Wahl Daniel J, Butki Andrew J, Butki Nikolai, Wisniewski Samuel J
McLaren Oakland.
Michigan State University, East Lansing, MI.
Spartan Med Res J. 2019 Mar 4;3(3):7402. doi: 10.51894/001c.7402.
During the past two decades, bedside ultrasound has revolutionized the practice of emergency medicine. Physicians are now expected to be competent in utilizing ultrasound skills, for patients presenting with conditions ranging from trauma to skin evaluations. The overall purpose of this quality improvement/patient safety (QIPS) project was to evaluate the effectiveness of a pair of five-hour, hands-on didactic/training sessions, aimed at preparing a sample of emergency medicine physicians, residents and medical students to perform peripheral ultrasound-guided nerve blocks.
The study location was set in a community-based emergency medicine program in Pontiac, Michigan. Data was collected from N = 54 emergency medicine residents, physicians and medical students. Data was collected from two training sessions in November 2017 and January 2018. The training consisted of a 12-question pre-test, followed by five hours of hands on & didactic training, with a subsequent post-test containing the same questions.
The authors compiled the data from both training sessions and found that the participants had an average correct percentage of 5.52 of 12 (46%) on the pre-test. After attending the training session, participants had an overall correct percentage of 9.24 of 12 (77%) on the post-test. This pre-to post-training increase of the mean scores was statistically significant, t (53) = -10.76 (p < 0.01), with an effect size (Cohen's d) of 1.82. Post hoc power calculations utilizing the d = 1.82 effect size revealed statistical power (1- ) of 100%.
The results of this QIPS evaluation project suggest that emergency physicians, residents and medical students may achieve an improved understanding of key ultrasound-guided nerve block material after a single five-hour session of hands-on training and didactics. Going forward, additional studies employing larger sample sizes that allow for outcome stratification by group (emergency physicians, residents, or medical students) along with relevant demographic variables (age, years in practice, etc.) in similar settings are needed to further verify these findings.
在过去二十年中，床边超声彻底改变了急诊医学的实践方式。如今，要求医生能够熟练运用超声技术，以应对从创伤到皮肤评估等各种病症的患者。这个质量改进/患者安全（QIPS）项目的总体目的是评估为期两天、每次五小时的实践教学/培训课程的效果，旨在让一部分急诊医学医生、住院医师和医学生有能力进行外周超声引导下的神经阻滞。
研究地点设在密歇根州庞蒂亚克市一个基于社区的急诊医学项目中。收集了N = 54名急诊医学住院医师、医生和医学生的数据。数据收集于2017年11月和2018年1月的两次培训课程。培训包括一个12道题的预测试，随后是五小时的实践和理论培训，之后进行包含相同问题的后测试。
作者汇总了两次培训课程的数据，发现参与者在预测试中12道题的平均正确百分比为5.52（46%）。参加培训课程后，参与者在后测试中12道题的总体正确百分比为9.24（77%）。从预测试到后测试平均分数的这种提高具有统计学意义，t（53）= -10.76（p < 0.01），效应量（科恩d值）为1.82。利用d = 1.82的效应量进行的事后功效计算显示统计功效（1 - ）为100%。
这个QIPS评估项目的结果表明，急诊医生、住院医师和医学生在单次五小时的实践培训和理论教学后，可能会对关键的超声引导下神经阻滞知识有更好的理解。展望未来，需要在类似环境中进行更多采用更大样本量的研究，以便能够按组（急诊医生、住院医师或医学生）以及相关人口统计学变量（年龄、从业年限等）对结果进行分层，以进一步验证这些发现。
