1
|
Clayton L, Wells M, Alter S, Solano J, Hughes P, Shih R. Educational concepts: A longitudinal interleaved curriculum for emergency medicine residency training. J Am Coll Emerg Physicians Open 2024; 5:e13223. [PMID: 38903766 PMCID: PMC11187808 DOI: 10.1002/emp2.13223] [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: 05/17/2023] [Revised: 05/14/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
Traditionally, emergency medicine (EM) residency programs teach non-adult emergency department activities (such as pediatric EM, point-of-care ultrasound [PoCUS], emergency medical services, and others) in a block format. In this way, a resident may have a 1-month pediatric EM rotation and then not have any further pediatric EM exposure until their next pediatric rotation 6‒9 months later. Furthermore, some rotations are only allotted for 1-month during the entire residency. A first-year EM resident may have their only formal PoCUS rotation early in the first year of training when their overall skills are developing, and their level of understanding and retention of information may not be optimal at that juncture of their residency training. This is far from ideal from an educational perspective. Learning scientists have now suggested that a longitudinal interleaved curriculum has substantial advantages over the traditional block format. This curriculum allows for a "spaced retrieval" practice that enhances retention of material and develops thinking processes that are important in clinical practice. The increased continuity of clinical experience has been shown to improve educational outcome and learner satisfaction. We developed a novel longitudinal interleaved curriculum for our EM resident trainees. This curriculum encompasses the entire 3 years of residency training and has the goals of increasing EM knowledge and clinical skills and being excellent preparation for board certification examinations. This concept has clear educational benefits. While adapting an existing medical training program would be challenging, a longitudinal curriculum could be phased in to replace a traditional EM curriculum.
Collapse
Affiliation(s)
- Lisa Clayton
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Emergency MedicineDelray Medical CenterDelray BeachFloridaUSA
- Department of Emergency MedicineBethesda Hospital EastBethesdaMarylandUSA
| | - Mike Wells
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - Scott Alter
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Emergency MedicineDelray Medical CenterDelray BeachFloridaUSA
- Department of Emergency MedicineBethesda Hospital EastBethesdaMarylandUSA
| | - Joshua Solano
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Emergency MedicineDelray Medical CenterDelray BeachFloridaUSA
- Department of Emergency MedicineBethesda Hospital EastBethesdaMarylandUSA
| | - Patrick Hughes
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Emergency MedicineDelray Medical CenterDelray BeachFloridaUSA
- Department of Emergency MedicineBethesda Hospital EastBethesdaMarylandUSA
| | - Richard Shih
- Department of Emergency MedicineCharles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
- Department of Emergency MedicineDelray Medical CenterDelray BeachFloridaUSA
- Department of Emergency MedicineBethesda Hospital EastBethesdaMarylandUSA
| |
Collapse
|
2
|
Müller-Wirtz LM, Patterson WM, Ott S, Brauchle A, Meiser A, Volk T, Berwanger U, Conrad D. Teaching Medical Students Rapid Ultrasound for shock and hypotension (RUSH): learning outcomes and clinical performance in a proof-of-concept study. BMC MEDICAL EDUCATION 2024; 24:360. [PMID: 38566149 PMCID: PMC10988853 DOI: 10.1186/s12909-024-05331-3] [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: 01/19/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a critical diagnostic tool in various medical settings, yet its instruction in medical education is inconsistent. The Rapid Ultrasound for Shock and Hypotension (RUSH) protocol is a comprehensive diagnostic tool, but its complexity poses challenges for teaching and learning. This study evaluates the effectiveness of a single-day training in RUSH for medical students by assessing their performance in clinical scenarios. METHODS In this prospective single-center observational proof-of-concept study, 16 medical students from Saarland University Medical Center underwent a single-day training in RUSH, followed by evaluations in clinical settings and on a high-fidelity simulator. Performance was assessed using a standardized scoring tool and time to complete the RUSH exam. Knowledge gain was measured with pre- and post-training written exams, and diagnostic performance was evaluated with an objective structured clinical examination (OSCE). RESULTS Students demonstrated high performance in RUSH exam views across patients (median performance: 85-87%) and improved scanning times, although not statistically significant. They performed better on simulators than on live patients. Written exam scores significantly improved post-training, suggesting a gain in theoretical knowledge. However, more than a third of students could not complete the RUSH exam within five minutes on live patients. CONCLUSIONS Single-day RUSH training improved medical students' theoretical knowledge and simulator performance but translating these skills to clinical settings proved challenging. The findings suggest that while short-term training can be beneficial, it may not suffice for clinical proficiency. This study underscores the need for structured and possibly longitudinal training programs to ensure skill retention and clinical applicability.
