Olszynski Paul, Anderson Jordan, Trinder Krista, Domes Trustin
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
J Ultrasound Med. 2018 Sep;37(9):2209-2213. doi: 10.1002/jum.14571. Epub 2018 Feb 24.
The effect of point-of-care ultrasound (US) training on clinical reasoning in undergraduate medical education remains largely unknown, with concerns arising about possible confusion among learners when such clinical tools are introduced too early. We studied the effect of a urology point-of-care US module on the performance of questions designed to assess clinical reasoning in urinary tract obstruction and voiding dysfunction.
All second-year medical students at the University of Saskatchewan (Regina [n = 36] and Saskatoon [n = 61]) were enrolled in the study. Each cohort participated in the urology point-of-care US module concurrently with its Foundations in the Kidney and Urinary Tract course. The Regina cohort completed the point-of-care US module 1 week before the Saskatoon cohort, thus allowing for a control-intervention comparison of script concordance question scores to evaluate the effect that the urology point-of-care US module had on clinical reasoning skills. Secondary outcomes included program evaluation metrics, such as overall course performance, urology point-of-care US objective structured clinical examination performance, and student course evaluation data.
The introduction of the urology point-of-care US module was not associated with a deterioration in scores on script concordance questions. There were no statistically significant differences between the Regina and Saskatoon students in their responses to the script concordance questions. There were statistically significant increases in student self-reported achievement of learning objectives, with the effect size being medium to large (Cohen d, 0.5-0.8).
Point-of-care US training complements standard undergraduate classroom teaching of urology. Students effectively learned the skills to apply point-of-care US in their assessment of patients, and this process did not interfere with achieving the course objectives.
即时超声（US）培训对本科医学教育临床推理的影响在很大程度上仍不明确，当这类临床工具引入过早时，学习者可能会产生困惑。我们研究了泌尿外科即时超声模块对旨在评估尿路梗阻和排尿功能障碍临床推理问题表现的影响。
萨斯喀彻温大学（里贾纳分校[n = 36]和萨斯卡通分校[n = 61]）的所有二年级医学生都参与了该研究。每个队列在其肾脏和尿路基础课程期间同时参加泌尿外科即时超声模块。里贾纳队列在萨斯卡通队列前1周完成即时超声模块，从而能够对脚本一致性问题得分进行对照干预比较，以评估泌尿外科即时超声模块对临床推理技能的影响。次要结果包括课程评估指标，如总体课程表现、泌尿外科即时超声客观结构化临床考试表现以及学生课程评估数据。
引入泌尿外科即时超声模块与脚本一致性问题得分的恶化无关。里贾纳和萨斯卡通的学生在对脚本一致性问题的回答上没有统计学上的显著差异。学生自我报告的学习目标达成情况有统计学上的显著提高，效应大小为中到大（科恩d值，0.5 - 0.8）。
即时超声培训补充了泌尿外科本科标准课堂教学。学生有效地学习了在评估患者时应用即时超声的技能，并且这个过程没有干扰课程目标的实现。
