultrasound courses were carried out and then qualitatively analyzed using questionnaires including an examination.

RESULTS

The purely virtual implementation of head and neck ultrasound courses proved to be a viable alternative to the conventional course format, with a high level of acceptance among the participants. The lack of practice among the participants remains a relevant criticism.

CONCLUSION

A more dominant role of web-based and remote ultrasound training is likely and should be considered as an alternative depending on existing conditions. Nevertheless, acquisition of practical sonographic skills remains a major hurdle if courses are purely digital.

Can you teach a hands-on skill online? A scoping review of e-learning for point-of-care ultrasound in medical education

Background

There is an increasing need and interest in teaching point-of-care ultrasound (POCUS) online. The objective of this study was to systematically review the literature regarding e-learning as a method for teaching POCUS in medical education, to assess the benefits and limitations of various styles of e-learning for POCUS, and to identify gaps in the literature that could help guide future research in this field.

Methods

A literature search was conducted on three databases including MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Clinical Trials on October 12, 2021, retrieving a total of 1630 studies. 31 studies met the inclusion and exclusion criteria. These studies were separated into different styles of e-learning and learner outcomes were analyzed based on Kirkpatrick's hierarchy.

Results

The studies were categorized into three styles of e-learning: a) blended learning b) online-only (asynchronous or synchronous) and c) use of handheld machines or telesonography. POCUS knowledge and image interpretation were successfully taught online, however online-only learning for image acquisition was not as consistently effective. Blended learning and telesonography were beneficial for learning image acquisition skills. Generally, novice learners benefited most from e-learning.

Conclusion

E-learning for POCUS is gaining in popularity in recent years. POCUS is a complex technical skill, and depending on the individual task being taught, different styles of e-learning may be more successful. These findings can inform future POCUS educational programs.

The effect of e-learning on point-of-care ultrasound education in novices

BACKGROUND

Current studies assessed the learning efficacy of e-learning in ultrasound (US) training using questionnaires, or simulation in well-controlled conditions. This study investigates the effect of e-learning on the clinical US performance of the first postgraduate year (PGY-1) residents.

METHODS

In this prospective observational study, we enrolled PGY-1 and second postgraduate year (PGY-2) residents. The e-learning was introduced on the first day and each PGY-1 was authorized to access the e-learning platform. The point-of-care ultrasound (PoCUS) curriculum for the focused assessment of sonography for trauma (FAST) was conducted on the 7^th day for PGY-1 and the objective structured clinical examination (OSCE) followed. The PGY-2 received bedside one-to-one random learning before the study and did not have the authorization to access the e-learning. The FAST examinations performed by the PGY-1 and PGY-2 were collected on the 30th day. The clinical FAST performance was assessed by the instructor not involved in the curriculum and blinded to the use of e-learning, including numbers, image quality, and diagnostic accuracy between PGY-1 e-learning users, non-users, and the PGY-2.

RESULTS

One hundred and seventy PGY-1 with 736 FAST examinations and 53 PGY-2 residents with 134 examinations were included. Seventy PGY-1 used e-learning with a median time spent of 13.2 mins (IQR, 6.5-21.1 mins) at the first access. The PGY-2 had more PoCUS experience than the PGY-1, however, the 70 e-learning users performed more FAST examinations than the PGY-2 (median [IQR], 4 [2-6] vs. 2 [1-3], p = 0.0004) and had better image quality than the PGY-2 (3 [3-3.2] vs. 3 [2.7-3], p = 0.044). There were no significant differences in the diagnostic accuracy between the PGY-1 and PGY-2.

CONCLUSIONS

E-learning has a positive effect on US learning. The PGY-1 users had comparable performance with the PGY-2 and even better image acquisition although the PGY-2 had more PoCUS experience.

TRIAL REGISTRATION

NCT03738033 at ClinicalTrials.gov.

E-learning and practical performance in musculoskeletal ultrasound: a multicentre randomized study

OBJECTIVES

To examine the effect of pre-course e-learning on residents' practical performance in musculoskeletal ultrasound (MSUS).

METHODS

This was a multicentre, randomized controlled study following the Consolidated Standards of Reporting Trials (CONSORT) statement. Residents with no or little MSUS experience were randomized to either an e-learning group or a traditional group. One week before a 2-day face-to-face MSUS course, the e-learning group received access to an interactive platform consisting of online lectures, assignments, and practical instruction videos aligned with the content of the course. The traditional group only received standard pre-course information (program, venue, and time). All participants performed a pre- and post-course practical MSUS examination and were assessed by two individual raters, blinded to the group allocation, using the validated Objective Structured Assessment of Ultrasound Skills (OSAUS) tool.

RESULTS

Twenty-eight participants completed the study. There were no statistically significant differences in the pre- or post-course practical MSUS performance between the e-learning group and the traditional group; the mean pre-course OSAUS score (s.d.) in the -learning group was 5.4 (3.7) compared with 5.2 (2.4) in the traditional group (P = 0.8), whereas the post-course OSAUS score in the e-learning group was 11.1 (2.8) compared with 10.9 (2.4) in the traditional group (P = 0.8). There was a significant difference between the mean pre- and post-course scores (5.74 points, P < 0.001). The OSAUS assessment tool demonstrated good inter-rater reliability (intra-class correlation = 0.84).

CONCLUSION

We found no significant impact of pre-course e-learning on novices' acquisition of practical MSUS skills. Hands-on training is of the utmost importance and improves MSUS performance significantly. The OSAUS assessment tool is an applicable tool with high interrater reliability.

TRIAL REGISTRATION

https://clinicaltrials.gov/ NCT04959162.

