Abstracts
Abstract
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.
Résumé
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.
Appendices
Bibliography
- Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011 Feb 24;364(8):749-57. https://doi.org/10.1056/NEJMra0909487
- Hoppmann RA, Rao VV, Poston MB, et al. An integrated ultrasound curriculum (iUSC) for medical students: 4-year experience. Crit Ultrasound J. 2011 Apr;3(1):1-12. https://doi.org/10.1007/s13089-011-0052-9.
- International Federation for Emergency Medicine. Point-of-Care Ultrasound Curriculum Guidelines. First ed. West Melbourne: International Federation for Emergency Medicine, 2014.
- Steinmetz P, Dobrescu O, Oleskevich S, Lewis J. Bedside ultrasound education in Canadian medical schools: A national survey. Can Med Educ J. 2016 Mar 31;7(1):e78-86. https://doi.org/10.36834/cmej.36646
- Olszynski P, Anderson J, Trinder K, Domes T. Point-of-care ultrasound in undergraduate urology education: a prospective control-intervention study. J Ultrasound Med. 2018 Sep;37(9):2209-2213. https://doi.org/10.1002/jum.14571.
- Olszynski P, Russell M, Neufeld A, Malin G. The Clinical Ultrasonography Elective in Clerkship (CUSEC): a pilot elective for senior clerkship students at the University of Saskatchewan. Can Med Educ J. 2020 Mar 16;11(1):e144-e146. https://doi.org/10.36834/cmej.61810.
- Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med. 1993 Jun;68(6):443-51; discussion 451-3. https://doi.org/10.1097/00001888-199306000-00002.
- Stillman PL, Swanson DB. Ensuring the clinical competence of medical school graduates through standardized patients. Arch Intern Med. 1987 Jun;147(6):1049-52. PMID: 3592872.
- Stillman PL, Regan MB, Philbin M, Haley HL. Results of a survey on the use of standardized patients to teach and evaluate clinical skills. Acad Med. 1990 May;65(5):288-92. https://doi.org/10.1097/00001888-199005000-00002.
- Bokken L, Rethans JJ, Scherpbier AJ, van der Vleuten CP. Strengths and weaknesses of simulated and real patients in the teaching of skills to medical students: a review. Simul Healthc. 2008 Fall;3(3):161-9. https://doi.org/10.1097/SIH.0b013e318182fc56.
- Parks AR, Atkinson P, Verheul G, Leblanc-Duchin D. Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study. Crit Ultrasound J. 2013 Nov 19;5(1):9. https://doi.org/10.1186/2036-7902-5-9.
- Mackay FD, Zhou F, Lewis D, Fraser J, Atkinson PR. Can you teach yourself point-of-care ultrasound to a level of clinical competency? Evaluation of a self-directed simulation-based training program. Cureus. 2018 Sep 17;10(9):e3320. https://doi.org/10.7759/cureus.3320.
- Vignon P, Pegot B, Dalmay F, et al. Acceleration of the learning curve for mastering basic critical care echocardiography using computerized simulation. Intensive Care Med. 2018 Jul;44(7):1097-1105. https://doi.org/10.1007/s00134-018-5248-z.
- Ma IWY, Steinmetz P, Weerdenburg K, et al. The Canadian medical student ultrasound curriculum: a statement from the Canadian ultrasound consensus for undergraduate medical education group. J Ultrasound Med. 2020 Jul;39(7):1279-1287. https://doi.org/10.1002/jum.15218.
- Russell FM, Zakeri B, Herbert A, Ferre RM, Leiser A, Wallach PM. The state of point-of-care ultrasound training in undergraduate medical education: findings from a national survey. Acad Med. 2022 May 1;97(5):723-727. https://doi.org/10.1097/ACM.0000000000004512
- Bell C, Hall AK, Wagner N, Rang L, Newbigging J, McKaigney C. The Ultrasound Competency Assessment Tool (UCAT): development and evaluation of a novel competency-based assessment tool for point-of-care ultrasound. AEM Educ Train. 2020 Oct 3;5(3):e10520. https://doi.org/10.1002/aet2.10520.
- Bell C, Wagner N, Hall A, Newbigging J, Rang L, McKaigney C. The ultrasound competency assessment tool for four-view cardiac POCUS. Ultrasound J. 2021;13(1):42. Published 2021 Sep 27. https://doi.org/10.1186/s13089-021-00237-3
- Gofton WT, Dudek NL, Wood TJ, Balaa F, Hamstra SJ. The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE): a tool to assess surgical competence. Acad Med. 2012 Oct;87(10):1401-7. https://doi.org/10.1097/ACM.0b013e3182677805.
- Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in undergraduate medical education: a systematic review. J Ultrasound Med. 2018 Nov;37(11):2667-2679. https://doi.org/10.1002/jum.14628.
- Evans DK, Thiessen MEW. Novel approach to introducing an ultrasonography curriculum with limited instructor resources. J Am Osteopath Assoc. 2019 Aug 1;119(8):533-540. https://doi.org/10.7556/jaoa.2019.095.