Lin-Martore Margaret, Olvera Michael P, Kornblith Aaron E, Zapala Matthew, Addo Newton, Lin Michelle, Werner Heidi C
Department of Emergency Medicine and Pediatrics University of California San Francisco CA USA.
School of Medicine University of California San Francisco CA USA.
AEM Educ Train. 2020 Sep 23;5(3):e10526. doi: 10.1002/aet2.10526. eCollection 2021 Jul.
Intussusception is a pediatric medical emergency that can be difficult to diagnose. Radiology-performed ultrasound is the diagnostic study of choice but may lead to delays due to lack of availability. Point-of-care ultrasound for intussusception (POCUS-I) studies have shown excellent accuracy and reduced lengths of stay, but there are limited POCUS-I training materials for pediatric emergency medicine (PEM) providers.
We performed a prospective cohort study assessing PEM physicians undergoing a primarily Web-based POCUS-I curriculum. We developed the POCUS-I curriculum using Kern's six-step model. The curriculum included a Web-based module and a brief, hands-on practice that was developed with a board-certified pediatric radiologist. POCUS-I technical skill, knowledge, and confidence were determined by a direct observation checklist, multiple-choice test, and a self-reported Likert-scale survey, respectively. We assessed participants immediately pre- and postcourse as well as 3 months later to assess for retention of skill, knowledge, and confidence.
A total of 17 of 17 eligible PEM physicians at a single institution participated in the study. For the direct observation skills test, participants scored well after the course with a median (interquartile range [IQR]) score of 20 of 22 (20-21) and maintained high scores even after 3 months (20 [20-21]). On the written knowledge test, there was significant improvement from 57.4% (95% CI = 49.8 to 65.2) to 75.3% (95% CI = 68.1 to 81.6; p < 0.001) and this improvement was maintained at 3 months at 81.2% (95% CI = 74.5 to 86.8). Physicians also demonstrated improved confidence with POCUS-I after exposure to the curriculum, with 5.9% reporting somewhat or very confident prior to the course to 76.5% both after the course and after 3 months (p < 0.001).
After a primarily Web-based curriculum for POCUS-I, PEM physicians performed well in technical skill in POCUS-I and showed improvement in knowledge and confidence, all of which were maintained over 3 months.
肠套叠是一种儿科急症，可能难以诊断。放射科进行的超声检查是首选的诊断方法，但由于设备可用性不足可能导致诊断延迟。针对肠套叠的床旁超声检查（POCUS-I）研究显示出极高的准确性并缩短了住院时间，但针对儿科急诊医学（PEM）提供者的POCUS-I培训材料有限。
我们进行了一项前瞻性队列研究，评估接受主要基于网络的POCUS-I课程的PEM医生。我们使用克恩的六步模型开发了POCUS-I课程。该课程包括一个基于网络的模块以及与一名获得董事会认证的儿科放射科医生共同开发的简短实践操作。POCUS-I的技术技能、知识和信心分别通过直接观察检查表、多项选择题测试和自我报告的李克特量表调查来确定。我们在课程前后以及3个月后对参与者进行评估，以评估技能、知识和信心的保持情况。
单一机构的17名符合条件的PEM医生全部参与了该研究。在直接观察技能测试中，参与者在课程结束后表现良好，中位数（四分位间距[IQR]）得分在22分中为20分（20 - 21分），即使在3个月后仍保持高分（20分[20 - 21分]）。在书面知识测试中，成绩从57.4%（95%置信区间 = 49.8至65.2）显著提高到75.3%（95%置信区间 = 68.1至81.6；p < 0.001），并且在3个月时保持在81.2%（95%置信区间 = 74.5至86.8）。医生在接触该课程后对POCUS-I的信心也有所提高，课程前报告有些或非常有信心的比例为5.9%，课程后以及课程后3个月均为76.5%（p < 0.001）。
在接受主要基于网络的POCUS-I课程后，PEM医生在POCUS-I的技术技能方面表现良好，知识和信心有所提高，并且所有这些在3个月内都得以保持。
