The Effects of an Eight-Hour Six-Step Point-of-Care Ultrasound Training Program: A Pilot Study

Abstract

Objective: The use of ultrasonography in emergency departments is becoming widespread all over the world. However, the recommendations of the guidelines that form the framework of training may not be suitable for all regions. In this study, we investigated the effect of a targeted eight-hour Point-of-Care Ultrasound (PoCUS) course planned in an emergency medicine clinic with limited facilities on the practical skills of emergency physicians. Materials and Methods: A six-step ultrasonography course was planned for twenty-six emergency physicians. Four hours of theoretical course followed by four hours of practical training was given. Participants were administered a practical exam a week before and a week after the training. Whether sufficient images were provided in the practical exam depended on certain criteria. The time to achieve adequate images by fulfilling all criteria was recorded in seconds. Results: After the training, the success rates of cardiac ultrasound (US), extended focused assessment with sonography in trauma (E-FAST), and the adequacy of hepatobiliary and aortic imaging increased statistically significantly (p<0.05). Conclusion: Targeted eight-hour theoretical and practical ultrasonography training, which was provided in line with the demands of emergency physicians, has a significant contribution to the successful imaging time of participating emergency physicians.

Keywords

• Ultrasonography
• Point-of-care systems
• Education

Sekiz Saatlik Altı Adımlı Bakım Noktası Ultrasonu Eğitim Programının Etkileri: Pilot Bir Çalışma

Abstract

Amaç: Acil servislerde ultrasonografi kullanımı tüm dünyada yaygınlaşmaktadır. Ancak, eğitimin çerçevesini oluşturan kılavuzların önerileri tüm bölgeler için uygun olmayabilir. Bu çalışmada, kısıtlı imkanlara sahip bir acil tıp kliniğinde planlanan hedefe yönelik sekiz saatlik Point-of-Care Ultrasound (PoCUS) kursunun acil hekimlerinin pratik becerileri üzerindeki etkisini araştırdık. Gereç ve Yöntem: Yirmi altı acil tıp hekimi için altı aşamalı bir ultrasonografi kursu planlandı. Dört saatlik teorik dersin ardından dört saatlik pratik eğitim verildi. Katılımcılara eğitimden bir hafta önce ve bir hafta sonra pratik sınav uygulandı. Pratik sınavda yeterli görüntü sağlanıp sağlanmadığı belirli kriterlere bağlıydı. Tüm kriterleri yerine getirerek yeterli görüntü elde etme süresi saniye cinsinden kaydedildi. Sonuçlar: Eğitim sonrasında kardiyak ultrasonografi (US), travmada sonografi ile genişletilmiş odaklı değerlendirme (E-FAST) ve hepatobiliyer ve aort görüntülemenin yeterliliği başarı oranları istatistiksel olarak anlamlı şekilde arttı (p<0.05). Sonuç: Acil hekimlerinin talepleri doğrultusunda verilen hedefe yönelik sekiz saatlik teorik ve pratik ultrasonografi eğitiminin, katılımcı acil hekimlerinin başarılı görüntüleme sürelerine önemli bir katkısı vardır.

