Alzaabi Ahmed N, Chaggar Gurpreet, Hussain Mohammed Wasif, Daniels Vijay J, Beecher Grayson
From the Division of Neurology, Department of Medicine (A.N.A., G.C., M.W.H., G.B.), Department of Medicine (V.J.D.), and Neuroscience and Mental Health Institute (NMHI) (G.B.), University of Alberta, Edmonton, Canada.
Neurol Educ. 2024 Oct 4;3(4):e200166. doi: 10.1212/NE9.0000000000200166. eCollection 2024 Dec 25.
Point-of-care neuromuscular ultrasound (NMUS) is increasingly used in the evaluation of peripheral nervous system disorders; however, there remains a gap in education and training for neurology residents. We evaluated whether neurology residents can feasibly be trained in basic NMUS skills and nerve cross-sectional area (CSA) measurement and whether they value incorporation of this training into their curriculum.
Participants included neurology residents (postgraduate years 1-5) at the University of Alberta (Edmonton, Alberta, Canada). All completed pretraining and posttraining surveys using a Likert scale, rating their confidence in independently performing NMUS and their degree of agreement regarding the educational value of NMUS training. Residents underwent training (7 hours) comprising 1 didactic and 2 hands-on sessions, detailing NMUS of median, ulnar, and fibular nerves. Participants could then opt-in to a posttraining testing session where CSA measurements (mm) of the median, ulnar, and fibular nerve at multiple sites were independently performed on 3 healthy volunteers and compared with measurements obtained by the trainer.
Eighteen residents participated in training and pretraining/posttraining surveys. Nine completed the testing component. Nerve CSA measurement reliability between the trainer and trainees across all nerve sites combined was very good (intraclass correlation coefficient [ICC] 0.93, 95% CI 0.83-0.96) but varied by nerve and site. ICC was good to very good (0.62-0.95) except for the ulnar nerve-distal forearm/wrist (0.39-0.58) and fibular nerve-fibular head (0.12) sites. The coefficient of variation (CoV) across all sites was 19.6% (95% CI 17.3-21.8) and best for the median nerve-wrist site at 15.5% (9.8-20.8). The mean absolute difference between trainer and trainee measurements was low (<0.5 mm across all sites). Comparing pretraining and posttraining survey responses, there was a significant increase in agreement that basic NMUS operational skills were obtained and in confidence in independently measuring each nerve. NMUS training was considered a valuable component of a neurology residency program curriculum (median rating: strongly agree).
Neurology residents across stages of training can acquire basic NMUS and CSA measurement skills of the median and ulnar nerves after 2 half-days of training and value incorporation of NMUS training in their educational curriculum.
床旁神经肌肉超声（NMUS）在周围神经系统疾病评估中的应用日益广泛；然而，神经病学住院医师的教育与培训仍存在差距。我们评估了神经病学住院医师是否能够切实接受基本NMUS技能和神经横截面积（CSA）测量的培训，以及他们是否重视将此培训纳入其课程。
参与者包括加拿大艾伯塔省埃德蒙顿市阿尔伯塔大学的神经病学住院医师（研究生1至5年级）。所有人均使用李克特量表完成培训前和培训后的调查，对他们独立进行NMUS的信心以及对NMUS培训教育价值的认同程度进行评分。住院医师接受了为期7小时的培训，包括1次理论授课和2次实践操作课程，详细讲解正中神经、尺神经和腓总神经的NMUS检查。之后，参与者可以选择参加培训后的测试环节，在3名健康志愿者身上独立测量正中神经、尺神经和腓总神经多个部位的CSA（mm），并与培训师获得的测量结果进行比较。
18名住院医师参加了培训及培训前/培训后的调查。9人完成了测试部分。所有神经部位培训师与学员之间神经CSA测量的可靠性非常好（组内相关系数[ICC]为0.93，95%可信区间为0.83 - 0.96），但因神经和部位而异。除尺神经-前臂远端/腕部（0.39 - 0.58）和腓总神经-腓骨头（0.12）部位外，ICC为良好至非常好（0.62 - 0.95）。所有部位的变异系数（CoV）为19.6%（95%可信区间为17.3 - 21.8），正中神经-腕部部位最佳，为15.5%（9.8 - 20.8）。培训师与学员测量结果的平均绝对差值较低（所有部位均<0.5 mm）。比较培训前和培训后的调查回复，在获得基本NMUS操作技能以及独立测量每条神经的信心方面，认同度有显著提高。NMUS培训被认为是神经病学住院医师培训项目课程的一个有价值的组成部分（中位数评分：强烈同意）。
不同培训阶段的神经病学住院医师在经过两天半的培训后，可以掌握正中神经和尺神经的基本NMUS及CSA测量技能，并重视将NMUS培训纳入其教育课程。