Implementation and Assessment of a Hybrid Training Course on Point-of-Care Pediatric Ultrasound in Vietnam During the COVID-19 Pandemic

Background As point-of-care ultrasound (POCUS) has gained popularity, some educational guidelines have been developed. However, in Vietnam, no training course in pediatric POCUS has yet been developed. This was challenging, especially during the COVID-19 pandemic. Objectives This study aimed to implement a three-month hybrid training course for pediatric POCUS training in Vietnam using both online and face-to-face hands-on sessions and to assess participants' self-efficacy level and change in their attitudes towards pediatric POCUS. Methods A hybrid training course in pediatric POCUS was implemented at a children's hospital in Vietnam. This study developed a standardized training course, including online learning, live lectures, hands-on sessions, and skill assessment based on the POCUS consensus educational guidelines. Physicians interested in pediatric POCUS were recruited for participation. They completed a self-evaluation survey before and after the course using a Likert score to assess their background, self-efficacy in performing POCUS, overall satisfaction with the course, and change in their attitudes towards POCUS three months after the course. Results A total of 19 physicians participated in the course. The mean post-training self-efficacy score was significantly higher than the pre-course assessment score: 73.1 (standard deviation (SD): 7.2) vs. 48.9 (SD: 12.5) (p <0.05). The efficacy level was retained three months after the course. Furthermore, overall satisfaction with the course was high at 9.5 (SD: 0.6). After the course, almost all participants strongly agreed to increase the use of POCUS in their clinical practice. Conclusion A hybrid training course in pediatric POCUS was successfully implemented in Vietnam and found the participants' self-efficacy level to be significantly higher after the course and the effect to be retained after the course. The training course could positively affect the participants' attitudes towards POCUS, encouraging them to use POCUS more frequently in their clinical practice.

Technology-enhanced trauma training in low-resource settings: A scoping review and feasibility analysis of educational technologies

BACKGROUND

Lack of training contributes to the burden of trauma-related mortality and morbidity in low- and lower-middle-income countries (LMICs). Educational technologies present a unique opportunity to enhance the quality of trauma training. Therefore, this study reviews current technologies used in trauma courses and evaluates their feasibility for LMICs.

METHODS

We conducted a scoping review evaluating the learning outcomes of technology-enhanced training in general trauma assessment, team skills or any procedures covered in the 2020 Advanced Trauma Life Support® program. Based on the Technology-Enhanced Learning criteria, we created and applied a feasibility analysis tool to evaluate the technologies for use in LMICs.

RESULTS

We screened 6471 articles and included 64. Thirty-four (45%) articles explored training in general trauma assessment, 28 (37%) in team skills, and 24 (32%) in procedures. The most common technologies were high-fidelity mannequins (60%), video-assisted debriefing (19%), and low-fidelity mannequins (13%). Despite their effectiveness, high-fidelity mannequins ranked poorly in production, maintenance, cost, and reusability categories, therefore being poorly suited for LMICs. Virtual simulation and digital courses had the best feasibility scores, but still represented a minority of articles in our review.

CONCLUSION

To our knowledge, this is the first study to perform a feasibility analysis of trauma training technologies in the LMIC context. We identified that the majority of trauma courses in the literature use technologies which are less suitable for LMICs. Given the urgent need for pediatric trauma training, educators must use technologies that optimize learning outcomes and remain feasible for low-resource settings.

LEVEL OF EVIDENCE

IV.

Lung ultrasound protocol decreases radiation in newborn population without side effects: A quality improvement project

OBJECTIVE

To reduce radiation exposure in newborns admitted due respiratory distress based on the implementation of lung ultrasound (LUS).

DESIGN

Quality improvement (QI), prospective, before-after, pilot study.

SETTING

Third level neonatal intensive care unit (NICU) level with 25-bed and 1800 deliveries/year.

PATIENTS

Inclusion criteria were neonates admitted with respiratory distress.

INTERVENTIONS

After a theoretical and practical LUS training a new protocol was approved and introduced to the unit were LUS was the first-line image. To study the effect of the intervention we compare two 6-month periods: group 1, with the previous chest X-ray (CXR)-protocol (CXR as the first diagnostic technique) vs. group 2, once LUS-protocol had been implemented.

MAIN VARIABLES OF INTEREST

The main QI measures were the total exposure to radiation. Secondary QI were to evaluate if the LUS protocol modified the clinical evolution as well as the frequency of complications.

RESULTS

122 patients were included. The number of CXR was inferior in group 2 (group 1: 2 CXR (IQR 1-3) vs. Group 2: 0 (IQR 0-1), p<0.001), as well as had lower median radiation per baby which received at least one CXR: 56 iGy (IQR 32-90) vs. 30 iGy (IQR 30-32), p<0.001. Respiratory support was similar in both groups, with lower duration of non-invasive mechanical ventilation and oxygen duration the second group (p<0.05). No differences regarding respiratory development complications, length of stay and mortality were found.

CONCLUSIONS

The introduction of LUS protocol in unit decreases the exposure radiation in infants without side effects.

Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review

BACKGROUND

Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools.

OBJECTIVE

To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods.

DESIGN AND SETTING

Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education.

METHODS

A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators.

RESULTS

The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement.

CONCLUSION

We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography.

REGISTRATION NUMBER

DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Review article: E-learning in emergency medicine: A systematic review

E‐learning (EL) has been developing as a medical education resource since the arrival of the internet. The COVID‐19 pandemic has minimised clinical exposure for medical trainees and forced educators to use EL to replace traditional learning (TL) resources. The aim of this review was to determine the impact of EL versus TL on emergency medicine (EM) learning outcomes of medical trainees. A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis statement using articles sourced from CINAHL, Embase, OVID Medline and PubMed. Articles were independently reviewed by two reviewers following strict inclusion and exclusion criteria. Bias was assessed using the Cochrane Risk of Bias tool. The search yielded a total of 1586 non‐duplicate studies. A total of 19 studies were included for data extraction. Fifteen of the included studies assessed knowledge gain of participants using multiple‐choice questions as an outcome measure. Eleven of the 15 demonstrated no statistically significant difference while two studies favoured EL with statistical significance and two favoured TL with statistical significance. Six of the included studies assessed practical skill gain of participants. Five of the six demonstrated no statistical significance while one study favoured EL with statistical significance. This systematic review suggests that EL may be comparable to TL for the teaching of EM. The authors encourage the integration of EL as an adjunct to face‐to‐face teaching where possible in EM curricula; however, the overall low quality of evidence precludes definitive conclusions from being drawn.

Training and assessment of musculoskeletal ultrasound and injection skills-a systematic review

OBJECTIVES

To examine how residents are trained and assessed in musculoskeletal ultrasound (MSUS), MSUS-guided and landmark-guided joint aspiration and injection. Additionally, to present the available assessment tools and examine their supporting validity evidence.