Collapse
Affiliation(s)
- Lukas Martin Müller-Wirtz
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany.
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany.
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA.
| | - William M Patterson
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Sascha Ott
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Annika Brauchle
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Andreas Meiser
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - Thomas Volk
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
- Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, 44195, Cleveland, OH, USA
| | - Ulrich Berwanger
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| | - David Conrad
- Saarland University, Anaesthesiology, 66424, Homburg, Saarland, Germany
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Center, 66424, Homburg, Saarland, Germany
| |
Collapse
|
3
|
Vasudeva R, Challa A, Chaaban N, Shah H, Brumfield E, Duran B, Vindhyal M. Cardiac POCUS: Another Tool in the Armory. Kans J Med 2023; 16:172-175. [PMID: 37539370 PMCID: PMC10395770 DOI: 10.17161/kjm.vol16.19802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/05/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction This study assessed the educational impact of hybrid cardiac Point of Care Ultrasonography (POCUS) training in a community-based academic setting. Methods Internal Medicine and Medicine/Pediatrics residents across all post-graduate years (PGY) at a midwestern medical school under-took a structured hybrid (online and hands-on teaching) model of POCUS training. Anonymous surveys with Likert-type scale responses were administered before and after the curriculum. Questions were categorized into domains to assess the residents' interest in learning POCUS, their understanding of fundamental cardiac ultrasound (US) concepts, and their confidence in its application. The authors used Fisher's Exact and t-test, and estimated odds ratios to gauge the impact of the training to achieve net scores above 0 on each domain. Results A total of 27 and 26 residents completed the pre-and post-training surveys, respectively. Experience with previous cardiac US use showed a positive skew. The training resulted in a significant increase in both, the understanding of the principles, and the residents' confidence in its application. These findings were most significant amongst PGY 2 and 3 residents. Post-training mean scores were similar across all domains for subgroups of PGY level and previous ultrasound experience. Conclusions Residents displayed greater understanding of the fundamental cardiac ultrasound concepts with improved confidence levels after implementing a structured hybrid teaching model for POCUS. Future studies with objective assessment tools are needed to gauge the clinical impact of POCUS and its adoption rate in clinical practice to guide a recommendation for its incorporation into the residency curriculum.
Collapse
Affiliation(s)
- Rhythm Vasudeva
- Internal Medicine/Pediatrics Residency Program, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Abhiram Challa
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Nourhan Chaaban
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Hamna Shah
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elisha Brumfield
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Brent Duran
- Internal Medicine/Pediatrics Residency Program, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Mohinder Vindhyal
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
4
|
Anstey J, Jensen T, Lalani F, Conner SM. Teaching the Teachers: A Flexible, Cognitive-Focused Curriculum in Point-of-Care Ultrasound Education for Hospital Medicine Faculty. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3103-3111. [PMID: 36063066 DOI: 10.1002/jum.16091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We aimed to decrease barriers to acquiring Point-of-Care Ultrasound (POCUS) knowledge among attending physicians and improve the safety of trainee POCUS use through a novel flexible and cognitive based curriculum. METHODS We developed three educational pathways using varied approaches to educational delivery: a novel and asynchronous cognitive curriculum to allow Educational Supervision, a hands-on pathway for Limited Practice, and a more robust pathway for Independent Practice and credentialing. RESULTS From November 2018 through June 2021, 102 of 116 hospitalists engaged in some portion of the curriculum. Twenty-four completed the Educational Supervision pathway, 31 completed the Limited Practice pathway, and 17 enrolled in the Independent Practice pathway with three achieving independent practice. Faculty who completed the Educational Supervision pathway had improved scores on a comprehensive POCUS knowledge assessment, 43.5% [95% Confidence Interval (CI) 38.2-48.8] versus 72.0% [95% CI 65.2-78.8], P < .001. Junior faculty were more likely to engage in the supervision pathway and senior faculty were more likely to complete an intensive course to complete the Limited Practice pathway. CONCLUSIONS A flexible, cognitive focused POCUS curriculum was effective in creating high levels of engagement, and a cognitive only curriculum resulted in significant improvement in hospitalists' POCUS knowledge without hands on training. Finally, we found that hospitalist engagement in the curriculum did not follow the lowest barrier to entry or time commitment and engagement varied by time in practice. Training faculty to independent practice remains a substantial challenge.
