Blackstock Uché, Munson Jaclyn, Szyld Demian
NYU School of Medicine/Bellevue Hospital Center, Department of Emergency Medicine, 462 First Avenue, OBV-A349A, NY, New York, 10016.
J Clin Ultrasound. 2015 Mar;43(3):139-44. doi: 10.1002/jcu.22224. Epub 2014 Aug 14.
Medical students on clinical rotations rarely receive formal bedside ultrasound (BUS) training. We designed, implemented, and evaluated a standardized BUS curriculum for medical students on their Emergency Medicine (EM) rotation. Teaching was aimed toward influencing four cognitive and psychomotor learning domains: BUS instrumentation knowledge, image interpretation, image acquisition, and procedural guidance.
Participants viewed three instructional Web-based tutorials on BUS instrumentation, the Focused Assessment for Sonography in Trauma (FAST) examination and ultrasound-guided central venous catheter (CVC) placement. Subsequently, participants attended a 3-hour hands-on training session to discuss the same content area and practice with faculty coaches. A Web-based, multiple-choice questionnaire was administered before and after the session. During the final week of the rotation, students returned for skills assessments on FAST image acquisition and CVC placement.
Forty-five medical students on an EM rotation were enrolled. Sonographic knowledge overall mean score improved significantly from 66.6% (SD ±11.2) to 85.7% (SD ±10.0), corresponding to a mean difference of 19.1% (95% CI 15.5-22.7; p < 0.001). There were high pass rates for FAST (89.0%, 40/45) and CVC (96.0%, 43/45) skills assessments. There was no significant difference between medical student posttest and EM resident test scores 85.7% (SD ±10.0) and 88.1% (SD ± 7.6) (p = 0.40), respectively.
A formal BUS curriculum for medical students on EM rotation positively influenced performance in several key learning domains. As BUS competency is required for residency in EM and other specialties, medical schools could consider routinely incorporating BUS teaching into their clinical rotation curricula.
参加临床轮转的医学生很少接受正规的床边超声(BUS)培训。我们为参加急诊医学(EM)轮转的医学生设计、实施并评估了一门标准化的BUS课程。教学旨在影响四个认知和心理运动学习领域:BUS仪器知识、图像解读、图像采集和操作指导。
参与者观看了三个关于BUS仪器、创伤超声重点评估(FAST)检查和超声引导中心静脉导管(CVC)置入的在线教学教程。随后,参与者参加了一个3小时的实践培训课程,讨论相同的内容领域并在教员指导下进行练习。在课程前后进行了一项基于网络的多项选择题问卷调查。在轮转的最后一周,学生们回来进行FAST图像采集和CVC置入的技能评估。
45名医学生参加了EM轮转。超声知识总体平均得分从66.6%(标准差±11.2)显著提高到85.7%(标准差±10.0),平均差异为19.1%(95%置信区间15.5 - 22.7;p < 0.001)。FAST(89.0%,40/45)和CVC(96.0%,43/45)技能评估的通过率很高。医学生的后测成绩与EM住院医师的测试成绩分别为85.7%(标准差±10.0)和88.1%(标准差±7.6),两者之间无显著差异(p = 0.40)。
为参加EM轮转的医学生开设的正规BUS课程对几个关键学习领域的表现产生了积极影响。由于EM和其他专业的住院医师需要具备BUS能力,医学院校可考虑将BUS教学常规纳入其临床轮转课程。