Reynolds Teri A, Noble Jeanne, Paschal Gehres, Sawe Hendry Robert, Sohoni Aparajita, Shah Sachita, Nicks Bret, Mwafongo Victor, Stein John
Emergency Medicine Department, Muhimbili National Hospital, Dar Es Salaam, Tanzania.
Department of Emergency Medicine, University of California, San Francisco, USA.
Afr J Emerg Med. 2016 Sep;6(3):125-131. doi: 10.1016/j.afjem.2016.03.001. Epub 2016 Apr 7.
In resource-rich settings, bedside ultrasound has rapidly evolved to be a crucial part of emergency centre practice and a growing part of critical care practice. This portable and affordable technology may be even more valuable in resource-limited environments where other imaging modalities are inaccessible, but the optimal amount of training required to achieve competency in bedside ultrasound is largely unknown. We sought to evaluate the feasibility of implementation of a mixed-modality bedside ultrasound training course for emergency and generalist acute care physicians in limited resource settings, and to provide a description of our core course components, including specific performance goals, to facilitate implementation of similar initiatives.
We conducted a standardised training course at two distinct sites-one large, urban tertiary hospital in Tanzania with a dedicated Emergency Centre, and one small, rural, hospital in southern Mexico with a general, acute intake area. We report on pre-training ultrasound use at both sites, as well as pre- and post-training views on most useful indications.
Overall, participants were very satisfied with the course, although approximately one-third of the providers at both sites would have preferred more hands-on training. All participants passed a standardised exam requiring image acquisition and interpretation.
Introducing bedside ultrasound training in two distinct resource-limited settings was feasible and well-received. After a brief intensive period of training, participants successfully passed a comprehensive examination, including demonstration of standardised image acquisition and accurate interpretation of normal and abnormal studies.
在资源丰富的环境中,床边超声已迅速发展成为急诊中心实践的关键部分,也是重症监护实践中日益重要的一部分。这种便携且经济实惠的技术在资源有限的环境中可能更具价值,因为在这些环境中无法使用其他成像方式,但要达到床边超声操作能力所需的最佳培训量在很大程度上尚不清楚。我们试图评估在资源有限的环境中为急诊和普通急性病护理医生实施混合模式床边超声培训课程的可行性,并描述我们核心课程的组成部分,包括具体的操作目标,以促进类似举措的实施。
我们在两个不同的地点开展了标准化培训课程——一个是坦桑尼亚的一家大型城市三级医院,设有专门的急诊中心;另一个是墨西哥南部的一家小型农村医院,设有普通急性病收治区。我们报告了两个地点培训前超声的使用情况,以及培训前后对最有用适应症的看法。
总体而言,参与者对该课程非常满意,尽管两个地点约三分之一的提供者希望有更多的实践培训。所有参与者都通过了一项要求进行图像采集和解读的标准化考试。
在两个不同的资源有限环境中引入床边超声培训是可行的,并且受到了广泛好评。经过短暂的强化培训期后,参与者成功通过了一项综合考试,包括展示标准化图像采集以及对正常和异常检查的准确解读。