Stolz Lori A, Amini Richard, Situ-LaCasse Elaine, Acuña Josie, Irving Steven C, Friedman Lucas, Fiorello Albert B, Stea Nicholas, Fan Heinrich, Adhikari Srikar
Emergency Medicine, University of Cincinnati, Cincinnati, USA.
Emergency Medicine, University of Arizona, Tucson, USA.
Cureus. 2018 Nov 15;10(11):e3597. doi: 10.7759/cureus.3597.
Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R= 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
引言 本研究的目的是确定一门多模块入门超声课程是否能提高急诊医学实习生进行床旁超声检查的信心，以及我们选定的课程结构能否实现我们的教育目标。方法 这是一项前瞻性观察性研究，评估了来自三个住院医师培训项目的连续三届急诊医学住院医师班级。开展了为期一天的入门超声课程。该课程包括：1）翻转课堂式教学，2）面对面的、基于病例的互动教学课程，以及3）按清单进行、目标驱动的实践指导。结果 在三年时间里，73名住院医师参与了本研究。各年份之间在笔试成绩（p = 0.54）或技能评估（p = 0.16）方面没有显著差异。笔试前测成绩并非技能测试成绩的预测指标（R = 0.028；p = 0.19）。培训前，住院医师在进行创伤超声重点评估检查时最有信心（在10分制李克特量表上，中位信心为5.5（四分位间距（IQR）：3 - 7），其中1表示信心低，10表示信心高）。他们表示在进行心脏超声检查时信心最低（3（IQR：2 - 6））。培训后，住院医师报告称对所有应用的信心都有所增强（p < 0.001）。85%（置信区间（CI）：73，92）的住院医师同意在线超声讲座有效地教授了床旁超声应用，98%（CI：88，100）同意基于病例的互动课程帮助他们理解了超声如何改变急性病患者的管理。结论 关于床旁超声使用的知识笔试成绩在住院医师培训开始时与操作技能不相关，这表明两种技能的教学和评估都是必要的。经过多模块入门超声课程培训后，住院医师在进行七种基本超声应用时信心增强。住院医师报告称，异步课程和基于病例的互动课程达到了学习目标，并有效地教授了床旁超声应用。