METHODS

A systematic search of PubMed, Cochrane Library, and Embase was conducted in accordance with the PRISMA guidelines and studies published from January 1, 2000 to May 31, 2021 were included. Two independent reviewers performed the search and data extraction. The studies were evaluated using the Medical Education Research Quality Instrument (MERSQI).

RESULTS

9,884 articles were screened, and 43 were included; 3 were randomized studies, 21 pre- and post-test studies, 16 descriptive studies, and 3 studies developing assessment tools. The studies used various theoretical training modalities e.g. lectures, anatomical quizzes and e-learning. The practical training models varied from mannequins and cadavers to healthy volunteers and patients. The majority of studies used subjective "comfort level" as assessment, others used practical examination and/or theoretical examination. All training programs increased trainees' self-confidence, theoretical knowledge, and/or practical performance, however few used validated assessment tools to measure the effect. Only one study met the MERSQI high methodical quality cut-off score of 14.

CONCLUSION

The included studies were heterogeneous, and most were of poor methodological quality and not based on contemporary educational theories. This review highlights the need for educational studies using validated theoretical and practical assessment tools to ensure optimal MSUS training and assessment in rheumatology.

Telementored ultrasonography: a narrative review

BACKGROUND

Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown.

OBJECTIVE

To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission.

DESIGN AND SETTING

Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil.

METHODS

A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated.

RESULTS

We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients.

CONCLUSIONS

Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

A training plan to implement lung ultrasound for diagnosing pneumonia in children

BACKGROUND

Lung ultrasound (LUS) for critical patients requires trained operators to perform them, though little information exists on the level of training required for independent practice. The aims were to implement a training plan for diagnosing pneumonia using LUS and to analyze the inter-observer agreement between senior radiologists (SRs) and pediatric intensive care physicians (PICPs).

METHODS

Prospective longitudinal and interventional study conducted in the Pediatric Intensive Care Unit of a tertiary hospital. Following a theoretical and practical training plan regarding diagnosing pneumonia using LUS, the concordance between SRs and the PICPs on their LUS reports was analyzed.

RESULTS

Nine PICPs were trained and tested on both theoretical and practical LUS knowledge. The mean exam mark was 13.5/15. To evaluate inter-observer agreement, a total of 483 LUS were performed. For interstitial syndrome, the global Kappa coefficient (K) was 0.51 (95% CI 0.43-0.58). Regarding the presence of consolidation, K was 0.67 (95% CI 0.53-0.78), and for the consolidation pattern, K was 0.82 (95% CI 0.79-0.85), showing almost perfect agreement.

CONCLUSIONS

Our training plan allowed PICPs to independently perform LUS and might improve pneumonia diagnosis. We found a high inter-observer agreement between PICPs and SRs in detecting the presence and type of consolidation on LUS.

IMPACT

Lung ultrasound (LUS) has been proposed as an alternative to diagnose pneumonia in children. However, the adoption of LUS in clinical practice has been slow, and it is not yet included in general clinical guidelines. The results of this study show that the implementation of a LUS training program may improve pneumonia diagnosis in critically ill patients. The training program's design, implementation, and evaluation are described. The high inter-observer agreement between LUS reports from the physicians trained and expert radiologists encourage the use of LUS not only for pneumonia diagnosis, but also for discerning bacterial and viral patterns.

Implementation and assessment of a pediatric point-of-care ultrasound training course in Japan: a pilot study

Purpose

The popularity of point-of-care ultrasound (POCUS) has led to the creation of educational guidelines for its use. In Japan, however, a comprehensive training course for POCUS use in pediatric emergency medicine has yet to be developed. The present study aimed to implement a pilot course for pediatric POCUS training in Japan and to compare participants’ self-efficacy level before and after the course.

Methods

A half-day training course in pediatric POCUS was implemented at a meeting of the Japan Society of Point-of-Care Ultrasound. A standardized training course, including pre-learning materials, live lectures, and hands-on sessions, was developed based on the US consensus educational guidelines. Physicians interested in pediatric POCUS were recruited for participation and completed a self-evaluation survey before and after the course to access their background, self-efficacy in performing selected ultrasound procedures before and after the course, and their overall satisfaction with the course.

Results

In total, 31 physicians participated. Of these, 25 completed the survey. Ten participants were in post-graduate year (PGY) 1–2, 13 were in PGY 3–5, and eight were in PGY 6 or higher. The post-training self-efficacy score was significantly higher than the pre-course assessment score (86.0 [standard deviation (SD): 19.2] vs. 35.6 [SD 17.6], p =  < 0.05, mean difference: 49.6 [95% confidence interval 39.6–61.2]). Furthermore, overall satisfaction with the course was high at 8.6 (SD 1.8).

Conclusion

The present study implemented a pilot training course in pediatric POCUS and found the participants’ self-efficacy level to be significantly higher after the course.

Effectiveness of face-to-face, blended and e-learning in teaching the application of local anaesthesia: a randomised study

BACKGROUND

Local anaesthesia plays a key role in many aspects of a dentist's work. The required skills to perform anaesthesia successfully are acquired at university. To take advantage of the possibilities for new teaching formats, a blended learning concept for the local anaesthesia course was developed. The aim of the study was to compare the effectiveness of face-to-face, blended and e-learning in teaching in local anaesthesia by assessing students' knowledge gain, performance of practical skills and satisfaction with the course.

METHODS

All participants (n = 37) were randomly allocated into three groups. After acquiring the theoretical background in the blended learning, e-learning or lecture groups, a test to assess knowledge gain was performed. The performance of the practical skills was assessed in a small-group seminar. Student attitudes were evaluated with a questionnaire.

RESULTS

The blended group showed significantly better results (mean = 17, SD =1.5) in theoretical knowledge gain than the other two groups (e-learning group: mean = 14.7, SD = 2.2; lecture group: mean = 14.8, SD =2.3). When comparing the results of the clinical skills assessment, there was no significant difference among all three groups (p > 0.017). The participants confirmed a high overall satisfaction with the course, in particular with the blended learning approach.

