Dupriez Florence, de Castro Bastian Rodrigues, Gendebien Félix, Fasseaux Antoine, Gensburger Matthieu, Marissiaux Laurent, Penaloza Andrea, Bobbia Xavier, Jarman Robert
Emergency Department, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200, Brussels, Belgium.
Emergency Department, Hôpital de Jolimont - Lobbes, Lobbes, Belgium.
Ultrasound J. 2023 Apr 10;15(1):18. doi: 10.1186/s13089-023-00317-6.
Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula.
Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students' PoCUS gallstone diagnosis were assessed. Secondary outcomes were students' confidence, image quality, acquisition time, and PoCUS skills.
Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes.
Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.
床旁超声（PoCUS）在临床实践中的应用越来越广泛，现在已被纳入许多本科课程。在此，我们旨在确定参加PoCUS教学计划并进行多次涉及健康志愿者的实践培训的医学生在识别胆囊病变时是否能达到较高的诊断准确性水平。干预组（IG）仅在健康胆囊的志愿者身上进行培训，而对照组（CG）则按照大多数PoCUS课程的建议，接触患有病理性胆囊的志愿者。
20名医学生被随机分配到IG和CG。在完成为期2个月的培训计划后，由三名独立考官对学生进行评估。学生和考官对分组情况和研究结果均不知情。评估了学生PoCUS诊断胆结石的敏感性和特异性。次要结果包括学生的信心、图像质量、采集时间和PoCUS技能。
IG组胆结石诊断的敏感性和特异性分别为0.85和0.97，CG组分别为0.80和0.83。基于受试者工作特征曲线分析的曲线下面积（AUC）在IG组和CG组分别为0.91和0.82，无显著差异（p = 0.271），AUC差异为-0.092。次要结果在组间未发现显著差异。
我们的初步研究表明，医学生在对健康志愿者进行培训后可以提高PoCUS诊断准确性。如果这些发现在更大的样本中得到证实，这可能有利于开展大型实践教学课程，而无需纳入患有病变的患者，从而便于对学生进行PoCUS培训。