Collapse
Affiliation(s)
- James Anstey
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Trevor Jensen
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Farhan Lalani
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
- Department of Medicine, Division of Hospital Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stephanie McCarty Conner
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
5
|
Ngo QN, Chorley A, Li S, Chan TM. Learning pediatric emergency medicine over time: A realist evaluation of a longitudinal pediatric emergency medicine clinical experience. AEM EDUCATION AND TRAINING 2022; 6:e10822. [PMID: 36518231 PMCID: PMC9731310 DOI: 10.1002/aet2.10822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Emergency medicine (EM) practitioners must be proficient at caring for patients of all ages, including pediatric patients. Traditionally, EM trainees learn pediatric emergency medicine (PEM) through block rotations. This is problematic due to the seasonal nature of pediatric diseases and infrequent critical events. Spaced repetition learning theory suggests PEM would be better learned through longitudinal rotations. The transition to competency-based medical education (CBME) in Canada is accelerating the need to find novel ways to attain competencies in postgraduate training. At McMaster University, senior EM trainees can choose either traditional PEM blocks or longitudinal rotations. Our objective was to understand how learners experience these different rotations given the transition to CBME in Canada. METHODS Using a realist framework of program evaluation, we conducted semistructured interviews with key stakeholders (trainees, program directors, attending physicians) in EM. The realist framework was used to understand how context interacts with theoretical mechanisms to produce outcomes of interest. Data were analyzed using inductive, conventional content analysis. All investigators coded a subset of transcripts independently and in duplicate to achieve intercoder agreement. RESULTS A total of 13 interviews were completed with trainees (n = 11) and staff physicians (n = 2). The learning experience exists within an educational and clinical context, which are logistically distinct but inseparable. The longitudinal learning experience appears to improve learning through spaced repetition, which prevents atrophy of skills and knowledge while also benefitting from the offsetting of seasonal variability associated with many pediatric diseases. Improved feedback and entrustment are facilitated through the building of coaching relationships over time. Barriers to the learning experience are related mainly to logistical difficulties associated with resolving longitudinal and blocked learning experiences. Improved relationships with the interprofessional team may provide distinct learning opportunities and improved team functioning. Block rotations were identified as more valuable to junior trainees learning fundamental concepts. CONCLUSIONS Longitudinal learning provides numerous advantages to learning PEM, including increased case variety, spaced repetition of core concepts, and a perception of greater entrustment of the learner through formation of coaching relationships over time. Future projects looking to quantify the differences between longitudinal and block learning to objectively show a difference in skills and knowledge are needed.
