University of Wisconsin, Department of Emergency Medicine, Madison, Wisconsin.
Tucson Medical Center, Department of Emergency Medicine, Tucson, Arizona.
West J Emerg Med. 2020 Dec 14;22(1):124-129. doi: 10.5811/westjem.2020.12.48717.
Point-of-care ultrasound (POCUS) has an emerging presence in medical student education; however, there is limited evidence that this translates into appropriate clinical care. We aimed to evaluate the ability of medical students to integrate newly obtained POCUS knowledge into simulated clinical cases.
We conducted an observational study of medical students participating in a mandatory rotation during their clinical years. Students in small groups underwent formalized lung POCUS lectures and hands-on training. Students participated in simulated "dyspnea" cases focused on either congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). They were observed for critical actions including elements related to medical decision-making and ultrasound use and interpretation. Ultrasound-specific written knowledge was gauged with a short assessment after the first lecture and at week 4.
A total of 62 students participated and were observed during simulations. All groups correctly identified and treated CHF in the simulated case. Most groups (7 out of 9) attempted to use ultrasound in the CHF case; five groups correctly recognized B-lines; and four groups correctly interpreted B-lines as pulmonary edema. No groups used ultrasound in the COPD case.
Most students attempted to use ultrasound during simulated CHF cases after a brief didactic intervention; however, many students struggled with clinical application. Interestingly, no students recognized the need to apply ultrasound for diagnosis and management of COPD. Future studies are needed to better understand how to optimize teaching for medical students to improve translation into POCUS skills and improved clinical practice.
即时超声（POCUS）在医学生教育中崭露头角；然而，仅有有限的证据表明这能转化为适当的临床护理。我们旨在评估医学生将新获得的 POCUS 知识整合到模拟临床病例中的能力。
我们对参加临床学年必修轮转的医学生进行了一项观察性研究。学生分组进行正式的肺部 POCUS 讲座和实践培训。学生参与以充血性心力衰竭（CHF）或慢性阻塞性肺疾病（COPD）为重点的模拟“呼吸困难”病例。观察他们的关键操作，包括与医疗决策和超声使用和解释相关的要素。在第一次讲座后和第 4 周，通过简短的评估来衡量超声特定的书面知识。
共有 62 名学生参与并在模拟中观察。所有组在模拟病例中均正确识别和治疗 CHF。大多数组（9 组中的 7 组）在 CHF 病例中尝试使用超声；5 组正确识别 B 线；4 组正确解释 B 线为肺水肿。没有组在 COPD 病例中使用超声。
在简短的教学干预后，大多数学生尝试在模拟 CHF 病例中使用超声；然而，许多学生在临床应用方面遇到困难。有趣的是，没有学生认识到需要应用超声来诊断和管理 COPD。需要进一步研究，以更好地了解如何优化医学生的教学，以提高 POCUS 技能和改善临床实践的转化。
