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Grubic N, Belliveau DJ, Herr JE, Nihal S, Wong SWS, Lam J, Gauthier S, Montague SJ, Durbin J, Mulvagh SL, Johri AM. Training of Non-expert Users Using Remotely Delivered, Point-of-Care Tele-Ultrasound: A Proof-of-Concept Study in 2 Canadian Communities. Ultrasound Q 2023; 39:118-123. [PMID: 36197076 DOI: 10.1097/ruq.0000000000000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Many physicians, particularly those practicing in remote regions, lack training opportunities to develop point-of-care ultrasound (POCUS) skills. This pretest-posttest study quantified the skill improvement of learners after participating in a virtual training program that used real-time, remotely delivered point-of-care tele-ultrasound (tele-POCUS) for teaching and learner feedback provision. Ten physicians practicing in an urban tertiary (Kingston, Ontario, Canada, n = 6) or remote care center (Moose Factory, Ontario, Canada, n = 4) completed a 3-week educational program that consisted of e-learning module review, independent image acquisition practice, and expert-guided tele-POCUS consultations. Pretraining and posttraining assessments were performed to evaluate skill enhancement in image acquisition, image quality, and image interpretation for cardiac and lung/pleura POCUS using a 5-point Likert scale. A total of 76 tele-POCUS consultations were performed during the study period. Significant improvements in image quality were noted following remotely delivered mentorship and guidance (all P < 0.01). In cardiac POCUS, pretraining and posttraining comparisons noted significant improvements in image acquisition (means, 2.69-4.33; P < 0.02), quality (means, 2.40-4.03; P < 0.01), and interpretation (means, 2.50-4.40; P < 0.02). In lung/pleura POCUS, significant improvements in image acquisition (means, 3.00-4.43; P < 0.01), quality (means, 3.23-4.37; P < 0.01), and interpretation (means, 3.00-4.40; P < 0.01) were demonstrated. Introductory ultrasound can be taught to novice users using a virtual, live-streamed training format with tele-POCUS while demonstrating significant enhancement in imaging skills.
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Affiliation(s)
| | | | | | - Salwa Nihal
- Medicine, Queen's University, Kingston, Ontario
| | | | - Jeffrey Lam
- Medicine, Queen's University, Kingston, Ontario
| | | | | | | | - Sharon L Mulvagh
- Department of Medicine, Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Weimer J, Rolef P, Müller L, Bellhäuser H, Göbel S, Buggenhagen H, Weimer A, Waezsada E, Kirchhoff F, Weinmann-Menke J. FoCUS cardiac ultrasound training for undergraduates based on current national guidelines: a prospective, controlled, single-center study on transferability. BMC MEDICAL EDUCATION 2023; 23:80. [PMID: 36726093 PMCID: PMC9893662 DOI: 10.1186/s12909-023-04062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In emergency and critical-care medicine, focused cardiac ultrasound (FoCUS) is indispensable for assessing a patient's cardiac status. The aim of this study was to establish and validate a peer-to-peer-supported ultrasound course for learning FoCUS-specific skills during undergraduate studies at a German university. METHODS A 1-day, 12 teaching units training course was developed for students in the clinical section of medical college, with content based on the current national guidelines. A total of 217 students participated in the study (97 in the course group and 120 in the control group). The course and the participants' subjective assessment of improved skills were evaluated using a questionnaire (7-point Likert scale; 7 = complete agreement and 1 = no agreement at all). Objective learning gains were assessed by tests before and after the course. These consisted of a test of figural intelligence (eight items) and a test of technical knowledge (13 items). RESULTS The course participants experienced significant improvement (P < 0.001) from before to after the course, with a large effect size of η2part = 0.26. In addition, the course group had significantly better results (P < 0.001) than the control group in the post-test, with a medium to large effect size of η2part = 0.14. No significant differences (P = 0.27) were detected in the test section on figural intelligence. The evaluations showed that the participants had a high degree of satisfaction with the course approach, teaching materials, and tutors. There was also a positive increase in their subjective assessment of their own skills, including areas such as technical knowledge, ultrasound anatomy, and performance of the examination. CONCLUSION The results of both the objective learning assessment and the subjective evaluations suggest that a FoCUS course originally intended for qualified physicians is equally suitable for students. With the development and provision of modern digital teaching media, even more students will be able to benefit from this approach in the future.