Collapse
Affiliation(s)
- Quang N. Ngo
- Division of Pediatric Emergency Medicine, Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Alex Chorley
- Division of Pediatric Emergency Medicine, Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
- McMaster Education Research, Innovation, and Theory, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Shelly‐Anne Li
- Department of Family & Community MedicineToronto Western Hospital, University Health NetworkTorontoOntarioCanada
| | - Teresa M. Chan
- McMaster Education Research, Innovation, and Theory, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
- Division of Emergency Medicine, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Division of Education & Innovation, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Office of Continuing Professional Development, Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| |
Collapse
|
6
|
Development of a Point-of-Care Ultrasound Track for Internal Medicine Residents. J Gen Intern Med 2022; 37:2308-2313. [PMID: 35713808 PMCID: PMC9205286 DOI: 10.1007/s11606-022-07505-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/23/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) training has been increasing among internal medicine (IM) residency programs, but few programs can provide longitudinal training due to barriers such as lack of trained faculty. AIM Describe the development of a longitudinal POCUS track for IM residents using local and external resources, including a national POCUS certificate program. SETTING University-based IM residency program affiliated with a public and veterans affairs hospital. PARTICIPANTS Twelve IM residents from 2018 to 2021. PROGRAM DESCRIPTION Residents complete a national POCUS certificate program by attending live courses and completing online modules, an image portfolio, and final knowledge/skills assessments. Locally, residents participate in 1-month procedure and diagnostic POCUS rotations and provide peer-to-peer POCUS teaching of residents and medical students. PROGRAM EVALUATION The POCUS track increased residents' use and comfort with diagnostic and procedural applications. All residents rated being satisfied or very satisfied with the track and would recommend it to prospective applicants (100%). The most commonly reported barriers to utilizing POCUS per residents were time constraints (83%), lack of available ultrasound equipment (83%), and lack of trained faculty (58%). DISCUSSION IM residency programs with limited faculty expertise in POCUS can leverage external resources to provide longitudinal POCUS training to its residents.
Collapse
|
7
|
LoPresti CM, Schnobrich D, Novak W, Fondahn E, Bardowell R, O'Connor AB, Uthlaut B, Ortiz J, Soni NJ. Current Point of Care Ultrasound Use and Training Among Internal Medicine Residency Programs from the 2020 APDIM Program Director's Survey. Am J Med 2022; 135:397-404. [PMID: 34890562 DOI: 10.1016/j.amjmed.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/17/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Charles M LoPresti
- Section of Acute Medicine, Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Daniel Schnobrich
- Department of General Internal Medicine, University of Minnesota School of Medicine, Minneapolis
| | - William Novak
- Department of Medicine, University of Rochester School of Medicine and Dentistry, NY
| | - Emily Fondahn
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Rachel Bardowell
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Alec B O'Connor
- Department of Medicine, University of Rochester School of Medicine and Dentistry, NY
| | - Brian Uthlaut
- Department of Medicine, University of Virginia Health System, Charlottesville
| | - Jordan Ortiz
- Alliance for Academic Internal Medicine, Alexandria, Va
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Tex
| |
Collapse
|
8
|
Toffoli A, Hartnett L, Mattick A, Goudie A. Credentialing of emergency medicine trainees in point-of-care ultrasound: An effective, efficient and enjoyable model. Emerg Med Australas 2021; 33:473-479. [PMID: 33084242 DOI: 10.1111/1742-6723.13657] [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: 07/07/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The Australasian College for Emergency Medicine Curriculum Framework contains numerous mentions of point-of-care ultrasound (PoCUS). However, obtaining formal PoCUS credentials is often problematic. The Fiona Stanley Hospital ED PoCUS training programme was devised to assist emergency medicine trainees to meet the credentialing requirements of the Australasian College for Emergency Medicine and the Australasian Society for Ultrasound in Medicine. METHODS Six emergency medicine registrars are selected for each 6-month semester. Successful applicants nominate two modules of Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound and receive dedicated non-clinical time. For 3 h a week, an emergency physician holding formal PoCUS credentials supervises a pair of trainees while they perform scans on ED patients. During these sessions, trainee logbooks can be reviewed and assessments occur as required by the module. RESULTS Over an 18-month period, 18 emergency registrars were involved, averaging eight 3-h sessions each. All selected the Extended Focused Abdominal Scan for Trauma module, 14 chose Abdominal Aortic Aneurysm and eight chose Basic Echo in Life Support. Overall, 30 (75%) of 40 modules were completed within the trainees' 6-month semester. Just under half of logged scans were obtained during the supervised sessions. Overall, the average number of scans performed exceeded each module's logbook requirements. Trainees perceived that involvement in the programme benefited their ability to manage patients. There was overwhelming support for the structure of the programme. CONCLUSIONS The Fiona Stanley Hospital ED model is effective in assisting emergency medicine trainees to gain formal PoCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many EDs around Australia and New Zealand.
