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单一机构中学生主导的肌肉骨骼和血管超声研讨会的有效性:一项回顾性调查分析。

The Effectiveness of Student-Led Musculoskeletal and Vascular Ultrasound Workshops at a Single Institution: A Retrospective Survey Analysis.

作者信息

Kim Jane J, Li Jeffrey J, Nguyen Quang, Neilson Eric

机构信息

Education, California University of Science and Medicine, Colton, USA.

Family Medicine, California University of Science and Medicine, Colton, USA.

出版信息

Cureus. 2023 Jul 14;15(7):e41902. doi: 10.7759/cureus.41902. eCollection 2023 Jul.

Abstract

Introduction Point-of-care ultrasound (POCUS) is a rapidly evolving field of diagnostic medicine as its low cost, portability, and versatility have made handheld ultrasound (US) probes an invaluable tool for many modern physicians. Despite US's benefits as a bedside evaluative tool, many medical schools have not integrated POCUS into their pre-clerkship medical education due to a lack of equipment and faculty. The first objective of our study was to determine whether student tutors (STs) would be effective resources to teach musculoskeletal (MSK) and vascular US to preclinical medical students. The second objective of our study was to determine whether students who previously attended ST-run MSK US workshops perform better in vascular US than those who did not. Methods Six POCUS workshops were led by STs after approval from experienced US faculty. These included US workshops on gastrointestinal structures, forearm structures, joint structures, basic echocardiography, and US-guided IV access. We collected data from two of our six workshops. We developed surveys to gauge the confidence and ability of students to perform US after an MSK workshop and US-guided IV access workshop led by STs. We also measured students' US abilities and collected student feedback after our US-guided IV access workshop. We evaluated students' US competency in US-guided IV access via their ability to correctly position the US probe, angle the needle of insertion, move the probe with the needle, and access the vein based on the accuracy of the movements. We divided student results into two groups: students who previously attended the MSK workshop before attending the US-guided IV access workshop and students who did not attend the MSK workshop before attending the US-guided IV access workshop. We used averages, frequencies, and two-tailed t-tests to analyze the survey responses and US-guided IV access skill assessments. Results Fifty percent of first- and second-year surveyed students "agreed," and 32.4% "strongly agreed" that they felt confident using US after an ST-run MSK workshop. About 29.4% of surveyed students "agreed" and 41.2% "strongly agreed" that they felt comfortable explaining basic US concepts, such as proper probe positioning and echogenicity. The group of students who attended the MSK workshop prior to the peripheral IV workshop scored similarly to the students who did not attend the MSK workshop (14.33±1.03 versus 14.20±0.84 points). Both groups of students had an average of over 94% accuracy in technique, positioning, angling, moving the US probe, and achieving US-guided venous access after being taught by STs. Qualitative surveying noted positive student feedback, such as "Teacher was great at guiding us through the procedure." Survey responses also included suggestions on adding and diversifying equipment, such as "[It would be useful to have a] different type of needle to see the difference on ultrasound." Conclusion Based on the high percentages of accuracy and confidence, we found that STs were effective resources to teach MSK and vascular POCUS and that students who attended previous MSK ST-run US workshops had stronger vascular US ability over time compared to those who did not. Our data support the use of STs as US educational resources, especially in institutions without an existing pre-clerkship US curriculum and limited US resources.

摘要

引言 床旁超声检查(POCUS)是诊断医学中一个快速发展的领域,因其成本低、便携且功能多样,使得手持式超声(US)探头成为许多现代医生的宝贵工具。尽管超声作为床边评估工具具有诸多优势,但由于设备和师资缺乏,许多医学院校尚未将床旁超声检查纳入其临床前医学教育中。我们研究的首要目标是确定学生导师(STs)是否是向临床前医学生教授肌肉骨骼(MSK)和血管超声的有效资源。我们研究的第二个目标是确定之前参加过由学生导师主持的MSK超声工作坊的学生在血管超声方面的表现是否优于未参加过的学生。

方法 在经验丰富的超声教员批准后,由学生导师主持了六次床旁超声检查工作坊。这些工作坊包括关于胃肠道结构、前臂结构、关节结构、基础超声心动图以及超声引导下静脉穿刺的工作坊。我们从六个工作坊中的两个收集了数据。我们设计了调查问卷,以评估学生在参加由学生导师主持的MSK工作坊和超声引导下静脉穿刺工作坊后进行超声检查的信心和能力。我们还在超声引导下静脉穿刺工作坊后测量了学生的超声能力并收集了学生反馈。我们通过学生正确放置超声探头、确定进针角度、随针移动探头以及根据操作准确性成功穿刺静脉的能力,评估学生在超声引导下静脉穿刺方面的超声技能水平。我们将学生的结果分为两组:在参加超声引导下静脉穿刺工作坊之前参加过MSK工作坊的学生和在参加超声引导下静脉穿刺工作坊之前未参加过MSK工作坊的学生。我们使用平均值、频率和双尾t检验来分析调查问卷的回复以及超声引导下静脉穿刺技能评估。

结果 在接受调查的大一和大二学生中,50%的学生“同意”,32.4%的学生“强烈同意”,他们在参加由学生导师主持的MSK工作坊后对使用超声检查感到自信。约29.4%的受调查学生“同意”,41.2%的学生“强烈同意”,他们能够自如地解释基本的超声概念,如正确的探头放置和回声特性。在参加外周静脉穿刺工作坊之前参加过MSK工作坊的学生组与未参加MSK工作坊的学生组得分相似(14.33±1.03分对14.20±0.84分)。两组学生在由学生导师授课后,在技术、定位、角度调整、移动超声探头以及实现超声引导下静脉穿刺方面的平均准确率均超过94%。定性调查显示学生反馈积极,例如“老师在指导我们完成操作方面做得很好”。调查问卷的回复还包括关于增加和使设备多样化的建议,例如“[使用]不同类型的针来观察超声图像上的差异会很有用”。

结论 基于高准确率和信心比例,我们发现学生导师是教授MSK和血管床旁超声检查的有效资源,并且与未参加过的学生相比,之前参加过由学生导师主持的MSK超声工作坊的学生随着时间推移在血管超声方面的能力更强。我们的数据支持将学生导师用作超声教育资源,特别是在没有现有临床前超声课程且超声资源有限的机构中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc13/10423848/c074e94587ea/cureus-0015-00000041902-i01.jpg

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