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Chatterji R, Foote J, Fry M, Erwin A, Crutcher J, Kesto W. Simulated subacromial injection instruction improves accuracy and skill level: a model for musculoskeletal procedural training. BMC MEDICAL EDUCATION 2024; 24:535. [PMID: 38745152 PMCID: PMC11094937 DOI: 10.1186/s12909-024-05456-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Musculoskeletal (MSK) complaints often present initially to primary care physicians; however, physicians may lack appropriate instruction in MSK procedures. Diagnostic and therapeutic injections are useful orthopedic tools, but inaccuracy leads to unnecessary costs and inadequate treatment. The authors hypothesized that trainees afforded the opportunity to practice on a cadaver versus those receiving visual-aided instruction on subacromial injections (SAI) will demonstrate differences in accuracy and technique. METHODS During Spring of the year 2022, 24 Internal Medicine and Family Medicine residents were randomly divided into control and intervention groups to participate in this interventional randomized cadaveric study. Each group received SAI instruction via lecture and video; the intervention group practiced on cadavers under mentored guidance. Subjects underwent a simulated patient encounter culminating in injection of latex dye into a cadaveric shoulder. Participants were evaluated based on a technique rubric, and accuracy of injections was assessed via cadaver dissection. RESULTS Twenty-three of twenty-four participants had performed at least one MSK injection in practice, while only 2 (8.3%) of participants had performed more than 10 SAIs. There was no difference in technique between control 18.4 ± 3.65 and intervention 19.2 ± 2.33 (p = 0.54). Dissections revealed 3 (25.0%) of control versus 8 (66.7%) of intervention injections were within the subacromial space. Chi-Square Analysis revealed that the intervention affected the number of injections that were within the subacromial space, in the tissues bordering the subacromial space, and completely outside the subacromial space and bordering tissues (p = 0.03). The intervention group had higher self-confidence in their injection as opposed to controls (p = 0.04). Previous SAI experience did not affect accuracy (p = 0.76). CONCLUSIONS Although primary care physicians and surgeons develop experience with MSK procedures in practice, this study demonstrates a role for early integrated instruction and simulation to improve accuracy and confidence. The goal of improving accuracy in MSK procedures amongst all primary care physicians may decrease costs and avoid unnecessary referrals, diagnostic tests, and earlier than desired surgical intervention.
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Affiliation(s)
- Rishi Chatterji
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA.
| | - Jake Foote
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Mike Fry
- Department of Orthopedic Surgery, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Ashley Erwin
- Department of Family Medicine, Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
| | - Joe Crutcher
- Simulation and Education Center Van Eslander Surgical Innovation Center, Ascension Providence Hospital - MSU, Novi, MI, USA
| | - William Kesto
- Ascension Providence Hospital - MSU, 16001 W. Nine Mile Rd., 4th Floor Fisher Building, Rm. #405, Southfield, MI, 48075, USA
- The Core Institute, Novi, MI, USA
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Aby ES, Lall D, Vasdev A, Mayer A, Olson APJ, Lim N. Rates of timely paracentesis for patients admitted to hospital with cirrhosis and ascites remain low but are unaffected by the COVID-19 pandemic. J Hosp Med 2022; 17:276-280. [PMID: 35535925 PMCID: PMC9088316 DOI: 10.1002/jhm.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
For the first 6 months of the novel coronavirus-19 (COVID-19) pandemic, the hospital medicine procedure service at our center was temporarily unavailable. We assessed paracentesis rates and clinical outcomes for patients admitted with cirrhosis and ascites before and during the COVID-19 pandemic. Two hundred and twenty-four and 131 patients with cirrhosis and ascited were admitted to hospital before and during COVID-19 respectively. Approximately 50.9% and 49.6% of patients underwent a paracentesis within 24 h pre- and mid-pandemic, p = .83. No differences were observed for length-of-stay or 30-day readmissions. GI consultation was associated with higher rates of paracentesis in both eras (p < .001 pre-COVID-19, and p = .01 COVID-19). Changes due to the COVID-19 pandemic did not result in changes to rates of timely paracentesis in patients admitted with cirrhosis and ascites. While involvement of gastroenterology may increase rates of paracentesis, further efforts are needed to optimize rates of timely paracentesis to positively impact clinical outcomes.
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Affiliation(s)
- Elizabeth S. Aby
- Division of Gastroenterology, Hepatology, and NutritionUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Drishti Lall
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Amrit Vasdev
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Adam Mayer
- University of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Andrew P. J. Olson
- Division of General Internal Medicine, Section of Hospital MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- Division of Pediatric Hospital MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Nicholas Lim
- Division of Gastroenterology, Hepatology, and NutritionUniversity of MinnesotaMinneapolisMinnesotaUSA
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Carstensen SMD, Velander MJ, Konge L, Østergaard M, Pfeiffer Jensen M, Just SA, Terslev L. Training and assessment of musculoskeletal ultrasound and injection skills-a systematic review. Rheumatology (Oxford) 2022; 61:3889-3901. [PMID: 35218339 DOI: 10.1093/rheumatology/keac119] [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: 12/17/2021] [Revised: 02/17/2022] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Stine M D Carstensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Marie Juul Velander
- Section of Rheumatology, Department of Medicine, Svendborg Hospital-OUH Baagøes Allé 15, Svendborg, Denmark
| | - Lars Konge
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mogens Pfeiffer Jensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Søren Andreas Just
- Section of Rheumatology, Department of Medicine, Svendborg Hospital-OUH Baagøes Allé 15, Svendborg, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet Glostrup Valdemar Hansens Vej 17, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Bretagne V, Delapierre A, Cerasuolo D, Bellot A, Marcelli C, Guillois B. Randomized Controlled Study of a Training Program for Knee and Shoulder Arthrocentesis on Procedural Simulators with Assessment on Cadavers. ACR Open Rheumatol 2022; 4:312-321. [PMID: 34989181 PMCID: PMC8992473 DOI: 10.1002/acr2.11400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis. Methods Two groups of 15 medical students were each trained to perform a single joint arthrocentesis (“knee group” and “shoulder group”) on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered “competent on the cadaver” if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study. Results Twenty‐two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver’s knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver’s shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students’ confidence level in arthrocentesis increased significantly during the study, as did the students’ theoretical knowledge. Conclusion Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
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