Collapse
Affiliation(s)
- Andrew Toffoli
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Leanne Hartnett
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Anthony Mattick
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|
9
|
Bauman B, Kernahan P, Weinhaus A, Walker MJ, Irwin E, Sundin A, Yerxa D, Vakayil V, Harmon JV. An Interprofessional Senior Medical Student Preparation Course: Improvement in Knowledge and Self-Confidence Before Entering Surgical Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:441-451. [PMID: 33994822 PMCID: PMC8112855 DOI: 10.2147/amep.s287430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE Senior medical students are variably prepared to begin surgical training; and a national curriculum was established through the American College of Surgeons to better prepare senior medical students for surgical training. The purpose of our course is to prepare senior medical students to more effectively enter surgical training programs. We recently enhanced our independently developed surgical training preparation course by increasing exposure to surgical anatomy, medical physiology, surgical skills, and point-of-care ultrasound. We evaluated the impact of our interprofessional training course to increase confidence and readiness among senior medical students entering surgical training. METHODS The course focused on pre- and post-operative patient care, surgical anatomy, human physiology, and bedside ultrasound. Didactic lectures in anatomy, human physiology, and bedside ultrasound were provided prior to all hands-on simulated patient care sessions and mock surgical procedures. To evaluate our interprofessional curriculum, we administered pre- and post-course surveys, pre- and post-course knowledge tests, and a final surgical anatomy laboratory practical examination to 22 senior medical students who were enrolled in the course. All students created a final surgical anatomy presentation. RESULTS The students demonstrated a 100% pass rate in surgical anatomy. The knowledge test, which included assessment of knowledge on perioperative surgical decision making, human physiology, and bedside ultrasound, demonstrated an average improvement of 10%. Statistically significant improvements in median confidence values were identified in 10 of 32 surveyed categories, including surgical skills (p < 0.05); 84% of student goals for the course were achieved. The medical students' surveys confirmed increased confidence related to the use of point-of-care ultrasound, teamwork experience, and basic surgical skills through small group interactive seminars and surgical simulation exercises. CONCLUSION Our preparation for surgical training course resulted in high student satisfaction and demonstrated an increased sense of confidence to begin surgical training. The 10% improvement in medical student knowledge, as evaluated by a written examination, and the significant improvement in confidence level self-assessment scores confirms this surgery preparation course for senior medical students successfully achieved the desired goals of the course.
Collapse
Affiliation(s)
- Brent Bauman
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Peter Kernahan
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA
| | - Anthony Weinhaus
- Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA
| | - Michael J Walker
- Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA
| | - Eric Irwin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Sundin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Derek Yerxa
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Victor Vakayil
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - James V Harmon
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Program in Human Anatomy, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
10
|
Situ-LaCasse E, Acuña J, Huynh D, Amini R, Irving S, Samsel K, Patanwala AE, Biffar DE, Adhikari S. Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules? BMC MEDICAL EDUCATION 2021; 21:175. [PMID: 33743680 PMCID: PMC7980807 DOI: 10.1186/s12909-021-02612-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/11/2021] [Indexed: 06/01/2023]
Abstract
BACKGROUND Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors, and with COVID-19, another challenge is the difficulty with social distancing between learners and educators. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules. METHODS This was a prospective study evaluating first-year medical students. Medical students were asked to complete four SonoSim® online modules (aorta/IVC, cardiac, renal, and superficial). They were subsequently asked to perform ultrasound examinations on standardized patients utilizing the learned techniques/skills in the online modules. Emergency Ultrasound-trained physicians evaluated medical students' sonographic skills in image acquisition quality, image acquisition difficulty, and overall performance. Data are presented as means and percentages with standard deviation. All P values are based on 2-tailed tests of significance. RESULTS Total of 44 medical students participated in the study. All (100%) students completed the hands-on skills evaluation with a median score of 83.7% (IQR 76.7-88.4%). Thirty-three medical students completed all the online modules and quizzes with median score of 87.5% (IQR 83.8-91.3%). There was a positive association between module quiz performance and the hands-on skills performance (R-squared = 0.45; p < 0.001). There was no statistically significant association between module performance and hands-on performance for any of the four categories individually. In all four categories, the evaluators' observation of the medical students' difficulty obtaining views correlated with hands-on performance scores. CONCLUSIONS Our study findings suggest that ultrasound-naïve medical students can develop basic hands-on skills in image acquisition after reviewing online modules.