CONCLUSION

This study indicates that blended learning improves the learning outcome for theoretical knowledge in teaching local anaesthesia more than either face-to-face learning or e-learning alone. Furthermore, the blended learning approach is highly appreciated by the students. For acquiring practical skills, this study shows that blended learning is as effective as other teaching methods.

Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic

OBJECTIVE

To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS).

METHODS

We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills.

RESULTS

There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, -2.5; 95% confidence interval [CI], -12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, -1.4, 5.3), and postcourse 2-month retention test (absolute difference, -0.8; 95% CI, -9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, -4.7 to 8.5) and 2-month retention (absolute difference, -0.6; 95% CI, -10.7 to 9.5).

CONCLUSIONS

Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.

Impact of a 4-hour Introductory eFAST Training Intervention Among Ultrasound-Naïve U.S. Military Medics

INTRODUCTION

Advances in the portability of ultrasound have allowed it to be increasingly employed at the point of care in austere settings. Battlefield constraints often limit the availability of medical officers throughout the operational environment, leading to increased interest in whether highly portable ultrasound devices can be employed by military medics to enhance their provision of combat casualty care. Data evaluating optimal training for effective medic employment of ultrasound is limited however. This prospective observational cohort study's primary objective was to assess the impact of a 4-hour introductory training intervention on ultrasound-naïve military medic participants' knowledge/performance of the eFAST application.

MATERIALS AND METHODS

Conventional U.S. Army Medics, all naïve to ultrasound, were recruited from across JBLM. Volunteer participants underwent baseline eFAST knowledge assessment via a 50-question multiple-choice exam. Participants were then randomized to receive either conventional, expert-led classroom didactic training or didactic training via an online, asynchronously available platform. All participants then underwent expert-led, small group hands-on training and practice. Participants' eFAST performance was then assessed with both live and phantom models, followed by a post-course knowledge exam. Concurrently, emergency medicine (EM) resident physician volunteers, serving as standard criterion for trained personnel, underwent the same OSCE assessments, followed by a written exam to assess their baseline eFAST knowledge. Primary outcome measures included (1) post-course knowledge improvement, (2) eFAST exam technical adequacy, and (3) eFAST exam OSCE score. Secondary outcome measures were time to exam completion and diagnostic accuracy rate for hemoperitoneum and hemopericardium. These outcome measures were then compared across medic cohorts and to those of the EM resident physician cohort.

RESULTS

A total of 34 medics completed the study. After 4 hours of ultrasound training, overall eFAST knowledge among the 34 medics improved from a baseline mean of 27% on the pretest to 83% post-test. For eFAST exam performance, the medics scored an average of 20.8 out of a maximum of 22 points on the OSCE. There were no statistically significant differences between the medics who received asynchronous learning versus traditional classroom-based learning, and the medics demonstrated comparable performance to previously trained EM resident physicians.

CONCLUSIONS

A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Online, asynchronously available platforms may effectively mitigate some of the resource requirement burden associated with point-of-care ultrasound training. Future studies evaluating medic eFAST performance on real-world battlefield trauma patients are needed. Skill and knowledge retention must also be assessed for this degradable skill to determine frequency of refresher training when not regularly performed.

Triage live lecture versus triage video podcast in pre-hospital students' education

Introduction

Triage is the process of determining the priority of patients’ treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students.

Methods

Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as one month later, post-tests were run for both groups, and the results were analysed using an independent t-test and covariance.

Results

No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately, or one month after training.

Discussion

We suggest that video podcasts are ready to replace traditional teaching methods in triage.

Online Digital Education for Postregistration Training of Medical Doctors: Systematic Review by the Digital Health Education Collaboration

Background

Globally, online and local area network–based (LAN) digital education (ODE) has grown in popularity. Blended learning is used by ODE along with traditional learning. Studies have shown the increasing potential of these technologies in training medical doctors; however, the evidence for its effectiveness and cost-effectiveness is unclear.

Objective

This systematic review evaluated the effectiveness of online and LAN-based ODE in improving practicing medical doctors’ knowledge, skills, attitude, satisfaction (primary outcomes), practice or behavior change, patient outcomes, and cost-effectiveness (secondary outcomes).

Methods

We searched seven electronic databased for randomized controlled trials, cluster-randomized trials, and quasi-randomized trials from January 1990 to March 2017. Two review authors independently extracted data and assessed the risk of bias. We have presented the findings narratively. We mainly compared ODE with self-directed/face-to-face learning and blended learning with self-directed/face-to-face learning.

Results

A total of 93 studies (N=16,895) were included, of which 76 compared ODE (including blended) and self-directed/face-to-face learning. Overall, the effect of ODE (including blended) on postintervention knowledge, skills, attitude, satisfaction, practice or behavior change, and patient outcomes was inconsistent and ranged mostly from no difference between the groups to higher postintervention score in the intervention group (small to large effect size, very low to low quality evidence). Twenty-one studies reported higher knowledge scores (small to large effect size and very low quality) for the intervention, while 20 studies reported no difference in knowledge between the groups. Seven studies reported higher skill score in the intervention (large effect size and low quality), while 13 studies reported no difference in the skill scores between the groups. One study reported a higher attitude score for the intervention (very low quality), while four studies reported no difference in the attitude score between the groups. Four studies reported higher postintervention physician satisfaction with the intervention (large effect size and low quality), while six studies reported no difference in satisfaction between the groups. Eight studies reported higher postintervention practice or behavior change for the ODE group (small to moderate effect size and low quality), while five studies reported no difference in practice or behavior change between the groups. One study reported higher improvement in patient outcome, while three others reported no difference in patient outcome between the groups. None of the included studies reported any unintended/adverse effects or cost-effectiveness of the interventions.

Conclusions

Empiric evidence showed that ODE and blended learning may be equivalent to self-directed/face-to-face learning for training practicing physicians. Few other studies demonstrated that ODE and blended learning may significantly improve learning outcomes compared to self-directed/face-to-face learning. The quality of the evidence in these studies was found to be very low for knowledge. Further high-quality randomized controlled trials are required to confirm these findings.

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

Background

Clinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification.

Methods

According to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment.

Results

Of 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants’ hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%).

Conclusion

All educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.

