Edrich Thomas, Stopfkuchen-Evans Matthias, Scheiermann Patrick, Heim Markus, Chan Wilma, Stone Michael B, Dankl Daniel, Aichner Jonathan, Hinzmann Dominik, Song Pingping, Szabo Ashley L, Frendl Gyorgy, Vlassakov Kamen, Varelmann Dirk
From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †Department of Anesthesiology, University Hospital Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany; ‡Department of Anesthesiology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany; §Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‖Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria; and ¶Ludwig-Maximilians-University Medical School, Munich, Germany.
Anesth Analg. 2016 Jul;123(1):123-8. doi: 10.1213/ANE.0000000000001383.
Lung ultrasound (LUS) is a well-established method that can exclude pneumothorax by demonstration of pleural sliding and the associated ultrasound artifacts. The positive diagnosis of pneumothorax is more difficult to obtain and relies on detection of the edge of a pneumothorax, called the "lung point." Yet, anesthesiologists are not widely taught these techniques, even though their patients are susceptible to pneumothorax either through trauma or as a result of central line placement or regional anesthesia techniques performed near the thorax. In anticipation of an increased training demand for LUS, efficient and scalable teaching methods should be developed. In this study, we compared the improvement in LUS skills after either Web-based or classroom-based training. We hypothesized that Web-based training would not be inferior to "traditional" classroom-based training beyond a noninferiority limit of 10% and that both would be superior to no training. Furthermore, we hypothesized that this short training session would lead to LUS skills that are similar to those of ultrasound-trained emergency medicine (EM) physicians.
After a pretest, anesthesiologists from 4 academic teaching hospitals were randomized to Web-based (group Web), classroom-based (group class), or no training (group control) and then completed a posttest. Groups Web and class returned for a retention test 4 weeks later. All 3 tests were similar, testing both practical and theoretical knowledge. EM physicians (group EM) performed the pretest only. Teaching for group class consisted of a standardized PowerPoint lecture conforming to the Consensus Conference on LUS followed by hands-on training. Group Web received a narrated video of the same PowerPoint presentation, followed by an online demonstration of LUS that also instructs the viewer to perform an LUS on himself using a clinically available ultrasound machine and submit smartphone snapshots of the resulting images as part of a portfolio system. Group Web received no other hands-on training.
Groups Web, class, control, and EM contained 59, 59, 20, and 42 subjects. After training, overall test results of groups Web and class improved by a mean of 42.9% (±18.1% SD) and 39.2% (±19.2% SD), whereas the score of group control did not improve significantly. The test improvement of group Web was not inferior to group class. The posttest scores of groups Web and class were not significantly different from group EM. In comparison with the posttests, the retention test scores did not change significantly in either group.
When training anesthesiologists to perform LUS for the exclusion of pneumothorax, we found that Web-based training was not inferior to traditional classroom-based training and was effective, leading to test scores that were similar to a group of clinicians experienced in LUS.
肺部超声（LUS）是一种成熟的方法，可通过显示胸膜滑动及相关超声伪像来排除气胸。气胸的阳性诊断较难实现，依赖于对气胸边缘（即“肺点”）的检测。然而，尽管麻醉医生的患者因创伤、中心静脉置管或胸部附近进行的区域麻醉技术而容易发生气胸，但这些技术并未得到广泛传授。鉴于对LUS培训需求的增加，应开发高效且可扩展的教学方法。在本研究中，我们比较了基于网络的培训和基于课堂的培训后LUS技能的提高情况。我们假设，基于网络的培训在不低于10%的非劣效性界限之外，不会逊于“传统的”基于课堂的培训，且两者均优于无培训。此外，我们假设这种短期培训课程将使LUS技能与接受过超声培训的急诊医学（EM）医生相似。
在进行预测试后，来自4家学术教学医院的麻醉医生被随机分为基于网络的培训组（网络组）、基于课堂的培训组（课堂组）或无培训组（对照组），然后完成后测试。网络组和课堂组在4周后返回进行留存测试。所有3项测试相似，同时考查实践知识和理论知识。EM医生（EM组）仅进行预测试。课堂组的教学包括一场符合LUS共识会议的标准化PowerPoint讲座，随后进行实践培训。网络组收到相同PowerPoint演示文稿的旁白视频，随后是LUS的在线演示，该演示还指导观看者使用临床可用的超声机器自行进行LUS检查，并提交所得图像的智能手机快照作为档案系统的一部分。网络组未接受其他实践培训。
网络组、课堂组、对照组和EM组分别有59名、59名、20名和42名受试者。培训后，网络组和课堂组的总体测试结果平均提高了42.9%（标准差±18.1%）和39.2%（标准差±19.2%），而对照组的分数没有显著提高。网络组的测试提高情况不逊于课堂组。网络组和课堂组的后测试分数与EM组没有显著差异。与后测试相比，两组的留存测试分数均无显著变化。
在培训麻醉医生进行LUS以排除气胸时，我们发现基于网络的培训不劣于传统的基于课堂的培训，且效果显著，导致测试分数与一组有LUS经验的临床医生相似。