Collapse
Affiliation(s)
- Elaine Situ-LaCasse
- University of Arizona, College of Medicine & Banner University Medical Center - Tucson, Department of Emergency Medicine, PO Box 245057, Tucson, AZ 85724 USA
| | - Josie Acuña
- University of Arizona, College of Medicine & Banner University Medical Center - Tucson, Department of Emergency Medicine, PO Box 245057, Tucson, AZ 85724 USA
| | - Dang Huynh
- Tucson Medical Center, Department of Emergency Medicine, Tucson, AZ USA
| | - Richard Amini
- College of Medicine, Department of Emergency Medicine, University of Arizona, Tucson, AZ USA
| | | | - Kara Samsel
- Department of Emergency Medicine, Texas Tech University Health Sciences Center, El Paso, TX USA
| | | | - David E. Biffar
- Arizona Simulation Technology and Education Center – University of Arizona Health Sciences, Tucson, AZ USA
| | - Srikar Adhikari
- College of Medicine, Department of Emergency Medicine, University of Arizona, Tucson, AZ USA
| |
Collapse
|
11
|
Schott CK, LoPresti CM, Boyd JS, Core M, Haro EK, Mader MJ, Pascual S, Finley EP, Lucas BP, Colon-Molero A, Restrepo MI, Pugh J, Soni NJ. Retention of Point-of-Care Ultrasound Skills Among Practicing Physicians: Findings of the VA National POCUS Training Program. Am J Med 2021; 134:391-399.e8. [PMID: 32931765 DOI: 10.1016/j.amjmed.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/07/2020] [Accepted: 08/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier among practicing physicians. Many physicians are obtaining POCUS training through postgraduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. METHODS Course participants' POCUS knowledge and hands-on technical skills were tested pre-course using an online, 30-question knowledge test and a directly observed skills test, respectively. The same knowledge and skills tests were repeated immediately post-course and after 6-9 months using remote tele-ultrasound software. Course participants completed a survey on their POCUS use pre-course and after 6-9 months post-course. RESULTS There were 127 providers who completed the POCUS training course from October 2016 to November 2017. Knowledge test scores increased from a median of 60% to 90% immediately post-course followed by a slight decrease to 87% after 8 months post-course. Median skills test scores for 4 common POCUS applications (heart, lung, abdomen, vascular access) increased 36-74 points from pre-course to immediately post-course with a 2-7-point decrease after 8 months. Providers reported more frequent POCUS use post-course, which suggests application of their POCUS knowledge and skills in clinical practice. More frequent use of cardiac POCUS applications was associated with significantly greater retention of cardiac skills at 8 months. CONCLUSIONS Practicing physicians can retain POCUS knowledge and hands-on skills 8 months after participating in a 2.5-day POCUS training course, regardless of frequency of POCUS use post-course.
Collapse
Affiliation(s)
- Christopher K Schott
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care System, Pittsburgh, Pa; Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center (UPMC), Pa.