E-learning for health professionals

BACKGROUND

The use of e-learning, defined as any educational intervention mediated electronically via the Internet, has steadily increased among health professionals worldwide. Several studies have attempted to measure the effects of e-learning in medical practice, which has often been associated with large positive effects when compared to no intervention and with small positive effects when compared with traditional learning (without access to e-learning). However, results are not conclusive.

OBJECTIVES

To assess the effects of e-learning programmes versus traditional learning in licensed health professionals for improving patient outcomes or health professionals' behaviours, skills and knowledge.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, five other databases and three trial registers up to July 2016, without any restrictions based on language or status of publication. We examined the reference lists of the included studies and other relevant reviews. If necessary, we contacted the study authors to collect additional information on studies.

SELECTION CRITERIA

Randomised trials assessing the effectiveness of e-learning versus traditional learning for health professionals. We excluded non-randomised trials and trials involving undergraduate health professionals.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies, extracted data and assessed risk of bias. We graded the certainty of evidence for each outcome using the GRADE approach and standardised the outcome effects using relative risks (risk ratio (RR) or odds ratio (OR)) or standardised mean difference (SMD) when possible.

MAIN RESULTS

We included 16 randomised trials involving 5679 licensed health professionals (4759 mixed health professionals, 587 nurses, 300 doctors and 33 childcare health consultants).When compared with traditional learning at 12-month follow-up, low-certainty evidence suggests that e-learning may make little or no difference for the following patient outcomes: the proportion of patients with low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL (adjusted difference 4.0%, 95% confidence interval (CI) -0.3 to 7.9, N = 6399 patients, 1 study) and the proportion with glycated haemoglobin level of less than 8% (adjusted difference 4.6%, 95% CI -1.5 to 9.8, 3114 patients, 1 study). At 3- to 12-month follow-up, low-certainty evidence indicates that e-learning may make little or no difference on the following behaviours in health professionals: screening for dyslipidaemia (OR 0.90, 95% CI 0.77 to 1.06, 6027 patients, 2 studies) and treatment for dyslipidaemia (OR 1.15, 95% CI 0.89 to 1.48, 5491 patients, 2 studies). It is uncertain whether e-learning improves or reduces health professionals' skills (2912 health professionals; 6 studies; very low-certainty evidence), and it may make little or no difference in health professionals' knowledge (3236 participants; 11 studies; low-certainty evidence).Due to the paucity of studies and data, we were unable to explore differences in effects across different subgroups. Owing to poor reporting, we were unable to collect sufficient information to complete a meaningful 'Risk of bias' assessment for most of the quality criteria. We evaluated the risk of bias as unclear for most studies, but we classified the largest trial as being at low risk of bias. Missing data represented a potential source of bias in several studies.

AUTHORS' CONCLUSIONS

When compared to traditional learning, e-learning may make little or no difference in patient outcomes or health professionals' behaviours, skills or knowledge. Even if e-learning could be more successful than traditional learning in particular medical education settings, general claims of it as inherently more effective than traditional learning may be misleading.

Quality Management of Ultrasound Surveillance for Hepatocellular Carcinoma Under the Korean National Cancer Screening Program

OBJECTIVES

The aim of this study was to investigate the quality of ultrasound (US) examinations for hepatocellular carcinoma surveillance under the Korean National Cancer Screening Program and to assess knowledge and experience about liver US of physicians who perform US examinations.

METHODS

The investigation about the quality of liver US for hepatocellular carcinoma screening was based on the results of a nationwide quality assurance (QA) evaluation between 2012 and 2014 at all medical institutions participating in the National Cancer Screening Program. The QA evaluation was for personnel, equipment, education, and clinical images. Medical institutions with fewer than 60 of 100 points were considered to have failed the evaluation. Follow-up education in the form of a hands-on workshop was provided for physicians who worked in medical institutions that failed the QA evaluation. A questionnaire about basic knowledge and experience with US was administered during follow-up education.

RESULTS

After the QA evaluation, 542 of 685 hospitals and 1340 of 1985 private clinics passed the test. The evaluation of private clinics and hospitals showed substantial differences in the frequency of adequacy or mean scores between the pass and fail groups for all QA items, even requirements. Among 233 participants in the hands-on workshops, 187 physicians (80.2%) responded to the questionnaire. Results revealed that physicians had deficient knowledge and experience about liver US.

CONCLUSIONS

The quality of liver US for hepatocellular carcinoma screening remains suboptimal. Education for physicians who perform liver US examinations is unsatisfactory in Korea. We should make an effort to improve the quality of liver US and teach basic US techniques to physicians.

Effectiveness of a Perioperative Transthoracic Ultrasound Training Program for Students and Residents

OBJECTIVE

Focused ultrasound (US) is being incorporated across all levels of medical education. Although many comprehensive US courses exist, their scope is broad, requiring expert instructors, access to simulation, and extensive time commitment by the learner. We aim to compare learning across levels of training and specialties using a goal-directed, web-based course without live skills training.

DESIGN

A prospective observational study of students and residents from medicine, surgery, and anesthesiology. Analysis compared pretests and posttests assessing 3 competencies. Individual mean score improvement (MSI) was compared by paired-sample t-tests and MSI among cohorts by analysis of variance, with significance set at p ≤ 0.05. McNemar test compared those who agreed or strongly agreed with survey items with those who did not before and after intervention.

SETTING

Jackson Memorial Hospital, Miami, FL residency training programs in Medicine, Surgery, and Anesthesiology.

RESULTS

A total of 180 trainees participated. A significant MSI was noted in each of 3 competencies in all 3 cohorts. Students' (S) MSI was significantly higher than residents' (R) and interns' (I) in US "knobology" and window recognition [S = 2.28 ± 1.29/5 vs R = 1.63 ± 1.21/5 (p = 0.014); vs I = 1.59 ± 1.12/5 (p = 0.032)]; students' total score MSI was significantly higher than residents [7.60 ± 3.43/20 vs 5.78 ± 3.08/20 (p < 0.008)]. All cohorts reported improved comfort in using transthoracic US and improved ability to recognize indications for use. More than 81% of all participants reported improved confidence in performing transthoracic US; more than 91% reported interest in additional training; and more than 88% believed course length was appropriate.

