Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic

Abstract Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-19 pandemic. Results Pre- and post-course knowledge test scores of learners from the in-person (n = 88) and tele-ultrasound course (n = 52) were compared. Though mean pre-course knowledge test scores were higher among learners of the tele-ultrasound versus in-person course (78% vs. 71%; p = 0.001), there was no significant difference in the post-course test scores between learners of the two course formats (89% vs. 87%; p = 0.069). Both learners and faculty rated the tele-ultrasound course highly (4.6–5.0 on a 5-point scale) for effectiveness of virtual lectures, tele-ultrasound hands-on scanning sessions, and course administration. Faculty generally expressed less satisfaction with their ability to engage with learners, troubleshoot image acquisition, and provide feedback during the tele-ultrasound course but felt learners completed the tele-ultrasound course with a better basic POCUS skillset. Conclusions Compared to a traditional in-person course, tele-ultrasound POCUS CME courses appeared to be as effective for improving POCUS knowledge post-course and fulfilling learning objectives. Our findings can serve as a roadmap for educators seeking guidance on development of a tele-ultrasound POCUS training course whose demand will likely persist beyond the COVID-19 pandemic.

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Point-of-Care Ultrasound for Family Medicine Residents: Attitudes and Confidence

Family Medicine ◽

10.22454/fammed.2021.930080 ◽

2021 ◽

Vol 53 (6) ◽

pp. 457-460

Author(s):

Jerica Johnson ◽

David Stromberg ◽

Byrch Willims ◽

Nina Greenberg ◽

Orrin Myers

Keyword(s):

Family Medicine ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Family Medicine Residency ◽

University Of New Mexico ◽

Confidence Levels ◽

Significant Difference ◽

Hands On ◽

Before And After ◽

Family Medicine Residents

Background and Objectives: Point-of-care ultrasound (POCUS) is increasingly being incorporated into family medicine residency training. Attitudes towards POCUS among family medicine residents (FMRs) are largely unknown, and confidence levels with performing and interpreting POCUS exams are also unknown among this group of learners. Our aim was to evaluate FMRs’ attitudes and confidence levels before and after the implementation of a new POCUS curriculum. Methods: Study participants included FMRs in all postgraduate years (ie, PGY1-PGY3) at the University of New Mexico (UNM) Family Medicine Residency Program. Our intervention was a yearlong implementation of a new POCUS curriculum based on the American Academy of Family Physicians POCUS curriculum guidelines. Our interventions included hands-on training sessions for both FMRs and faculty along with a resource website. We assessed attitudes and confidence levels with various POCUS exams using a pre- and postintervention survey. Results: Overall, FMRs felt significantly more confident in their ability to perform and interpret a point-of-care ultrasound after the implementation of POCUS curriculum. There was no significant difference in participants’ expectations of their use of POCUS during or after residency. Conclusions: Overall, this study provides evidence that the implementation of a POCUS curriculum that includes hands-on and didactic training is associated with increased confidence in utilizing POCUS among FMRs.

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LO22: Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHoC-ED investigators

CJEM ◽

10.1017/cem.2019.65 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S15

Author(s):

P. Atkinson ◽

M. Peach ◽

S. Hunter ◽

A. Kanji ◽

L. Taylor ◽

...

Keyword(s):

Cardiogenic Shock ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Primary Outcome ◽

Point Of Care ◽

Statistical Tests ◽

Controlled Study ◽

Point Of Care Ultrasound ◽

Randomized Controlled ◽

Significant Difference

Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.

