Smith Andrew, Addison Reuben, Rogers Peter, Stone-McLean Jordan, Boyd Sarah, Hoover Kristopher, Pollard Megan, Dubrowski Adam, Parsons Mike
Primary Healthcare Research Unit, Health Sciences Center, St John's, Newfoundland, Canada.
School of Human Kinetics and Recreation, Health Sciences Center, St John's, Newfoundland, Canada.
J Ultrasound Med. 2018 Nov;37(11):2517-2525. doi: 10.1002/jum.14609. Epub 2018 Mar 25.
Telemedicine technology contributes to the teaching of point-of-care ultrasound (US); however, expensive equipment can limit its deployment in resource-challenged settings. We assessed 3 low-cost telemedicine solutions capable of supporting remote US training to determine feasibility, acceptability, and effectiveness. We also explored the value of instructional videos immediately before telementoring.
Thirty-six participants were randomly assigned to receive US mentoring in 1 of 3 telemedicine conditions: multiple fixed cameras, a smartphone, and traditional audio with a live US stream. Participants were then asked to perform a standardized US examination of the right upper quadrant under remote guidance. We measured observer's global ratings of performance along with the mentor's and student's rating of effort and satisfaction to determine which of the 3 approaches was most feasible, acceptable, and effective. During the second phase, students were randomized to watch an instructional video or not before receiving remote coaching on how to complete a subxiphoid cardiac examination. Effort, satisfaction, and performance from the independent observer's and student's perspective were surveyed.
There was no significant difference between the different telemedicine setups from the observer's perspective; however, the mentor rated the smartphone significantly worse (P = .028-.04) than other technologies. Platforms were rated equivalent from the student's perspective. No benefit was detected for watching an instructional video before the mentored task.
Remote US skills can be taught equally effectively by using a variety of telemedicine technologies. Smartphones represent a viable option for US training in resource-challenged settings.
远程医疗技术有助于即时超声（US）教学；然而，昂贵的设备可能会限制其在资源匮乏地区的应用。我们评估了3种能够支持远程超声培训的低成本远程医疗解决方案，以确定其可行性、可接受性和有效性。我们还探讨了在远程指导前立即播放教学视频的价值。
36名参与者被随机分配到3种远程医疗条件中的1种接受超声指导：多个固定摄像头、智能手机以及带有实时超声流的传统音频。然后要求参与者在远程指导下对右上腹进行标准化超声检查。我们测量了观察者对操作的总体评分以及指导者和学生对努力程度和满意度的评分，以确定这3种方法中哪种最可行、最可接受且最有效。在第二阶段，学生被随机分为在接受关于如何完成剑突下心腔检查的远程指导之前观看教学视频或不观看。从独立观察者和学生的角度对努力程度、满意度和操作表现进行了调查。
从观察者的角度来看，不同的远程医疗设置之间没有显著差异；然而，指导者对智能手机的评分明显低于其他技术（P = 0.028 - 0.04）。从学生的角度来看，各平台的评分相当。在接受指导任务前观看教学视频未发现有任何益处。
使用多种远程医疗技术可以同样有效地教授远程超声技能。智能手机是在资源匮乏地区进行超声培训的一个可行选择。