CONCLUSIONS

Learners across levels of medical training and specialties can benefit from a brief, goal-directed, web-based training with early incorporation producing maximal yield.

Influence of case-based e-learning on students' performance in point-of-care ultrasound courses: a randomized trial

BACKGROUND

Theoretical knowledge, visual perception, and sensorimotor skills are key elements in ultrasound education. Classroom-based presentations are used routinely to teach theoretical knowledge, whereas visual perception and sensorimotor skills typically require hands-on training (HT). We aimed to compare the effect of classroom-based lectures versus a case-based e-learning (based on clinical cases only) on the hands-on performance of trainees during an emergency ultrasound course.

PARTICIPANTS AND METHODS

This is a randomized, controlled, parallel-group study. Sixty-two medical students were randomized into two groups [group 1 (G1) and group 2 (G2)]. G1 (n=29) was subjected to a precourse e-learning, based on 14 short screencasts (each 5 min), an on-site discussion (60 min), and a standardized HT session on the day of the course. G2 (n=31) received classroom-based presentations on the day of the course before an identical HT session. Both groups completed a multiple-choice (MC) pretest (test A), a practical postcourse test (objective structured clinical exam), and MC tests directly after the HT (test B) and 1 day after the course (test C). The Mann-Whitney U-test was used for statistical analysis.

RESULTS

G1 performed markedly better in test A (median 84.2, 25%; 75% percentile: 68.5; 92.2) compared with G2 (65.8; 53.8; 80.4), who had not participated in case-based e-learning (P=0.0009). No differences were found in the objective structured clinical exam, test B, and test C.

CONCLUSION

e-learning exclusively based on clinical cases is an effective method of education in preparation for HT sessions and can reduce attendance time in ultrasound courses.

Focused assessment with sonography for trauma: current perspectives

Focused assessment with sonography for trauma (FAST) is a part of resuscitation of trauma patients recommended by international panel consensus. The purpose of FAST is to identify free fluid, which necessarily means blood in acute trauma patients. In this article, the authors focused on various aspects of FAST in the emergency department, prehospital care, pediatric setting, training and general pearls/pitfalls. Detailed techniques and interpretation of FAST are beyond the scope of this article.

Point-of-Care Ultrasound for Jugular Venous Pressure Assessment: Live and Online Learning Compared

Introduction

Point-of-care ultrasound (POCUS) is a novel technique for the assessment of jugular venous pressure. Distance education may allow for efficient dissemination of this technique. We compared online learning to a live course for teaching ultrasonography jugular venous pressure (u-JVP) to determine if these teaching methods yielded different levels of comfort with and use of u-JVP.

Methods

This was an interventional trial of Canadian emergency physicians who had taken a basic POCUS course. The participants were in one of three Groups: online learning (Group OL), live teaching (Group LT), control (Group C). Group LT participants also took an advanced course prior to the study that included instruction in u-JVP. The participants who took the basic course were randomized to Group OL or Group C. Group OL was subject to the intervention, online learning. Group C only received an article citation regarding u-JVP. Questionnaires were completed before and after the intervention. The primary outcome was physician self-reported use and comfort with the technique of u-JVP after online learning compared to live teaching.

Results

Of the 287 advanced course participants, 42 completed the questionnaires (Group LT). Of the 3303 basic course participants, 47 who were assigned to Group OL completed the questionnaires and 47 from Group C completed the questionnaires. Use of u-JVP increased significantly in Group OL (from 15% to 55%) and Group C (from 21% to 47%) with the intervention. The comfort with use did not differ between Group LT and Group OL (p=0.14). The frequency of use remained higher in Group LT than Group OL (p=0.07).

Conclusion

Online learning increases the use and comfort with performing u-JVP for emergency physicians with prior POCUS experience. Although the comfort with use of u-JVP was similar in Groups LT and OL, online learning appears to yield levels of use that are less than those of a live course.

Online Versus Face-To-Face Training of Critical Time Intervention: A Matching Cluster Randomized Trial

This study examined the effectiveness of online education to providers who serve people experiencing homelessness, comparing online and face-to-face training of Critical Time Intervention (CTI), an evidence-based case management model. The authors recruited 184 staff from 19 homeless service agencies to participate in one of two training conditions: (a) Online Training + Community of Practice or (b) Face-to-Face Training + Telephone Consultation. Each group received 24 hours of instruction and support. Through baseline, follow-up, and nine-month post-training surveys, the authors examined satisfaction, knowledge gains, knowledge retention, and readiness to implement CTI. While satisfaction rates were higher among participants in the face-to-face group, the two training conditions produced comparable pre/post knowledge gains. Furthermore, both groups showed increased knowledge retention scores at nine-month follow up, with the online group scoring higher than the face-to-face group.

Social media to supplement point-of-care ultrasound courses: the "sandwich e-learning" approach. A randomized trial

Background

Point-of-care ultrasound (POC-US) is gaining importance in almost all specialties. E-learning has been used to teach theoretical knowledge and pattern recognition. As social media are universally available, they can be utilized for educational purposes. We wanted to evaluate the utility of the sandwich e-learning approach defined as a pre-course e-learning and a post-course learning activity using Facebook after a one-day point-of-care ultrasound (POC-US) course and its effect on the retention of knowledge.

Methods

A total of 62 medial students were recruited for this study and randomly assigned to one of four groups. All groups received an identical hands-on training and performed several tests during the study period. The hands-on training was performed in groups of five students per instructor with the students scanning each other. Group 1 had access to pre-course e-learning, but not to post-course e-learning. Instead of a pre-course e-learning, group 2 listened to presentations at the day of the course (classroom teaching) and had access to the post-course learning activity using Facebook. Group 3 had access to both pre- and post-course e-learning (sandwich e-learning) activities, while group 4 listened classroom presentations only (classroom teaching only). Therefore only groups 2 and 3 had access to post-course learning via Facebook by joining a secured group. Posts containing ultrasound pictures and videos were published to this group. The students were asked to “like” the posts to monitor attendance. Knowledge retention was assessed 6 weeks after the course.