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Barriers to point-of-care ultrasound use in rural emergency departments

CJEM ◽

10.1017/cem.2016.337 ◽

2016 ◽

Vol 18 (6) ◽

pp. 475-479 ◽

Cited By ~ 11

Author(s):

Taft Micks ◽

Kyle Sue ◽

Peter Rogers

Keyword(s):

Emergency Medicine ◽

Emergency Departments ◽

Point Of Care ◽

The United States ◽

Point Of Care Ultrasound ◽

Advanced Imaging ◽

The Past ◽

Rural Physicians ◽

Training Courses ◽

Rural Sites

AbstractOver the past few decades, point-of-care ultrasound (PoCUS) has come to play a major role in the practice of emergency medicine. Despite its numerous benefits, there has been a slow uptake of PoCUS use in rural emergency departments. Surveys conducted across Canada and the United States have identified a lack of equipment, training, funding, quality assurance, and an inability to maintain skills as major barriers to PoCUS use. Potential solutions include expanding residency training in ultrasound skills, extending funding for PoCUS training to rural physicians in practice, moving PoCUS training courses to rural sites, and creating telesonography training for rural physicians. With these barriers identified and solutions proposed, corrective measures must be taken so that the benefits of PoCUS are extended to patients in rural Canada where, arguably, it has the greatest potential for benefit when access to advanced imaging is not readily available.

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Pre-clinical medical student cardiac point-of-care ultrasound curriculum based on the American Society of Echocardiography recommendations: a pilot and feasibility study

10.21203/rs.3.rs-43731/v1 ◽

2020 ◽

Author(s):

Satoshi Jujo ◽

Jannet J Lee-Jayaram ◽

Brandan I Sakka ◽

Atsushi Nakahira ◽

Akihisa Kataoka ◽

...

Keyword(s):

Medical Student ◽

Medical Students ◽

Pilot Study ◽

Point Of Care ◽

Scoring Systems ◽

Recruitment Rate ◽

Point Of Care Ultrasound ◽

Hands On ◽

Test Scoring ◽

American Society

Abstract Background Cardiac point-of-care ultrasound (POCUS) training has been integrated into medical school curricula. However, there is no standardized cardiac POCUS training method for medical students. To address this issue, the American Society of Echocardiography (ASE) proposed a framework for medical student cardiac POCUS training. The objective of this pilot study was to develop a medical student cardiac POCUS curriculum with test scoring systems and test the curriculum feasibility for a future definitive study.Methods Based on the ASE-recommended framework, we developed a cardiac POCUS curriculum consisting of a pre-training online module and hands-on training with a hand-held ultrasound (Butterfly iQ). The curriculum learning effects were assessed with a 10-point maximum skill test and a 40-point maximum knowledge test at pre-, immediate post-, and 8-week post-training. To determine the curriculum feasibility, we planned to recruit 6 pre-clinical medical students. We semi-quantitatively evaluated the curriculum feasibility in terms of recruitment rate, follow-up rate 8 weeks after training, instructional design of the curriculum, the effect size (ES) of the test score improvements, and participant satisfaction. Discriminatory ability of the test scoring systems were assessed by comparing the scores of the medical students, medical interns, and experts.Results Six pre-clinical medical students participated in the curriculum. The recruitment rate was 100% (6/6 students) and the follow-up rate 8 weeks after training was 100% (6/6). ESs of skill and knowledge test score differences between pre- and immediate post-, and between pre- and 8-week post-training were large. The students reported high satisfaction with the curriculum. The test scoring systems demonstrated excellent discriminatory ability between the 3 different performance levels.Conclusions This pilot study confirmed the curriculum design as feasible with instructional design modifications including the hands-on training group size, content of the cardiac POCUS lecture, hands-on teaching instructions, and hand-held ultrasound usage. Based on the pilot study findings, we plan to conduct the definitive study with the primary outcome of long-term skill retention 8 weeks after initial training. The definitive study has been registered in ClinicalTrials.gov (Identifier: NCT04083924).

