McConnaughey Shannon, Freeman Rosario, Kim Sara, Sheehan Florence
Chief Resident, Department of Medicine, University of Washington Medical Center.
Professor, Division of Cardiology, University of Washington Medical Center.
MedEdPORTAL. 2018 Jan 19;14:10671. doi: 10.15766/mep_2374-8265.10671.
Focused cardiac ultrasound (FoCUS) is widely used for the point-of-care evaluation of basic cardiac pathology, and there is a need for efficient and consistent training in this modality. We designed a simulator-based FoCUS curriculum that integrates instructional scaffolding and deliberate practice to create a directed, self-regulated learning experience for novices. The goal of this strategy was to guide the novice's learning efforts more efficiently and moderate cognitive load while retaining the benefits of independent learning.
The complex task of learning cardiac ultrasound is broken into discrete steps, with focused didactic information immediately followed by targeted simulator practice for each module. The practice complexity increases through successive modules, and learners ultimately apply their skills by completing unassisted simulator cases. Immediate visual and quantitative feedback is provided by the simulator whenever an ultrasound image was captured during practice. The entire curriculum is self-guided.
Sixteen nurse practitioners and resident physicians completed this FoCUS curriculum. In comparison to a previously validated, lecture-before-practice-style curriculum, the average time to completion decreased from 8.0 ± 2.5 hours to 4.7 ± 1.9 hours ( < .0001). There was no difference in posttraining cognitive or psychomotor outcomes between the curricula as measured by a simulator posttest.
A curriculum integrating scaffolding and deliberate practice provides a more efficient, but equally effective, means of teaching psychomotor and cognitive skills in FoCUS. These instructional design principles may translate to other operational learning tasks and allow novices to build skills and reach basic competency more rapidly.
聚焦心脏超声（FoCUS）被广泛用于床边对基本心脏病理情况的评估，因此需要对这种方法进行高效且一致的培训。我们设计了一种基于模拟器的FoCUS课程，该课程整合了教学支架和刻意练习，为新手创造一种有指导的、自我调节的学习体验。这一策略的目标是更有效地指导新手的学习努力，减轻认知负荷，同时保留自主学习的益处。
将学习心脏超声这一复杂任务分解为离散的步骤，每个模块在提供重点教学信息后紧接着进行有针对性的模拟器练习。通过连续的模块，练习的复杂性逐渐增加，学习者最终通过完成无辅助的模拟器病例来应用他们的技能。在练习过程中，每当捕获超声图像时，模拟器会立即提供视觉和定量反馈。整个课程是自我指导的。
16名执业护士和住院医师完成了这一FoCUS课程。与之前经过验证的先讲课再练习式课程相比，平均完成时间从8.0±2.5小时降至4.7±1.9小时（P<0.0001）。通过模拟器后测衡量，两种课程在培训后的认知或心理运动结果上没有差异。
整合支架和刻意练习的课程提供了一种更高效但同样有效的方法，用于教授FoCUS中的心理运动和认知技能。这些教学设计原则可能适用于其他操作性学习任务，并使新手能够更快地培养技能并达到基本能力水平。