Keywords

• Ultrasonografi
• Yatakbaşı teknolojisi
• Eğitim

References

1. Hoppmann RA, Rao VV, Poston MB, Howe DB, Hunt PS, Fowler SD, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011;3(1):1-12. Epub 2011/04/26. doi: 10.1007/s13089-011-0052-9. PubMed PMID: 21516137; PubMed Central PMCID: PMC3064888.
2. Hoppmann RA, Rao VV, Bell F, Poston MB, Howe DB, Riffle S, et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J. 2015;7(1):18. Epub 2015/11/22. doi: 10.1186/s13089-015-0035-3. PubMed PMID: 26589313; PubMed Central PMCID: PMC4654731.
3. Dinh VA, Dukes WS, Prigge J, Avila M. Ultrasound Integration in Undergraduate Medical Education: Comparison of Ultrasound Proficiency Between Trained and Untrained Medical Students. J Ultrasound Med. 2015;34(10):1819-24. Epub 20150902. doi: 10.7863/ultra.14.12045. PubMed PMID: 26333569.
4. Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med. 2023;82(3):e115-e55. doi: 10.1016/j.annemergmed.2023.06.005. PubMed PMID: 37596025.
5. Ahern M, Mallin MP, Weitzel S, Madsen T, Hunt P. Variability in Ultrasound Education among Emergency Medicine Residencies. West J Emerg Med. 2010;11(4):314-8. Epub 2010/11/17. PubMed PMID: 21079699; PubMed Central PMCID: PMC2967679.
6. Amini R, Adhikari S, Fiorello A. Ultrasound competency assessment in emergency medicine residency programs. Acad Emerg Med. 2014;21(7):799-801. Epub 2014/07/22. doi: 10.1111/acem.12408. PubMed PMID: 25039680.
7. Wells M, Goldstein LN, Beringer C, Farham B. Emergency Medicine Society of South Africa guidelines for the training and credentialing in emergency point-of-care ultrasound. S Afr Med J. 2021;111(5b):13296. Epub 20210503. doi: 10.7196/SAMJ.2021.v111i5b.15346. PubMed PMID: 33944752.
8. Micks T, Sue K, Rogers P. Barriers to point-of-care ultrasound use in rural emergency departments. CJEM. 2016;18(6):475-9. Epub 2016/07/25. doi: 10.1017/cem.2016.337.