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Point of care ultrasound in disaster triage

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v86i1.2165 ◽

2017 ◽

Vol 86 (1) ◽

pp. 38-39

Author(s):

Brandon Chau ◽

Gayathri Sivakumar

Keyword(s):

Imaging Modality ◽

Point Of Care ◽

Accurate Method ◽

Point Of Care Ultrasound ◽

Life Threatening ◽

Intraperitoneal Bleeding ◽

Ultrasound Technology ◽

Fast Exam ◽

Disaster Scenario ◽

The Military

Ultrasound technology has rapidly progressed over the past decades to emerge as a portable, versatile imaging modality to complement the physical exam. It has been shown to be superior to clinical exam and equivalent to computed-tomography in detecting many life-threatening conditions, and thus is used in a variety of resuscitative settings, including the front lines of the military. A variety of imaging protocols exist for ultrasound, but in resource-deplete settings such as a disaster scenario, the focused assessment with sonography for trauma (FAST) exam is a rapid and accurate method of determining acute intraperitoneal bleeding. With improving portability, as well as the ability to transmit images to a centralized command hub, it can become a key component of the first responder’s toolkit.

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LO090: Introduction of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽

10.1017/cem.2016.127 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S61-S61

Author(s):

C. Hrymak ◽

C. Pham

Keyword(s):

Emergency Medicine ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Educational Module ◽

Ultrasound Education ◽

Didactic Teaching ◽

Video Clips ◽

Simulation Based ◽

Hands On ◽

Future Direction

Introduction / Innovation Concept: Expanding point of care ultrasound education in emergency medicine (EM) programs is a necessary part of curriculum development. Our objective was to integrate core and advanced applications for point of care ultrasound in caring for critically ill patients with undifferentiated shock. We chose to develop and implement an educational module using the systematic approach of the RUSH Exam for EM residents in our institution. Methods: After review of the literature in point-of-care ultrasound, a module was designed. An educational proposal outlining the RUSH Exam training within the -EM and CCFP-EM curricula was submitted to and accepted by the residency training committee. The objectives and goals were outlined in accordance with CanMEDS roles, and the ultrasound director provided supervision for the project. Curriculum, Tool, or Material: An 8-hour educational module was implemented between October 7 and November 18, 2014. All residents received formal training on the core applications in FAST and aortic scans prior to implementation. The following components of the RUSH Exam were included: two hours of didactic teaching with video clips on advanced cardiac, IVC, DVT, and pulmonary assessment; three hours of hands-on practice on standardized patients performed in the simulation lab to practice image acquisition and interpretation; one hour of didactic teaching on the overall approach to a patient with undifferentiated shock using the RUSH Exam; and two hours of hands-on RUSH Exam practice. A corresponding research project integrating a SonoSim Livescan training platform, a simulation-based testing device, demonstrated improvement in resident performance, subjective comfort with imaging patients in shock and making clinical decisions based on the findings. Conclusion: This 8-hour RUSH Exam educational module combined theoretical learning and hands-on practice for trainees. This module significantly broadened the scope of ultrasound training in our curriculum by providing the necessary skills in approaching patients in shock in a systematic fashion. Future direction will include ongoing education in this area and expansion as appropriate.

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Orthopaedic residents demonstrate retention of point of care ultrasound knowledge after a brief educational session: a quasi experimental study

BMC Medical Education ◽

10.1186/s12909-019-1916-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Samuel Larrivée ◽

Robyn Rodger ◽

Patricia Larouche ◽

Jeff Leiter ◽

Tomislav Jelic ◽

...

Keyword(s):

