Das Devjani, Kapoor Monica, Brown Cara, Husain Abbas, Rubin Marina, Chacko Jerel, Rudnin Simone, Hahn Barry, Greenstein Josh
Emergency Medicine, New York Columbia Presbyterian Hospital, New York, USA.
Emergency Medicine, UMass Memorial Medical Center, Worcester, USA.
Cureus. 2020 Jul 6;12(7):e9021. doi: 10.7759/cureus.9021.
Introduction In the emergency department, the diagnosis of an Achilles tendon rupture (ATR) is reportedly missed in greater than 20% of cases. A limited number of studies evaluate the use of cadaver models as a potential ultrasound teaching and training modality. We hypothesize that emergency medicine residents can effectively utilize point-of-care ultrasound (POCUS) on cadaver models and a focused teaching intervention to assess their ability to detect ATRs. Methods A prospective study of 23 EM residents was performed. All participants in the study were divided into two learner groups: (a) independent and (b) hands-on. The independent learner group received a 30-minute online didactic lecture demonstrating how to diagnose ATRs. The hands-on learner group received direct instruction on cadaver lower leg models with a ruptured and normal Achilles tendon (AT). Both groups then participated in identifying either normal or ruptured ATs on six cadaver lower leg models. Results The sensitivity and specificity were 89% and 82% in the independent learner group 96% and 100% in the hands-on learner group, respectively. The overall sensitivity and specificity were 91% and 88%, respectively. There was a trend toward successful identification with increased years of residency training. Conclusions In this study, lower leg and ankle cadaver models were found to be as effective as an independent learner model for potential POCUS teaching and training modality in both novice and more advanced trainees.
引言 在急诊科，据报道超过20%的跟腱断裂（ATR）病例被漏诊。仅有少数研究评估了使用尸体模型作为一种潜在的超声教学和培训方式。我们假设急诊医学住院医师能够有效地在尸体模型上使用床旁超声（POCUS），并通过针对性的教学干预来评估他们检测跟腱断裂的能力。方法 对23名急诊医学住院医师进行了一项前瞻性研究。研究中的所有参与者被分为两个学习组：（a）自主学习组和（b）实践操作组。自主学习组接受了一次30分钟的在线理论讲座，演示如何诊断跟腱断裂。实践操作组在带有跟腱断裂和正常跟腱（AT）的尸体小腿模型上接受了直接指导。然后两组都参与在六个尸体小腿模型上识别正常或断裂的跟腱。结果 自主学习组的敏感性和特异性分别为89%和82%，实践操作组分别为96%和100%。总体敏感性和特异性分别为91%和88%。随着住院医师培训年限的增加，成功识别的趋势明显。结论 在本研究中，发现小腿和踝关节尸体模型对于新手和更高级别的受训者而言，作为潜在的床旁超声教学和培训方式，与自主学习模型一样有效。