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Affiliation(s)
- Johannes Weimer
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Peter Rolef
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University of Mainz, Mainz, Germany
| | - Henrik Bellhäuser
- Institute of Psychology, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Sebastian Göbel
- Department of Medicine II, Cardiology Center, Department of Medicine, University of Mainz, Mainz, Germany
| | - Holger Buggenhagen
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Andreas Weimer
- Center for Orthopedics, Emergency Surgery, and Paraplegics, Department of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Elias Waezsada
- Department of Cardiology, Kerckhoff Hospital, Bad Nauheim, Germany
| | - Friederike Kirchhoff
- Rudolf-Frey Lernklinik, Department of Medicine, University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Julia Weinmann-Menke
- Department of Medicine I, Nephrology Center, Department of Medicine, University of Mainz, Mainz, Germany
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Nazari E, Tajani ZB, Maroufizadeh S, Ghorbani M, Rad AH, Badeli H. The effect of short-course point-of-care echocardiography training on the performance of medical interns in children. PLoS One 2022; 17:e0278173. [PMID: 36520779 PMCID: PMC9754179 DOI: 10.1371/journal.pone.0278173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) can add complementary information to physical examination. Despite its development in several medical specialties, there is a lack of similar studies on children by medical interns and cardiologists. Therefore, investigators aimed to assess the effect of short-course training on the performance of medical interns in point-of-care echocardiography in children. METHODS This analytic cross-sectional study was conducted on 161 hospitalized children in 17 Shahrivar children's hospital, Iran, from January 2021 to May 2021. Seven interns (trainees) participated in a short course of point-of-care echocardiography to assess left ventricular ejection fraction (LVEF), inferior vena cava collapsibility index (IVCCI), and the presence of pericardial effusion (PEff). Each patient underwent point-of-care echocardiography by one of the trainees. Then, in less than one hour, the echocardiography was performed by a single cardiologist. Agreement between the cardiologist and trainees was examined using Cohen's kappa coefficient and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK). For numerical variables, the agreement was examined using the concordance correlation coefficient (CCC) and intraclass correlation coefficient (ICC). RESULTS Results showed that the cardiologist and trainees detected LVEF >50, IVCCI >50%, and the absence of PEff in most of the participants. A good agreement in terms of ICC and CCC for LVEF (0.832 and 0.831, respectively) and a good agreement in terms of ICC and CCC for IVCCI (0.878 and 0.877, respectively) were noted. Using categorical scoring of LVEF and IVCCI showed 94.4% and 87.6% complete agreement, respectively. Furthermore, using categorical scoring of LVEF and IVCCI, Cohen's kappa coefficient was 0.542 (moderate) and 0.619 (substantial), respectively. The PABAK for LVEF and IVCCI were 0.886 (almost perfect) and 0.752 (substantial), respectively. For PEff, Cohen's kappa and PABAK were 0.797 (moderate) and 0.988 (almost perfect), respectively, and the complete agreement was noted in 160 patients (99.4%). CONCLUSIONS This study showed that a short teaching course could help medical interns to assess LVEF, IVCCI, and PEff in children. Therefore, it seems that adding this course to medical interns' curricula can be promising.
