How Does Ultrasound Simulation during High Fidelity Simulation Contribute to the Development of Emergency Ultrasound Skills Amongst Emergency Medicine Trainees?

The growing worldwide use of clinician-performed ultrasound (CPU) marks a dramatic change in bedside medicine and patient care. With steadily improving portability, accessibility and technology, ultrasound use continues to grow amongst many medical specialties. Likewise, the application of CPU in emergency medicine is increasing. Emergency Medicine (EM) is a medical specialty “based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury…” (International Federation for Emergency Medicine, 1991). Increasingly, emergency physicians are using emergency department ultrasound (ED U/S) to enhance their assessment of critically-ill patients (American College of Emergency Physicians, 2008). The purpose of this study was to evaluate and describe those aspects of ultrasound simulation (during HFS) that contribute to the development of critical care ED U/S skills. Secondly, it was of interest to assess how a novel ultrasound simulator (edus2) compared to video playback on a laptop in terms of the above-mentioned aspects. The population of interest included both EM trainees and faculty. This investigation was a randomized, prospective, crossover study with two intervention treatments for all participants. In Phase I, EM trainees and faculty from London, UK, were invited to participate in one of four day-long critical-care HFS sessions during which they participated in four critical-care scenarios. Faculty were involved in assisting with session debriefing and feedback. All participants completed two cases with each intervention. In Phase II, faculty in Saskatoon, SK, Canada, were invited to review video recordings of the sessions from Phase I and evaluate the educational merits of the two ED U/S simulation interventions. iii This study produced both quantitative and qualitative data. As this study looked at two interventions and how they could contribute to the development of ED U/S skills, pre- and postintervention changes were analysed for statistically significant differences between them. T-test analyses were used for comparisons. Effect sizes (Cohen’s d) were calculated where statistically significant findings were observed. Qualitative data was assessed through emergent thematic analysis and triangulation. The findings of the study support the integration of ED U/S simulation into HFS. Integration was found to be of value to both trainees and faculty by allowing trainees to demonstrate knowledge of indications as well as correct image interpretation and general integration of ED U/S into critical care (p<0.05). Trainees described an increased motivation to develop their ED U/S skills as well as greater desire to use ED U/S in everyday practice. Furthermore, the edus2 was identified as being the preferred training intervention. The edus2 met functional fidelity through its real time and hands-on applicability. Faculty preferred the edus2 as it allowed for better assessment of trainee skills that then influenced session debriefing and formative feedback. Faculty in Phase II found the edus2 intervention sufficient in offering basic insights into trainee ED U/S skills and mastery (p<0.05). Implications of the study include support for the use of ultrasound simulation during HFS for the development of critical care ED U/S skills amongst EM trainees. Further study on the effects of such hybrid simulation on clinical performance is warranted

The Clinical Ultrasonography Elective in Clerkship (CUSEC): A pilot elective for senior clerkship students at the University of Saskatchewan

We created a clinical ultrasound (CUS) elective in clerkship, which gave medical students the opportunity to enhance their knowledge and technical skills while refining their CUS-related clinical decision making. This elective uniquely allowed medical students to integrate their CUS knowledge and skills into real patient care within the clinical environment (discipline) of their choice. As such, beyond supporting increasing technical competence, students learned to advocate for appropriate use of CUS, an important skill for trainees to develop.&nbsp

Amélioration des compétences en matière d’échographie au point d’intervention grâce à la rétroaction supplémentaire fournie par des patients simulés instructeurs

Background: Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience.  Methods: Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation. Results: Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly.  Conclusions: Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.Contexte : L’enseignement de l’échographie au point d’intervention (POCUS) dans les programmes de médecine de premier cycle au Canada est en pleine expansion. Jusqu’à présent, les patients simulés (PS) de notre programme ne fournissaient que des commentaires sur le confort et le professionnalisme. La participation de patients simulés en tant qu’instructeurs (PS-instructeurs) pour les compétences POCUS offre une occasion d’apprentissage supplémentaire. Dans cette étude pilote, nous avons exploré l’effet de l’intervention des PS-instructeurs dans le cadre d’une séance de formation en POCUS. Les résultats sont intéressants en ce qui concerne le niveau de compétences atteint par les stagiaires à la suite de la séance et sur le plan de leur satisfaction à l’égard de cette expérience d’apprentissage. Méthodes : Des étudiants en deuxième année de médecine ont été répartis au hasard entre un groupe qui a reçu une formation traditionnelle et un groupe qui a reçu la formation avec l’intervention de PS-instructeurs. Les deux groupes ont eu accès au même tutoriel, aux mêmes conseils de l’instructeur et à une rétroaction de base de la part des PS (confort et professionnalisme). Les apprenants du groupe travaillant avec des PS-instructeurs ont reçu des commentaires supplémentaires de la part de ces derniers (repères, technique du transducteur et dépannage) pendant que les instructeurs assistaient d’autres stagiaires. Les étudiants ont évalué la séance et ont ensuite fait l’objet d’une évaluation par observation directe. Résultats : Les étudiants qui ont bénéficié de l’intervention de PS-instructeurs ont obtenu des résultats nettement plus élevés en ce qui concerne l’acquisition d’images (p=0,029, d=1,26) et leur score de confiance global (p=0,002, d=1,75). Les deux groupes ont évalué leur séance de formation de manière très positive. Conclusions : On a constaté que les étudiants qui ont bénéficié de commentaires supplémentaires de la part des PS-instructeurs ont eu de meilleurs résultats en acquisition d’images et un score de confiance plus élevé. D’après cette étude pilote, les PS-instructeurs ont eu un effet positif sur l’acquisition de compétences en POCUS