Test Scores ◽

Orthopaedic Surgery ◽

Online Survey ◽

Point Of Care ◽

Interdisciplinary Approach ◽

Comfort Level ◽

Point Of Care Ultrasound ◽

Significant Drop ◽

Written Test

Abstract Background Musculoskeletal point of care ultrasound (MSK POCUS) has many uses for orthopaedic surgeons, but orthopaedic trainees are rarely exposed to this modality. The purpose of this project was to assess the usefulness in clinical education of a newly implemented MSK POCUS course in an orthopaedic surgery program. Methods An MSK POCUS course for orthopaedic surgery residents was developed by an interdisciplinary team. Online videos were created to be viewed by residents prior to a half-day long practical course. An online survey covering the level of training of the resident and their previous use of ultrasound (total hours) was completed by the participants prior to the course. Resident’s knowledge acquisition was measured with written pre-course, same-day post-course and six-month follow-up tests. Residents were also scored on a practical shoulder examination immediately after the course and at six-month follow-up. Changes in test scores between time points were evaluated using Wilcoxon signed-rank tests. Results Ten orthopaedic surgery residents underwent the MSK POCUS curriculum. Pre-course interest in MSK-POCUS was moderate (65%) and prior exposure was low (1.5 h mean total experience). Written test scores improved significantly from 50.7 ± 17.0% before to 84.0 ± 10.7% immediately after the course (p < 0.001) and suffered no significant drop at 6 months (score 75.0 ± 8.7%; p = 0.303). Average post-course practical exam score was 78.8 ± 3.1% and decreased to 66.2 ± 11.3% at 6 months (p = 0.012). Residents significantly improved their subjective comfort level with all aspects of ultrasound use at 6 months (p = 0.007–0.018) but did not significantly increase clinical usage frequency. Conclusion An MSK POCUS curriculum was successfully developed and implemented using an interdisciplinary approach. The course succeeded in improving the residents’ knowledge, skills, and comfort with MSK POCUS. This improvement was maintained at 6 months on the written test but did not result in higher frequency of use by the residents.

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Point-of-care ultrasound augments physical examination learning by undergraduate medical students

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-137773 ◽

2020 ◽

Vol 97 (1143) ◽

pp. 10-15

Author(s):

Chun Ka Wong ◽

JoJo Hai ◽

Kwong Yue Eric Chan ◽

Ka Chun Un ◽

Mi Zhou ◽

...

Keyword(s):

Medical Students ◽

Physical Examination ◽

Medical Curriculum ◽

Instant Messaging ◽

Point Of Care ◽

Group Discussion ◽

Point Of Care Ultrasound ◽

Undergraduate Medical Students ◽

Significant Difference ◽

The Impact

BackgroundLittle is known about the impact of the provision of handheld point-of-care ultrasound (POCUS) devices on physical examination skills of medical students.MethodsWe describe an educational initiative that comprised a POCUS workshop followed by allocation of a POCUS device to medical students for use over the subsequent 8 weeks. They were encouraged to scan patients and correlate their physical examination findings. A mobile instant messaging group discussion platform was set to provide feedback from instructors. Physical examination skills were assessed by means of clinical examination.Results210 final-year medical students from the University of Hong Kong participated in the programme. 46.3% completed the end of programme electronic survey: 74.6% enjoyed using the POCUS device, 50.0% found POCUS useful to validate physical examination findings and 47.7% agreed that POCUS increased their confidence with physical examination. 93.9% agreed that the programme should be incorporated into the medical curriculum and 81.9% would prefer keeping the device for longer time from 16 weeks (45.6%) to over 49 weeks (35.3%). Medical students who participated in the POCUS programme had a higher mean score for abdominal examination compared with those from the previous academic year with no POCUS programme (3.65±0.52 vs 3.21±0.80, p=0.014), but there was no statistically significant difference in their mean score for cardiovascular examination (3.62±0.64 vs 3.36±0.93, p=0.203).ConclusionThe POCUS programme that included provision of a personal handheld POCUS device improved students’ attitude, confidence and ability to perform a physical examination.

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Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the time of COVID-19

Journal of Veterinary Medical Education ◽

10.3138/jvme-2020-0131 ◽

2021 ◽

pp. e20200131

Author(s):

Zoë J. Williams ◽

Abby Sage ◽

Stephanie J. Valberg

Keyword(s):

Point Of Care ◽

Present Report ◽

Core Competencies ◽

The United States ◽

Ease Of Use ◽

Point Of Care Ultrasound ◽

Veterinary Students ◽

Clinical Rotations ◽

Hands On ◽

Veterinary Student

The coronavirus pandemic abruptly halted all in-person clerkships, or clinical rotations, for clinical veterinary students across the United States (US). Online clerkships in radiology offered the opportunity to expand the student’s ability to interpret medical images but did not allow for the development of physical hands-on imaging skills recognized as core competencies in veterinary medicine. The present report highlights the value of providing veterinary students with a smartphone-associated Butterfly iQ point-of-care ultrasound during a 3-week self-driven virtual clerkship. During the virtual rotation, the student was able to develop the skills required to generate sufficient quality images using three horses residing on her property. The affordability, portability, ease of use of the Butterfly iQ and availability of animals made it possible to develop hands-on imaging skills when distance learning was required.

