Effect of a point-of-care ultrasound protocol on the diagnostic performance of medical learners during simulated cardiorespiratory scenarios

Parks, Adam R; Verheul, Glenn; LeBlanc-Duchin, Denise; Atkinson, Paul

doi:10.1017/cem.2014.41

Cited by 21 publications

(23 citation statements)

References 12 publications

(10 reference statements)

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“…A number of previous studies employed training curricula for medical students on ultrasonography protocols [37][38][39]. Four other studies used a point-of-care ultrasonography training program to determine diagnostic performance in various clinical scenarios [36,[40][41][42]. All studies showed feasibility to train medical students to perform ultrasonography after a relatively short amount of training, which is comparable to the training medical students received in our study.…”

Section: Discussionsupporting

confidence: 74%

Feasibility of cardiac output measurements in critically ill patients by medical students

et al. 2020

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Background: Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. Objective: The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. Methods: In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. Results: There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min −1 with limits of agreement of − 2.6 L min −1 to 2.7 L min −1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. Conclusions: Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements.

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Section: Discussionsupporting

confidence: 74%

Feasibility of cardiac output measurements in critically ill patients by medical students

et al. 2020

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“…In these nine studies evaluating medical students' diagnostic accuracy with POCUS, relatively few students were trained and evaluated (sample sizes ranged from 2 to 30 subjects, with a median of 10). Trained medical students performed POCUS with acceptably proficient accuracy compared with the diagnostic standard . Medical students' diagnostic accuracy using ultrasound was found to be superior to that of the clinical evaluation of attending physicians in the two studies evaluating this outcome .…”

Section: Resultsmentioning

confidence: 88%

“…Trained medical students performed POCUS with acceptably proficient accuracy compared with the diagnostic standard. 10,[70][71][72] Medical students' diagnostic accuracy using ultrasound was found to be superior to that of the clinical evaluation of attending physicians in the two studies evaluating this outcome. 36,55 Results were mixed for the incremental benefit outcome; whereas one study reported significant improvement in diagnostic accuracy with the addition of POCUS, 73 rates of accurate diagnosis of some conditions were not always improved by the addition of ultrasound (e.g.…”

Section: Rationale 3: Ultrasound Improves Medical Students' Diagnostimentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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IntroductionPoint-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications. MethodsThis research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA. ResultsWe identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent, and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate. DiscussionOur analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

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“…Following the sessions, students completed an anonymous 5-point Likert questionnaire. The 5-point Likert scale ranged from not confident [1] to very confident [5] and assessed students' confidence in the following competency domains: ▪ Ability to identify major abdominal organs using hands-on wireless ultrasound scanners ▪ Physical examination skills after the hands-on ultrasound sessions…”

Section: Assessment Of Student Confidencementioning

confidence: 99%

Confidence Level and Ability of Medical Students to Identify Abdominal Structures After Integrated Ultrasound Sessions

Nausheen

Young

Brazil

et al. 2020

Ultrasound Int Open

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Determine the confidence level and ability of first year medical students to identify abdominal structures using a wireless portable ultrasound scanner.The students were assessed for their confidence and ability to perform abdominal ultrasound. The 5-point Likert survey included questions on their perception about ultrasound as a resource for learning anatomy, physical examination skills, and the quality of the pre-session instructions. Data was also recorded by the faculty about the students’ ultrasound skills and confidence. Goodman and Kruskal's gamma was used to demonstrate an association between the students’ ability to identify the structures and the self-reported student confidence level. Most of the students had confidence and were able to identify the liver, kidney, and urinary bladder, while almost half of them needed faculty help them to identify the inferior vena cava and aorta. The spleen and gall bladder were the most difficult to locate even for the very confident students. The perception of supervising faculty was that the confidence level was low in most of the students and only 13–20% of students felt “very confident” about performing ultrasound. Almost 37% needed encouragement and support and almost 10% of the students were not willing to try to locate difficult organs. Some students started locating the ureteric jet and portal vein. Most of the students agreed that ultrasound is an excellent resource for learning anatomy and physical examination skills. All students suggested having more ultrasound sessions. Most of the students feel confident about performing ultrasound and they perceive that ultrasound can enhance their basic sciences and physical examination skills.

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Effect of a point-of-care ultrasound protocol on the diagnostic performance of medical learners during simulated cardiorespiratory scenarios

Cited by 21 publications

References 12 publications

Feasibility of cardiac output measurements in critically ill patients by medical students

Feasibility of cardiac output measurements in critically ill patients by medical students

Ultrasound in undergraduate medical education: a systematic and critical review

Confidence Level and Ability of Medical Students to Identify Abdominal Structures After Integrated Ultrasound Sessions

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