9. Shah S, Bellows BA, Adedipe AA, Totten JE, Backlund BH, Sajed D. Perceived barriers in the use of ultrasound in developing countries. Critical Ultrasound Journal. 2015;7(1):11. doi: 10.1186/s13089-015-0028-2.
10. Kern DE. Curriculum development for medical education: a six step approach: JHU Press; 1998.
11. Smith M, Krishnan SV, Leamon A, Galwankar S, Sinha TP, Kumar VA, et al. Removing Barriers to Emergency Medicine Point-of-Care Ultrasound: Illustrated by a Roadmap for Emergency Medicine Point-of-Care Ultrasound Expansion in India. J Emerg Trauma Shock. 2023;16(3):116-26. Epub 20230929. doi: 10.4103/jets.jets_50_23. PubMed PMID: 38025509; PubMed Central PMCID: PMC10661575.
12. Fourie L, Pather MK, Hendricks G. Point-of-care ultrasound: The new district focus. Afr J Prim Health Care Fam Med. 2023;15(1):e1-e8. Epub 20230614. doi: 10.4102/phcfm.v15i1.3576. PubMed PMID: 37403679; PubMed Central PMCID: PMC10319924.
13. Moore CL, Molina AA, Lin H. Ultrasonography in community emergency departments in the United States: access to ultrasonography performed by consultants and status of emergency physician-performed ultrasonography. Ann Emerg Med. 2006;47(2):147-53. Epub 20051121. doi: 10.1016/j.annemergmed.2005.08.023. PubMed PMID: 16431225.
14. Fischer LM, Woo MY, Lee AC, Wiss R, Socransky S, Frank JR. Emergency medicine point-of-care ultrasonography: a national needs assessment of competencies for general and expert practice. Cjem. 2015;17(1):74-88. doi: 10.2310/8000.2013.131205. PubMed PMID: 25961081.
15. Smalley CM, Simon EL, Muir MR, Fertel BS. A Real-World Experience: Retrospective Review of Point-of-Care Ultrasound Utilization and Quality in Community Emergency Departments. West J Emerg Med. 2023;24(4):685-92. Epub 20230630. doi: 10.5811/westjem.58965. PubMed PMID: 37527388; PubMed Central PMCID: PMC10393449.
16. Kim DJ, Olszynski P, Smith DJW, Lalande E, Woo MY. Point of care ultrasound training in Canadian emergency medicine residency programs. Cjem. 2022;24(3):329-34. Epub 20220303. doi: 10.1007/s43678-022-00269-1. PubMed PMID: 35239169.
17. Rao VV, DellaValle J, Gelin G, Day J. Mission POCUS in Haiti. J Radiol Nurs. 2023;42(1):77-84. Epub 20230201. doi: 10.1016/j.jradnu.2022.12.006. PubMed PMID: 36742420; PubMed Central PMCID: PMC9890376.
18. Jhagru R, Singh R, Rupp J. Evaluation of an emergency medicine point-of-care ultrasound curriculum adapted for a resource-limited setting in Guyana. Int J Emerg Med. 2023;16(1):57. Epub 20230906. doi: 10.1186/s12245-023-00531-y. PubMed PMID: 37674124; PubMed Central PMCID: PMC10481457.
19. Lewiss RE, Pearl M, Nomura JT, Baty G, Bengiamin R, Duprey K, et al. CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med. 2013;20(7):740-5. doi: 10.1111/acem.12164. PubMed PMID: 23859589.
20. Hofer M, Kamper L, Sadlo M, Sievers K, Heussen N. Evaluation of an OSCE assessment tool for abdominal ultrasound courses. Ultraschall Med. 2011;32(2):184-90. Epub 20110214. doi: 10.1055/s-0029-1246049. PubMed PMID: 21321843.
21. Ma IWY, Desy J, Woo MY, Kirkpatrick AW, Noble VE. Consensus-Based Expert Development of Critical Items for Direct Observation of Point-of-Care Ultrasound Skills. J Grad Med Educ. 2020;12(2):176-84. doi: 10.4300/jgme-d-19-00531.1. PubMed PMID: 32322351; PubMed Central PMCID: PMC7161337.
22. Boniface KS, Ogle K, Aalam A, LeSaux M, Pyle M, Mandoorah S, et al. Direct Observation Assessment of Ultrasound Competency Using a Mobile Standardized Direct Observation Tool Application With Comparison to Asynchronous Quality Assurance Evaluation. AEM Educ Train. 2019;3(2):172-8. Epub 20190219. doi: 10.1002/aet2.10324. PubMed PMID: 31008429; PubMed Central PMCID: PMC6457355.
23. Shokoohi H, Boniface K, Kaviany P, Armstrong P, Calabrese K, Pourmand A. An Experiential Learning Model Facilitates Learning of Bedside Ultrasound by Preclinical Medical Students. J Surg Educ. 2016;73(2):208-14. doi: 10.1016/j.jsurg.2015.10.007. PubMed PMID: 26868311.
24. Ahn JS, French AJ, Thiessen ME, Kendall JL. Training peer instructors for a combined ultrasound/physical exam curriculum. Teach Learn Med. 2014;26(3):292-5. doi: 10.1080/10401334.2014.910464. PubMed PMID: 25010242.
25. Mandavia DP, Aragona J, Chan L, Chan D, Henderson SO. Ultrasound training for emergency physicians--a prospective study. Acad Emerg Med. 2000;7(9):1008-14. doi: 10.1111/j.1553-2712.2000.tb02092.x. PubMed PMID: 11043996.
26. Geis RN, Kavanaugh MJ, Palma J, Speicher M, Kyle A, Croft J. Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff. Mil Med. 2023;188(5-6):e936-e41. doi: 10.1093/milmed/usab392. PubMed PMID: 34591116.
27. Damewood SC, Leo M, Bailitz J, Gottlieb M, Liu R, Hoffmann B, et al. Tools for Measuring Clinical Ultrasound Competency: Recommendations From the Ultrasound Competency Work Group. AEM Educ Train. 2020;4(Suppl 1):S106-s12. Epub 20190730. doi: 10.1002/aet2.10368. PubMed PMID: 32072114; PubMed Central PMCID: PMC7011402.