How Does Ultrasound Simulation during High Fidelity Simulation Contribute to the Development of Emergency Ultrasound Skills Amongst Emergency Medicine Trainees?

The growing worldwide use of clinician-performed ultrasound (CPU) marks a dramatic change in bedside medicine and patient care. With steadily improving portability, accessibility and technology, ultrasound use continues to grow amongst many medical specialties. Likewise, the application of CPU in emergency medicine is increasing. Emergency Medicine (EM) is a medical specialty “based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury…” (International Federation for Emergency Medicine, 1991). Increasingly, emergency physicians are using emergency department ultrasound (ED U/S) to enhance their assessment of critically-ill patients (American College of Emergency Physicians, 2008). The purpose of this study was to evaluate and describe those aspects of ultrasound simulation (during HFS) that contribute to the development of critical care ED U/S skills. Secondly, it was of interest to assess how a novel ultrasound simulator (edus2) compared to video playback on a laptop in terms of the above-mentioned aspects. The population of interest included both EM trainees and faculty. This investigation was a randomized, prospective, crossover study with two intervention treatments for all participants. In Phase I, EM trainees and faculty from London, UK, were invited to participate in one of four day-long critical-care HFS sessions during which they participated in four critical-care scenarios. Faculty were involved in assisting with session debriefing and feedback. All participants completed two cases with each intervention. In Phase II, faculty in Saskatoon, SK, Canada, were invited to review video recordings of the sessions from Phase I and evaluate the educational merits of the two ED U/S simulation interventions. iii This study produced both quantitative and qualitative data. As this study looked at two interventions and how they could contribute to the development of ED U/S skills, pre- and postintervention changes were analysed for statistically significant differences between them. T-test analyses were used for comparisons. Effect sizes (Cohen’s d) were calculated where statistically significant findings were observed. Qualitative data was assessed through emergent thematic analysis and triangulation. The findings of the study support the integration of ED U/S simulation into HFS. Integration was found to be of value to both trainees and faculty by allowing trainees to demonstrate knowledge of indications as well as correct image interpretation and general integration of ED U/S into critical care (p<0.05). Trainees described an increased motivation to develop their ED U/S skills as well as greater desire to use ED U/S in everyday practice. Furthermore, the edus2 was identified as being the preferred training intervention. The edus2 met functional fidelity through its real time and hands-on applicability. Faculty preferred the edus2 as it allowed for better assessment of trainee skills that then influenced session debriefing and formative feedback. Faculty in Phase II found the edus2 intervention sufficient in offering basic insights into trainee ED U/S skills and mastery (p<0.05). Implications of the study include support for the use of ultrasound simulation during HFS for the development of critical care ED U/S skills amongst EM trainees. Further study on the effects of such hybrid simulation on clinical performance is warranted

The Clinical Ultrasonography Elective in Clerkship (CUSEC): A pilot elective for senior clerkship students at the University of Saskatchewan

We created a clinical ultrasound (CUS) elective in clerkship, which gave medical students the opportunity to enhance their knowledge and technical skills while refining their CUS-related clinical decision making. This elective uniquely allowed medical students to integrate their CUS knowledge and skills into real patient care within the clinical environment (discipline) of their choice. As such, beyond supporting increasing technical competence, students learned to advocate for appropriate use of CUS, an important skill for trainees to develop.&nbsp

Amélioration des compétences en matière d’échographie au point d’intervention grâce à la rétroaction supplémentaire fournie par des patients simulés instructeurs

Background: Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience.  Methods: Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation. Results: Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly.  Conclusions: Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.Contexte : L’enseignement de l’échographie au point d’intervention (POCUS) dans les programmes de médecine de premier cycle au Canada est en pleine expansion. Jusqu’à présent, les patients simulés (PS) de notre programme ne fournissaient que des commentaires sur le confort et le professionnalisme. La participation de patients simulés en tant qu’instructeurs (PS-instructeurs) pour les compétences POCUS offre une occasion d’apprentissage supplémentaire. Dans cette étude pilote, nous avons exploré l’effet de l’intervention des PS-instructeurs dans le cadre d’une séance de formation en POCUS. Les résultats sont intéressants en ce qui concerne le niveau de compétences atteint par les stagiaires à la suite de la séance et sur le plan de leur satisfaction à l’égard de cette expérience d’apprentissage. Méthodes : Des étudiants en deuxième année de médecine ont été répartis au hasard entre un groupe qui a reçu une formation traditionnelle et un groupe qui a reçu la formation avec l’intervention de PS-instructeurs. Les deux groupes ont eu accès au même tutoriel, aux mêmes conseils de l’instructeur et à une rétroaction de base de la part des PS (confort et professionnalisme). Les apprenants du groupe travaillant avec des PS-instructeurs ont reçu des commentaires supplémentaires de la part de ces derniers (repères, technique du transducteur et dépannage) pendant que les instructeurs assistaient d’autres stagiaires. Les étudiants ont évalué la séance et ont ensuite fait l’objet d’une évaluation par observation directe. Résultats : Les étudiants qui ont bénéficié de l’intervention de PS-instructeurs ont obtenu des résultats nettement plus élevés en ce qui concerne l’acquisition d’images (p=0,029, d=1,26) et leur score de confiance global (p=0,002, d=1,75). Les deux groupes ont évalué leur séance de formation de manière très positive. Conclusions : On a constaté que les étudiants qui ont bénéficié de commentaires supplémentaires de la part des PS-instructeurs ont eu de meilleurs résultats en acquisition d’images et un score de confiance plus élevé. D’après cette étude pilote, les PS-instructeurs ont eu un effet positif sur l’acquisition de compétences en POCUS

The development of two Point of Care Ultrasound stations for Objective Structured Clinical Examinations in undergraduate medical education

Introduction: Point-of-care ultrasound (POCUS) is a valuable clinical skill that improves clinical care but requires substantial training. Validated assessment tools provide empirical evidence regarding trainee performance while also informing program-level evaluation. We developed two POCUS-specific stations for objective structured clinical examinations (OSCEs) to assess skill acquisition and inform best practices in undergraduate medical education. Methods: A multidisciplinary group of POCUS educators identified two POCUS applications (pleural effusion and abdominal free fluid) well suited for the undergraduate level. A modified Delphi approach was used to develop POCUS-application-specific skill checklists and global rating scale. Two medical programs piloted the stations to inform reliability. Results: Across two sites, 46 and 41 students participated in the pleural effusion and abdominal free fluid stations respectively. Checklists showed high internal reliability, with Cronbach’s alpha of 0.85 (95% CI 0.71-0.93) for the pleural effusion station and 0.87 (95% CI 0.74-0.95) for the abdominal free fluid station. Krippendorff’s alpha, a measure of inter-rater reliability, was also equally strong at 0.85 (95% CI 0.43-0.94) and 0.83 (95% CI 0.50-0.94) respectively. Conclusion: Both POCUS OSCE stations demonstrated good internal and inter-rater reliability. Deployment of these OSCE stations at programs with integrated POCUS curricula may help refine programming and training expectations