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E-Learning vs. E-Learning with Hands-on: An Experimental Study to Improve Clinical Skills

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931213601651 ◽

2017 ◽

Vol 61 (1) ◽

pp. 660-660

Author(s):

Daniel Diethei ◽

Franz Ertle ◽

Tobias Grundgeiger ◽

Christoph Mengelkamp ◽

Volker Held

Keyword(s):

Clinical Skills ◽

Syringe Pump ◽

Knowledge Test ◽

Learning Module ◽

Significant Difference ◽

Hands On ◽

E Learning ◽

Subjective Confidence ◽

Independent Variable ◽

The Difference

The training of healthcare staff is an important aspect in reducing adverse events related to medical devices. For medical devices, e-learning has been shown to be a successful method for knowledge acquisition (e.g., Grundgeiger et al, 2016). However, research addressed the learning of clinical skills to a lesser extent. Hands-on learning seems to be superior to conventional classroom learning when it comes to long-term-memory performance (e.g., Hearns, Miller, & Nelson, 2010). This study examined whether using a syringe pump while learning improves the skills to operate the pump, subjective confidence when using the pump, and knowledge about the pump compared to a training without the pump. We tested two groups of nursing students. One group received training with an e-learning module and a syringe pump for hands-on practice (e-learning + pump, n = 25), whereas the other group used the e-learning module only (e-learning only, n = 26). In the first session, the participants were asked to conduct a 35-minute training session, followed by a questionnaire, a knowledge test, and a skills test. In a follow-up session, the tests were repeated but these results are not part of this abstract. Ethical approval was obtained from the local ethics committee and the participants gave their informed consent. The independent variable was learning method and was manipulated between participants. One group was instructed to make use of a syringe pump placed next to the e-learning computer during the e-learning module (e-learning + pump). The second group did not have the syringe pump while learning (e-learning only). The main dependent variable was the number of tasks solved in the skills test. In addition, we investigated the participants’ subjective confidence in operating the syringe pump, their knowledge about the pump, and the amount of assistance that the participants needed to solve the tasks. Based on the literature, we expected that the e-learning + pump group would solve more tasks in the skill test, is more confident in using the pump, and would require less assistance compared to the e-learning only group. The difference of the proportion of solved tasks in the skills test between e-learning + pump group and the e-learning only group was not significant. There was even a slight descriptive advantage for the e-learning only group. For the confidence rating, we observed no significant difference between the groups. In the knowledge test, the e-learning + pump group performed slightly better than the e-learning only group, but the difference was not statistically significant. To assess the amount of required assistance, we counted every sub-task for which a participant needed assistance, regardless of the amount of assistance given per sub-task. Again, there was no effect of the learning method. The results suggest that, with the current study design, there is no benefit of having the device at hand. One may argue that the power of our study might have been too low to find a statistically significant difference between the learning methods. However, because our main independent variable indicated a trend in the opposite direction, we conclude that the current e-learning + pump training does not provide any benefits over e-learning only. The null-effect found in the present study may be due to the split-attention effect. Participants in the e-learning + pump group were told to use the syringe pump combined with the e-learning application. Therefore, they had to switch between the e-learning application and the syringe pump in an unsteady manner to receive all of the relevant information. Considering the split-attention effect (Ayres & Sweller, 2014), switching back and forth might have increased the participants’ cognitive extraneous load (Sweller et al., 1998). Although our results are somewhat unexpected, our study showed that “just” providing a device and instructing healthcare staff to use the device alongside a e-learning module does not improve learning outcomes. Based on the literature (Keers et al., 2013), however, there is a need to improve learning. Future studies should develop and evaluate innovative approaches to teach clinical skills in order to improve overall patient safety.

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