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Ohio; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jeremy S Boyd
- Department of Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville; Department of Emergency Medicine, Vanderbilt University, Nashville, Tenn
| | - Megan Core
- Department of Emergency Medicine Service, Orlando Veterans Affairs Medical Center, Fla; Department of Medicine, University of Central Florida College of Medicine, Orlando
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Michael J Mader
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | | | - Erin P Finley
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vt; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Angel Colon-Molero
- VHA Specialty Care Service, Veterans Affairs Central Office (VACO), Washington, DC
| | - Marcos I Restrepo
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Jacqueline Pugh
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, Texas
| |
Collapse
|
12
|
Brant JA, Orsborn J, Good R, Greenwald E, Mickley M, Toney AG. Evaluating a longitudinal point-of-care-ultrasound (POCUS) curriculum for pediatric residents. BMC MEDICAL EDUCATION 2021; 21:64. [PMID: 33468138 PMCID: PMC7816421 DOI: 10.1186/s12909-021-02488-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/01/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND POCUS is a growing field in medical education, and an imaging modality ideal for children given the lack of ionizing radiation, ease of use, and good tolerability. A 2019 literature review revealed that no US pediatric residency programs integrated obligatory POCUS curricula. Our objective was to provide a formalized POCUS curriculum over multiple years, and to retrospectively assess improvement in resident skills and comfort. METHODS During intern year, pediatric residents received didactics and hands-on scanning opportunities in basic POCUS applications. Their evaluation tools included pre- and post-surveys and tests, and a final performance exam. In the second and third years of residency, all participants were required to complete 8 hours per year of POCUS content review and additional hands-on training. An optional third-year curriculum was offered to interested residents as career-focused education elective time. RESULTS Our curriculum introduced POCUS topics such as basic and advanced cardiac, lung, skin/soft tissues and procedural based ultrasound to all pediatric residents. Among first-year residents, application-specific results showed POCUS comfort level improved by 61-90%. Completed evaluations demonstrated improvement in their ability to recognize and interpret POCUS images. Second- and third-year residents reported educational effectiveness that was rated 3.9 on a 4-point Likert scale. Four third-year residents took part in the optional POCUS elective, and all reported a change in their practice with increased POCUS incorporation. CONCLUSIONS Our longitudinal pediatric residency POCUS curriculum is feasible to integrate into residency training and exhibits early success.
Collapse
Affiliation(s)
- Julia Aogaichi Brant
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA.
| | - Jonathan Orsborn
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Ryan Good
- Department of Pediatrics, Section of Pediatric Intensive Care, University of Colorado/Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Greenwald
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Megan Mickley
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Amanda G Toney
- Department of Pediatrics, Denver Health Medical Center, Denver, CO, USA
| |
Collapse
|
13
|
Matthews L, Contino K, Nussbaum C, Hunter K, Schorr C, Puri N. Skill retention with ultrasound curricula. PLoS One 2020; 15:e0243086. [PMID: 33270718 PMCID: PMC7714199 DOI: 10.1371/journal.pone.0243086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background Implementation of a point of care ultrasound curricula is valuable, but optimal integration for internal medicine residency is unclear. The purpose of this study was to evaluate if a structured ultrasound curriculum vs. structured ultrasound curriculum plus supervised thoracic ultrasounds would improve internal medicine residents’ skill and retention 6 and 12 months from baseline. Methods We conducted a randomized controlled study evaluating internal medical residents’ skill retention of thoracic ultrasound using a structured curriculum (control, n = 14) vs. structured curriculum plus 20 supervised bedside thoracic ultrasounds (intervention, n = 14). We used a stratified randomization based on program year. All subjects attended a half-day course that included 5 lectures and hands-on sessions at baseline. Assessments included written and practical exams at baseline, immediately post-course and at 6 and 12 months. Scores are reported as a percentage for the number of correct responses/number of questions (range 0–100%). The Mann Whitney U and the Friedman tests were used for analyses. Results Twenty-eight residents were enrolled. Two subjects withdrew prior to the 6-month exams. Written exam scores for all subjects improved, baseline median (IQR) 60 (46.47 to 66.67) post-course 80 (65 to 86.67), 6-month 80 (66.67 to 86.67) and 12-month 86.67 (80 to 88.34), p = <0.001. All subjects practical exam scores median (IQR) significantly improved, baseline 18.18 (7.95 to 32.95), post-course 59.09 (45.45 to 70.45), 6 month 71.74 (60.87 to 82.61) and 12-month 76.09 (65.22 to 88.05), p = <0.001. Comparing the control group to the intervention group, there were statistically significant higher scores, median (IQR), in the intervention group on the practical exam at 6 months 63.05 (48.92 to 69.57) vs. 82.61(72.83 to89.13), p = <0.001. Conclusion In this cohort, internal medicine residents participating in a structured thoracic ultrasound course plus 20-supervised ultrasounds achieved higher practical exam scores long-term compared to controls.
