Integrating Scaffolding and Deliberate Practice Into Focused Cardiac Ultrasound Training: A Simulator Curriculum

Abstract

Introduction: Focused cardiac ultrasound (FoCUS) is widely used for the point-of-care evaluation of basic cardiac pathology, and there is a need for efficient and consistent training in this modality. We designed a simulator-based FoCUS curriculum that integrates instructional scaffolding and deliberate practice to create a directed, self-regulated learning experience for novices. The goal of this strategy was to guide the novice's learning efforts more efficiently and moderate cognitive load while retaining the benefits of independent learning. Methods: The complex task of learning cardiac ultrasound is broken into discrete steps, with focused didactic information immediately followed by targeted simulator practice for each module. The practice complexity increases through successive modules, and learners ultimately apply their skills by completing unassisted simulator cases. Immediate visual and quantitative feedback is provided by the simulator whenever an ultrasound image was captured during practice. The entire curriculum is self-guided. Results: Sixteen nurse practitioners and resident physicians completed this FoCUS curriculum. In comparison to a previously validated, lecture-before-practice-style curriculum, the average time to completion decreased from 8.0 ± 2.5 hours to 4.7 ± 1.9 hours (p < .0001). There was no difference in posttraining cognitive or psychomotor outcomes between the curricula as measured by a simulator posttest. Discussion: A curriculum integrating scaffolding and deliberate practice provides a more efficient, but equally effective, means of teaching psychomotor and cognitive skills in FoCUS. These instructional design principles may translate to other operational learning tasks and allow novices to build skills and reach basic competency more rapidly.

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

“…One possible explanation for these disparities is that cardiac and FAST applications were more difficult to interpret, due to increased complexity of anatomy (cardiac, FAST), differences in number of views (FAST), or low a priori skill due to low rates of pathology of these applications at the bedside. Strategies that may enhance diagnostic performance outcomes using the education intervention in this study include scaffolding (e.g., embedding electronic hints or coaching),more deliberate review of incorrect cases (including referring to supplemental resources), and/or repeating cases as many times as needed to reach a desired performance outcome.…”

Focused cardiac ultrasound training in medical students: Using an independent, simulator‐based curriculum to objectively measure skill acquisition and learning curve

“…Frequent feedback was recommended as a key component of competence‐based medical education 25 . In addition, the curriculum utilizes integrated didactics and experiential learning, instructional techniques built into the curriculum to provide temporary support to novices, and focus them on constant improvement through repetitive practice 13 . Third, the simulator displays actual patient images to ensure a realistic training experience.…”

“…We designed a self‐guided curriculum that teaches first‐ and second‐year medical students FoCUS images and their acquisition using a simulator developed and validated at the University of Washington (UW) 11 . The curriculum employs educational tools previously shown to be efficacious in teaching internal medicine residents and nurse practitioners 12,13 . The present study sought to test whether medical students can learn FoCUS from a simulator‐based curriculum, how much they improve their skills, and the rate at which these skills are acquired.…”

Characteristics of Simulation-Based Point-of-Care Ultrasound Education: A Systematic Review of MedEdPORTAL Curricula

“…All the identified curricula were tailored at least partially toward physician trainees enrolled in graduate medical education programs, and most (6/8) were aimed at acute care audiences. [14][15][16]. Finally, the tamponade scenario created by Augenstein et al was uniquely targeted toward pediatric residents [12].…”

“…However, the specific materials used varied considerably. The simulations in the curricular package developed by Kobayashi et calls for the use of a mock transducer and computer with a high-fidelity ultrasound simulator validated in prior work [14,18]. The curriculum designed by Vusse et al involved the creation of a makeshift paracentesis trainer [16].…”