Results

After 6 weeks, group 3 achieved comparable results when compared to group 2 (82.2 % + −8.2 vs. 84.3 + −8.02) (p = 0.3). Students who participated in the post-course activity were more satisfied with the overall course than students without post-course learning (5.5 vs. 5.3 on a range from 1 to 6).

Conclusions

In this study, the sandwich e-learning approach led to equal rates of knowledge retention compared to classroom lectures and post-course learning. Students appreciate new media for learning experiences and are more satisfied with their learning activity. The sandwich e-learning can be used to maximize hands-on training during courses.

Electronic supplementary material

The online version of this article (doi:10.1186/s13089-016-0037-9) contains supplementary material, which is available to authorized users.

Disaster response team FAST skills training with a portable ultrasound simulator compared to traditional training: pilot study

Introduction

Pre-hospital focused assessment with sonography in trauma (FAST) has been effectively used to improve patient care in multiple mass casualty events throughout the world. Although requisite FAST knowledge may now be learned remotely by disaster response team members, traditional live instructor and model hands-on FAST skills training remains logistically challenging. The objective of this pilot study was to compare the effectiveness of a novel portable ultrasound (US) simulator with traditional FAST skills training for a deployed mixed provider disaster response team.

Methods

We randomized participants into one of three training groups stratified by provider role: Group A. Traditional Skills Training, Group B. US Simulator Skills Training, and Group C. Traditional Skills Training Plus US Simulator Skills Training. After skills training, we measured participants’ FAST image acquisition and interpretation skills using a standardized direct observation tool (SDOT) with healthy models and review of FAST patient images. Pre- and post-course US and FAST knowledge were also assessed using a previously validated multiple-choice evaluation. We used the ANOVA procedure to determine the statistical significance of differences between the means of each group’s skills scores. Paired sample t-tests were used to determine the statistical significance of pre- and post-course mean knowledge scores within groups.

Results

We enrolled 36 participants, 12 randomized to each training group. Randomization resulted in similar distribution of participants between training groups with respect to provider role, age, sex, and prior US training. For the FAST SDOT image acquisition and interpretation mean skills scores, there was no statistically significant difference between training groups. For US and FAST mean knowledge scores, there was a statistically significant improvement between pre- and post-course scores within each group, but again there was not a statistically significant difference between training groups.

Conclusion

This pilot study of a deployed mixed-provider disaster response team suggests that a novel portable US simulator may provide equivalent skills training in comparison to traditional live instructor and model training. Further studies with a larger sample size and other measures of short- and long-term clinical performance are warranted.

Sounding out the future of ultrasound education

As in so many other fields, the internet has revolutionised medical education. It has done this by circumventing the traditional constraints of medical education, in particular the availability of local resources such as teachers and textbooks. This "education revolution" has been most successful in the areas of theoretical knowledge. This article explores the available resources, and the challenges that arise when attempting to teach point-of-care ultrasound via the internet, such as the visuomotor and visuospatial skills required to create a diagnostic image. This article also describes the progress to date in this field.

Bedside ultrasound training using web-based e-learning and simulation early in the curriculum of residents

BACKGROUND

Focused bedside ultrasound is rapidly becoming a standard of care to decrease the risks of complications related to invasive procedures. The purpose of this study was to assess whether adding to the curriculum of junior residents an educational intervention combining web-based e-learning and hands-on training would improve the residents' proficiency in different clinical applications of bedside ultrasound as compared to using the traditional apprenticeship teaching method alone.

METHODS

Junior residents (n = 39) were provided with two educational interventions (vascular and pleural ultrasound). Each intervention consisted of a combination of web-based e-learning and bedside hands-on training. Senior residents (n = 15) were the traditionally trained group and were not provided with the educational interventions.

RESULTS

After the educational intervention, performance of the junior residents on the practical tests was superior to that of the senior residents. This was true for the vascular assessment (94% ± 5% vs. 68% ± 15%, unpaired student t test: p < 0.0001, mean difference: 26 (95% CI: 20 to 31)) and even more significant for the pleural assessment (92% ± 9% vs. 57% ± 25%, unpaired student t test: p < 0.0001, mean difference: 35 (95% CI: 23 to 44)). The junior residents also had a significantly higher success rate in performing ultrasound-guided needle insertion compared to the senior residents for both the transverse (95% vs. 60%, Fisher's exact test p = 0.0048) and longitudinal views (100% vs. 73%, Fisher's exact test p = 0.0055).

CONCLUSIONS

Our study demonstrated that a structured curriculum combining web-based education, hands-on training, and simulation integrated early in the training of the junior residents can lead to better proficiency in performing ultrasound-guided techniques compared to the traditional apprenticeship model.

Focused Assessment Sonography for Trauma (FAST) training: a systematic review

BACKGROUND

The aim of this study was to systematically review the different methods for training Focused Assessment Sonography for Trauma (FAST), course design, and requirements for hospital credentialing.

METHODS

We searched MEDLINE/PubMed, EMBASE, and the Cochrane database and performed a manual search of selected papers. All papers and abstracts written in English that studied training and education of FAST were included. Papers were critically evaluated, looking into training methods and models of FAST, their advantages and disadvantages, number and type of training hours, practice exams in the course, and number of cases advised to achieve hospital credentialing.

RESULTS

A total of 52 studies were critically analyzed. The theoretical part of the courses lasted over a median (range) of 4 (1-16) h (n = 35 studies), while the practical part lasted over a median (range) of 4 (1-32) h (n = 34 studies). The participants performed a median (range) of 10 (3-20) FAST exams during the courses (n = 13 studies). The most commonly used model was the normal human model (65 %), followed by peritoneal dialysis patients (27 %). The least used models were animal (4 %) and cadaveric models (2 %). Each of these models had their advantages and disadvantages. The median number (range) of FAST exams needed for credentialing was 50 (10-200) (n = 19 studies).

CONCLUSION

Standardization of FAST training is important to improving the clinical impact of FAST. Different models used in FAST training are complementary; each has its own advantages and disadvantages. It is recommended that FAST courses be at least 2 days (16 h) long. The first day should include 4 h of theory and 4 h of training on normal human models. The second day should enforce learning using animal models, case scenarios including video clips, or simulators.