Correction to: Position statement: minimum archiving requirements for emergency medicine point‑of‑care ultrasound—a modified Delphi‑derived national consensus (Canadian Journal of Emergency Medicine, (2021), 23, 4, (450-454), 10.1007/s43678-021-00109-8)

A correction to this paper has been published: https://doi.org/10.1007/s43678-021-00117-8

Enhanced point of care ultrasound skills after additional instruction from simulated patients

Background: Point of Care Ultrasound (POCUS) training in Canadian undergraduate medical programs is steadily increasing. To date, the simulated patients (SPs) in our program have only provided feedback on comfort and professionalism. Involving the POCUS SPs as teachers (SP-teachers) of POCUS skills provides an additional opportunity for instruction. In this pilot study, we explored the impact of SP-teachers instructing medical trainees while they learned POCUS. Outcomes of interest included the level of proficiency achieved after the session and trainee satisfaction with the learning experience.Methods: Second year medical students were randomized into a conventional or SP-teacher learning experience. Both groups received the same video tutorial, instructor guidance, and basic SP feedback (comfort and professionalism). The SP-teaching group received additional instruction (landmarks, transducer technique, and troubleshooting) from the SP-teachers when session instructors were assisting others. Students evaluated the session and were subsequently assessed through direct observation.Results: Students that received SP-teaching scored significantly higher in both image acquisition (p = 0.029, d = 1.26) and overall entrustment (p = 0.002, d =1.75). Both groups rated their sessions highly.Conclusions: Students that received SP-teaching were observed to better acquire images and achieved higher entrustment scores. In this pilot study, SP-teachers had a positive effect on acquisition of POCUS skills.Contexte : L’enseignement de l’échographie ciblée (ÉC) dans les programmes de médecine de premier cycle au Canada est en pleine expansion. Jusqu’à présent, les patients simulés (PS) de notre programme ne fournissaient qu’une rétroaction sur leur confort et le professionnalisme. La participation de patients simulés en tant qu’instructeurs (PS-instructeurs) pour les compétences POCUS offre une occasion d’apprentissage supplémentaire. Dans cette étude pilote, nous avons exploré l’effet de l’intervention de PS-instructeurs dans le cadre d’une séance de formation en POCUS. Nous nous sommes intéressés tout particulièrement au niveau de compétence atteint par les stagiaires à la suite de la séance et sur le plan et de leur satisfaction à l’égard de cette expérience d’apprentissage.Méthodes : Des étudiants en deuxième année de médecine ont été répartis au hasard entre un groupe qui a reçu une formation traditionnelle et un groupe qui a reçu la formation avec rétroaction du PS-formateur. Les deux groupes ont eu accès au même tutoriel, aux mêmes conseils de l’instructeur et à une rétroaction de base de la part des PS (confort et professionnalisme). Les apprenants du groupe travaillant avec des PS-formateur i ont reçu des commentaires supplémentaires de la part de ces dernier (repères, manipulation de la sonde transducteur et dépannage) pendant que les instructeurs aidaient d’autres stagiaires. Les étudiants ont évalué la séance et ont ensuite fait l’objet d’une évaluation par observation directe.Résultats : Les étudiants qui ont bénéficié de l’intervention du PS-formateur ont obtenu des résultats nettement meilleurs élevés en ce qui concerne l’acquisition d’images (p=0,029, d=1,26) et leur score de confiance global (p=0,002, d=1,75). Les deux groupes ont évalué leur séance de formation de manière très positive.Conclusions : les étudiants qui ont bénéficié de commentaires supplémentaires de la part des leur PS-formateur ont eu de meilleurs résultats en acquisition d’images et un score de confiance plus élevé. D’après cette étude pilote, les PS-instructeurs ont eu un effet positif sur l’acquisition de compétences en POCUS

Protocol: A Randomized-controlled Mixed Method Study of Video Modeling and Video Feedback to Reduce Time to Perform Intravenous Cannulation in Medical Students

Study protocol pertaining to research study: "A qualitative synthesis of video feedback in higher education", currently in reviewN/ANon-Peer Reviewe

The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan

Objectives: The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards. Methods: A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan’s annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system. Results: The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents. Conclusion: The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.Medicine, Faculty ofNon UBCEmergency Medicine, Department ofReviewedFacult

EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound:Part One (Common Heart and Pulmonary Applications) SHORT VERSION

Aims To evaluate the evidence and produce a summary and recommendations for the most common heart and lung applications of point-of-care ultrasound (PoCUS). Methods We reviewed 10 clinical domains/questions related to common heart and lung applications of PoCUS. Following review of the evidence, a summary and recommendation were produced, including assignment of levels of evidence (LoE) and grading of the recommendation, assessment, development, and evaluation (GRADE). 38 international experts, the expert review group (ERG), were invited to review the evidence presented for each question. A level of agreement of over 75 % was required to progress to the next section. The ERG then reviewed and indicated their level of agreement regarding the summary and recommendation for each question (using a 5-point Likert scale), which was approved if a level of agreement of greater than 75 % was reached. A level of agreement was defined as a summary of “strongly agree” and “agree” on the Likert scale responses. Findings and Recommendations One question achieved a strong consensus for an assigned LoE of 3 and a weak GRADE recommendation (question 1). The remaining 9 questions achieved broad agreement with one assigned an LoE of 4 and weak GRADE recommendation (question 2), three achieving an LoE of 3 with a weak GRADE recommendation (questions 3–5), three achieved an LoE of 3 with a strong GRADE recommendation (questions 6–8), and the remaining two were assigned an LoE of 2 with a strong GRADE recommendation (questions 9 and 10). Conclusion These consensus-derived recommendations should aid clinical practice and highlight areas of further research for PoCUS in acute settings