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Affiliation(s)
- Esfandiar Nazari
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Bahman Tajani
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Saman Maroufizadeh
- Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Ghorbani
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Afagh Hassanzadeh Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamidreza Badeli
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
- * E-mail:
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Jujo S, Sakka BI, Lee-Jayaram JJ, Kataoka A, Izumo M, Kusunose K, Nakahira A, Oikawa S, Kataoka Y, Berg BW. Medical student medium-term skill retention following cardiac point-of-care ultrasound training based on the American Society of Echocardiography curriculum framework. Cardiovasc Ultrasound 2022; 20:26. [PMID: 36224597 PMCID: PMC9554392 DOI: 10.1186/s12947-022-00296-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background No studies have demonstrated medium- or long-term skill retention of cardiac point-of-care ultrasound (POCUS) curriculum for medical student. Based on the American Society of Echocardiography (ASE) curriculum framework, we developed a blended-learning cardiac POCUS curriculum with competency evaluation. The objective of this study was to investigate the curriculum impact on image acquisition skill retention 8 weeks after initial training. Methods This study was a prospective, pre-post education intervention study for first- and second-year medical students, with blinded outcome assessment. The curriculum included a pre-training ASE online module and healthy volunteer hands-on training to obtain 5 views: parasternal long-axis (PLAX), parasternal short-axis (PSAX), apical 4-chamber (A4C), subcostal 4-chamber (S4C), and subcostal inferior vena cava (SIVC) views. Students took 5-view image acquisition skill tests at pre-, immediate post-, and 8-week post-training, using a healthy volunteer. Three blinded assessors rated the image quality using a validated 10-point maximum scoring system. Students used a hand-held ultrasound probe (Butterfly iQ). Results Fifty-four students completed hands-on training, and pre- and immediate post-training skill tests. Twenty-seven students completed 8-week post-training skill tests. Skill test score improvement between pre- and 8-week post-training was 2.11 points (95% CI, 1.22–3.00; effect size, 1.13). Conclusion The cardiac POCUS curriculum demonstrated medium-term skill retention. The curriculum was sufficient for S4C and SIVC skill retention, but inadequate for PLAX, PSAX, and A4C. Therefore, instructional design modifications or re-training for PLAX, PSAX, and A4C are needed to make the curriculum more effective for clinically relevant skill retention.
Supplementary Information The online version contains supplementary material available at 10.1186/s12947-022-00296-z.
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Affiliation(s)
- Satoshi Jujo
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA. .,Department of Anesthesiology, Kameda Medical Center, Chiba, Japan.
| | - Brandan I Sakka
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
| | - Jannet J Lee-Jayaram
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Atsushi Nakahira
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA.,Division of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Japan
| | - Sayaka Oikawa
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA.,Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Benjamin W Berg
- SimTiki Simulation Center, John A. Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo St, MEB 212, Honolulu, HI, 96813, USA
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Karimpour K, Brenner RJ, Dong GZ, Cleve J, Martina S, Harris C, Graf GJ, Kistler BJ, Hoang AH, Jackson O, Papadopoulou V, Tillmans F. Comparison of Newer Hand-Held Ultrasound Devices for Post-Dive Venous gas Emboli Quantification to Standard Echocardiography. Front Physiol 2022; 13:907651. [PMID: 35755430 PMCID: PMC9222333 DOI: 10.3389/fphys.2022.907651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Decompression sickness (DCS) can result from the growth of bubbles in tissues and blood during or after a reduction in ambient pressure, for example in scuba divers, compressed air workers or astronauts. In scuba diving research, post-dive bubbles are detectable in the venous circulation using ultrasound. These venous gas emboli (VGE) are a marker of decompression stress, and larger amounts of VGE are associated with an increased probability of DCS. VGE are often observed for hours post-dive and differences in their evolution over time have been reported between individuals, but also for the same individual, undergoing a same controlled exposure. Thus, there is a need for small, portable devices with long battery lives to obtain more ultrasonic data in the field to better assess this inter- and intra-subject variability. We compared two new handheld ultrasound devices against a standard device that is currently used to monitor post-dive VGE in the field. We conclude that neither device is currently an adequate replacement for research studies where precise VGE grading is necessary.
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Affiliation(s)
- Kamellia Karimpour
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | | | | | - Jayne Cleve
- Divers Alert Network, Durham, NC, United States
| | | | | | | | | | - Andrew H Hoang
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
| | | | - Virginie Papadopoulou
- Joint Department of Biomedical Engineering, The University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, United States
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