Assessment of a new e-learning system on thorax, trachea, and lung ultrasound

Background. Lung ultrasound has become an emerging tool in acute and critical care medicine. Combined theoretical and hands-on training has been required to teach ultrasound diagnostics. Current computer technology allows for display, explanation, and animation of information in a remote-learning environment. Objective. Development and assessment of an e-learning program for lung ultrasound. Methods. An interactive online tutorial was created. A prospective learning success study was conducted with medical students using a multiple-choice test (Trial A). This e-learning program was used as preparation for a certified course followed by an evaluation of trained doctors (Trial B) by linear analogue scales. Pretests were compared with postcourse tests and sustainability tests as well as a posttest of a one-day custom classroom training. Results. In Trial A, during the learning success study (n = 29), the increase of correct answers was 11.7 to 17/20 in the post-test and to 16.6/20 in the sustainability test (relative change 45.1%, P < 0.0001). E-learning almost equalled scores of classroom-based training regarding gain and retention of factual knowledge. In Trial B, nineteen participating doctors found a 79.5% increase of knowledge (median, 95% CI: 69%; 88%). Conclusion. The basics of lung ultrasound can be taught in a highly effective manner using e-learning.

Acquiring credentials in bedside ultrasound: a cross-sectional survey

OBJECTIVE

Although there are training guidelines to credential emergency physicians in bedside ultrasound, many faculty groups have members who completed residency without a mandatory curriculum. These physicians are therefore required to learn bedside ultrasound while out in practice. The objective of this descriptive report is to illustrate a single academic facility's experience with acquiring credentials for emergency physicians in bedside ultrasound and the faculty's impressions on the motivators of and barriers to completion of the requirements.

DESIGN

Cross-sectional survey.

SETTING

Two urban teaching hospitals with a combined volume of 170 000 visits a year.

PARTICIPANTS

41 emergency medicine attending physicians.

INTERVENTION

Emergency medicine attending physicians underwent training and credentialing in the applications of aorta and pelvic ultrasound over a 9-month period.

OUTCOME MEASURE

After the credentialing period, we conducted a survey to evaluate the physicians' perceptions of this process.

RESULTS

There were 41 faculty members during the credentialing survey period. 11 of the faculty members were exempt from ultrasound training. We asked attending physicians (N=41 exempt and non-exempt) to complete a web-based survey after the completion of the credentialing period. Questions about the potential barriers and incentives were listed and responders were asked to rank answers on a five-point Likert scale. Of the 31 respondents, 21 (67.7%) completed the credentialing requirements by the 9-month deadline. 19 of 26 emergency medicine residency trained physicians completed the requirements compared with 2/5 of those that were not emergency medicine residency trained. Our pilot study data suggest an association between fewer years in practice and completion of the requirements.

CONCLUSIONS

This is a report on a single academic institution's experience with a faculty credentialing programme in bedside ultrasound for physicians with a diversity of prior experience in bedside ultrasonography. We describe the success of the credentialing process and identify survey-based faculty characteristics associated with fulfilling the requirements.

Performance of emergency physicians in point-of-care echocardiography following limited training

OBJECTIVES

The aim of this study was to evaluate if emergency medicine trainees with a short duration of training in echocardiography could perform and interpret bedside-focused echocardiography reliably on emergency department patients.

METHODS

Following a web-based learning module and 3 h of proctored practical training, emergency medicine trainees were evaluated in technical and interpretative skills in estimating left ventricular function, detection of pericardial effusion and inferior vena cava (IVC) diameter measurements using bedside-focused echocardiography on emergency department patients. An inter-rater agreement analysis was performed between the trainees and a board-certified cardiologist.

RESULTS

100 focused echocardiography examinations were performed by nine emergency medicine trainees. Agreement between the trainees and the cardiologist was 93% (K=0.79, 95% CI 0.773 to 0.842) for visual estimation of left ventricular function, 92.9% (K=0.80, 95% CI 0.636 to 0.882) for quantitative left ventricular ejection fraction by M-mode measurements, 98% (K=0.74, 95% CI 0.396 to 1.000) for the detection of pericardial effusion, and 64.2% (K=0.45, 95% CI 0.383 to 0.467) for IVC diameter assessment. The Bland-Altman limits of agreement for left ventricular function was -9.5% to 13.7%, and a Pearson's correlation yielded a value of 0.82 (p<0.0001, 95% CI 0.734 to 0.881). The trainees detected pericardial effusion with a sensitivity of 60%, specificity of 100%, positive predictive value of 100% and negative predictive value of 97.9%.

CONCLUSIONS

Emergency medicine trainees were found to be able to perform and interpret focused echocardiography reliably after a short duration of training.

Asynchronous web-based learning, a practical method to enhance teaching in emergency medicine

Abstract Objective: To compare medical knowledge acquisition among emergency medicine (EM) residents who attend weekly core content lectures with those absent but asynchronously viewing the same lectures in a Web-based electronic platform.

SUBJECTS AND METHODS

During the study period all EM residents attending or absent from weekly educational conferences were given a quiz on the covered material. During Phase 1, absentees were not given supplemental educational content for missed lectures. During Phase 2, absentees were sent a link to an online multimedia module containing an audiovisual recording of the actual missed lecture with presentation slides. Scores between attendees and absentees during both phases were compared using a repeated-measures analysis to evaluate the effect of the supplemental online module on knowledge acquisition.

RESULTS

Thirty-nine EM residents (equally distributed in postgraduate years 1-4) were studied during a 15-week period. Overall and after adjusting for sex and postgraduate year level, both lecture attendance (b=27; 95% confidence interval, 22-32; p<0.0001) and Web-based learning (b=32; 95% confidence interval, 26-37; p<0.0001) were associated with significant increases in test scores compared with residents who were absent and not receiving supplemental Web-based learning. Neither the self-perceived level of mastery with the lecture topic nor the amount of reported reading was found to be a predictor of test scores.

CONCLUSIONS

In an EM residency program, asynchronous Web-based learning may result in medical knowledge acquisition similar to or better than attending traditional core content lectures. The percentage of curriculum delivery by asynchronous learning that may be used to achieve overall terminal learning objectives in medical knowledge acquisition requires further study.