Collapse
Affiliation(s)
| | - Krysta Contino
- Cooper University Health Care, Camden, NJ, United States of America
| | | | - Krystal Hunter
- Cooper University Health Care, Camden, NJ, United States of America
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | - Christa Schorr
- Cooper University Health Care, Camden, NJ, United States of America
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
| | - Nitin Puri
- Cooper University Health Care, Camden, NJ, United States of America
- Cooper Medical School of Rowan University, Camden, NJ, United States of America
- * E-mail:
| |
Collapse
|
14
|
Das D, Kapoor M, Brown C, Husain A, Rubin M, Chacko J, Rudnin S, Hahn B, Greenstein J. Comparison of Hands-On Versus Online Learning in Teaching Ultrasound Skills for Achilles Tendon Rupture: A Pilot Study. Cureus 2020; 12:e9021. [PMID: 32775101 PMCID: PMC7405972 DOI: 10.7759/cureus.9021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction In the emergency department, the diagnosis of an Achilles tendon rupture (ATR) is reportedly missed in greater than 20% of cases. A limited number of studies evaluate the use of cadaver models as a potential ultrasound teaching and training modality. We hypothesize that emergency medicine residents can effectively utilize point-of-care ultrasound (POCUS) on cadaver models and a focused teaching intervention to assess their ability to detect ATRs. Methods A prospective study of 23 EM residents was performed. All participants in the study were divided into two learner groups: (a) independent and (b) hands-on. The independent learner group received a 30-minute online didactic lecture demonstrating how to diagnose ATRs. The hands-on learner group received direct instruction on cadaver lower leg models with a ruptured and normal Achilles tendon (AT). Both groups then participated in identifying either normal or ruptured ATs on six cadaver lower leg models. Results The sensitivity and specificity were 89% and 82% in the independent learner group 96% and 100% in the hands-on learner group, respectively. The overall sensitivity and specificity were 91% and 88%, respectively. There was a trend toward successful identification with increased years of residency training. Conclusions In this study, lower leg and ankle cadaver models were found to be as effective as an independent learner model for potential POCUS teaching and training modality in both novice and more advanced trainees.
Collapse
Affiliation(s)
- Devjani Das
- Emergency Medicine, New York Columbia Presbyterian Hospital, New York, USA
| | - Monica Kapoor
- Emergency Medicine, UMass Memorial Medical Center, Worcester, USA
| | - Cara Brown
- Emergency Medicine, The Mount Sinai Hospital, New York, USA
| | - Abbas Husain
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | - Marina Rubin
- Emergency Medicine, Newark Beth Israel Medical Center, Newark, USA
| | - Jerel Chacko
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | - Simone Rudnin
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | - Barry Hahn
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| | - Josh Greenstein
- Emergency Medicine, Staten Island University Hospital, Staten Island, USA
| |
Collapse
|
15
|
Lam J, Wong S, Grubic N, Nihal S, Herr JE, Belliveau DJ, Gauthier S, Montague SJ, Johri AM. Accelerated Remote Consultation Tele-POCUS in Cardiopulmonary Assessment (ARCTICA). POCUS JOURNAL 2020; 5:55-58. [PMID: 36896439 PMCID: PMC9979931 DOI: 10.24908/pocus.v5i2.14452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The ability of point-of-care ultrasound (POCUS) to provide rapid and accurate bedside assessment of both the heart and lungs allows it to be a powerful tool in the management of patients presenting with dyspnea. However, while ultrasound equipment is readily available even in remote healthcare settings in Canada, physicians lack effective training opportunities to develop expertise in this potentially life-saving skill. To answer this critical call to action, we have developed the Accelerated Remote Consultation Tele-POCUS in Cardiopulmonary Assessment (ARCTICA) program to innovate POCUS training for today’s physician leaders. This article outlines the background, research methods, and progress-to-date of ARCTICA.
Collapse
Affiliation(s)
- Jeffrey Lam
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Sherwin Wong
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Nicholas Grubic
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Salwa Nihal
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Julia E Herr
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Daniel J Belliveau
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Stephen Gauthier
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Steven J Montague
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University Kingston, Ontario Canada
| |
Collapse
|