Shrestha Roshana, Blank Wolfgang, Shrestha Anmol Purna, Pradhan Alok
Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal.
Medical Clinic I, Klinikum am Steinenberg Reutlingen Teaching Hospital, University Tübingen, Tübingen, Germany.
Open Access Emerg Med. 2020 Apr 29;12:99-109. doi: 10.2147/OAEM.S246656. eCollection 2020.
Point-of-care ultrasound (POCUS) is a quick bedside tool that has the potential to improve emergency care in resource-limited settings due to its relatively low cost and accessibility. Effort to disseminate the knowledge and skills about POCUS is inadequate in low and middle income countries like Nepal. We conducted a two-day interdisciplinary advanced emergency ultrasound workshop that targeted physicians working in emergency department and primary care, especially in rural Nepal. We explored the effectiveness of this training based on validated Kirkpatrick's 4 steps of evaluating training outcomes.
We conducted a prospective quasi-experimental study with mixed research design. Multidisciplinary physicians working in emergency departments participated in the two-day workshop. We assessed and compared the pre- and post-workshop knowledge. We collected on-site and a follow-up feedback to explore pre- and post-workshop confidence level, perceived usefulness and clinical use of ultrasound using a 5-point Likert scale. The barriers to use POCUS were explored.
A total of 50 physicians from different parts of Nepal participated in the workshop. The academic level of the participants, duration of their clinical experience and the previous use of POCUS did not have a significant difference in their pre- and posttest knowledge scores. The difference between the median (IQR) pre- and posttest scores [14 (12.75-17.75) and 24.5 (22.25-25.5), respectively] was statistically significant (p<0.001). Perceived confidence level and usefulness of the POCUS increased significantly in all of its domains (p<0.001). Self-reported increase in its clinical use was significant (p<0.001) for all fields.
The participation in this emergency ultrasound workshop increased the knowledge of participants in POCUS. Their confidence, perceived usefulness and clinical use of POCUS improved significantly. Objective longitudinal follow-up of participants' skill and demonstration of increased clinical use of POCUS in emergency department influencing the clinical outcome would be the focus of future research.
即时超声检查（POCUS）是一种便捷的床边检查工具，因其成本相对较低且易于获取，有潜力改善资源有限地区的急诊医疗。在尼泊尔等低收入和中等收入国家，传播POCUS知识和技能的工作力度不足。我们针对尼泊尔农村地区急诊科和基层医疗部门的医生，举办了为期两天的跨学科高级急诊超声研讨会。我们基于经过验证的柯克帕特里克评估培训结果的4个步骤，探讨了此次培训的效果。
我们采用混合研究设计进行了一项前瞻性准实验研究。急诊科的多学科医生参加了为期两天的研讨会。我们评估并比较了研讨会前后的知识水平。我们收集了现场和后续反馈，以使用5点李克特量表探讨研讨会前后对超声检查的信心水平、感知有用性和临床应用情况。还探讨了使用POCUS的障碍。
共有50名来自尼泊尔不同地区的医生参加了此次研讨会。参与者的学术水平、临床经验时长以及之前对POCUS的使用情况，在其测试前后的知识得分上没有显著差异。测试前和测试后的中位数（四分位间距）得分分别为[14（12.75 - 17.75）和24.5（22.25 - 25.5）]，差异具有统计学意义（p<0.001）。POCUS在所有领域的感知信心水平和有用性均显著提高（p<0.001）。所有领域自我报告的临床应用增加均具有统计学意义（p<0.001）。
参加此次急诊超声研讨会增加了参与者对POCUS的知识。他们对POCUS的信心、感知有用性和临床应用均有显著改善。对参与者技能进行客观的纵向随访，以及证明POCUS在急诊科临床应用增加对临床结果的影响，将是未来研究的重点。
