Resident Accuracy of Musculoskeletal Palpation With Ultrasound Verification

Mehta, Priyesh; Rand, Ethan; Visco, Christopher J.; Wyss, James F.

doi:10.1002/jum.14523

Cited by 16 publications

(23 citation statements)

References 14 publications

(34 reference statements)

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“…Ultrasound use in clinical practice has become progressively more common in the United States, a trend likely to continue as portable ultrasound machines become more accessible and residency and fellowship programs implement ultrasound curricula . As stated by the American Institute of Ultrasound in Medicine, “Infection control is an integral part of the safe and effective use of ultrasound in medicine.” However, despite increased ultrasound use, institutions have adopted widely varied approaches to ultrasound cleaning. Some hospitals have yet to implement any cleaning protocol for ultrasound procedures.…”

Section: Discussionmentioning

confidence: 99%

Identification and Analysis of Bacterial Contamination of Ultrasound Transducers and Multiuse Ultrasound Transmission Gel Bottle Tips Before and After the Aseptic Cleansing Technique

Mullins

Burnham

Henricson

et al. 2020

J of Ultrasound Medicine

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Objectives-To provide a descriptive analysis for species identification of culture and Gram stain results from ultrasound transducers and multiuse ultrasound transmission gel bottle tips in active clinical use and to compare bacterial cultures from ultrasound transducers before and after aseptic cleansing. Methods-A prospective blinded descriptive analytic study of 18 distinct clinical care sites within a single primary clinical institution was conducted. Before and after a disinfectant towel cleanse, transducers were pressed against tryptic soy agar contact plates. Plates were deidentified and submitted for blind incubation, Gram staining, and species identification with microsequencing. Results were classified as clinically relevant (CR) or non-clinically relevant. In total, 188 samples were analyzed: 80 from ultrasound transducers before and cleansing, 13 from multiuse gel bottle tips before and after cleansing, and 2 precleansing samples from the data collector's pen and badge. Results-Fifty-nine precleansing samples (73.8%) grew cultures with CR bacteria, and 21 samples (26.3%) did not. Staphylococcus simulans represented 31.0% of all positive culture samples. Thirteen postcleansing samples (16.3%) grew cultures with CR bacteria, equating to a 78.0% reduction of CR bacterial growth (likelihood ratio, 57.10; P < .001). Conclusions-Ultrasound transducers have a notable CR bacterial burden and may serve as potential infective vectors. Aseptic cleansing effectively eliminates most of the bacterial load from ultrasound transducers, but some bacteria persist, presenting a risk of nosocomial infection with ultrasound-guided interventions. These findings support American Institute of Ultrasound in Medicine 2018 guidelines intended to ensure an appropriate level of transducer preparation based on the examination type while emphasizing rational infection control measures to minimize the risk of potential patient harm.

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Section: Discussionmentioning

confidence: 99%

Identification and Analysis of Bacterial Contamination of Ultrasound Transducers and Multiuse Ultrasound Transmission Gel Bottle Tips Before and After the Aseptic Cleansing Technique

Mullins

Burnham

Henricson

et al. 2020

J of Ultrasound Medicine

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“…2 One of the major challenges in learning and teaching palpation skills for Physical Medical and Rehabilitation (PM&R) residents is verifying accuracy. 3 Limitation of feedback or verification on accurate palpation of anatomic structures often hinders PM&R residents' improvement in their palpation skills. 4 It is often difficult for a supervising physician to discern from observation alone whether the PM&R resident is palpating the correct structure.…”

Section: Introductionmentioning

confidence: 99%

“…These were limited to large joints such as the shoulder 5,6 and knee. 3,4 Foot and ankle pain, affecting approximately 1 in 5 middle-aged to older people, 7 is frequently encountered in a PM&R practice. It impairs quality of life 8 and functional ability in the older population.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Resident Palpation Skills in Foot and Ankle Anatomic Structures Using Bedside Ultrasound

Lee¹,

Le²,

Dien³

et al. 2020

HCA Healthcare Journal of Medicine

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The objective is to determine the accuracy of foot and ankle joint and soft tissue structure palpation in Physical Medicine and Rehabilitation (PM&R) residents using ultrasonography (US) verification. Methods PM&R residents were tested in an outpatient musculoskeletal (MSK) clinic on palpated foot and ankle anatomic structures in a human model. Once the presumed structures were localized, residents marked a 1 cm size circle on the overlying skin with a ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US. Results The overall palpation accuracy for 22 joint line and soft tissue structures was 38.0%. Accuracy by foot and ankle region, including the posterior, medial, lateral, plantar, and dorsal were 72.9%, 47.5%, 42.5%, 35% and 7.8% respectively. There was a positive trend with level of education without a statistically significant difference in palpation accuracy (30.4% in PGY-2, 38.3% in PGY-3, 44.2% in PGY-4, p = 0.11). Conclusions Residents in this study demonstrated suboptimal accuracy of foot and ankle anatomic structure identification by palpation. US may be a useful adjunctive tool to advance current methods of teaching musculoskeletal examination skills to PM&R residents.

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“…Multiple medical schools report integrating ultrasound into preclinical education, each reporting high student satisfaction, and some noting improved accuracy and confidence in medical student musculoskeletal landmark palpation . Ultrasound‐aided education is a potential solution to reports that physical examination aptitude of physicians‐in‐training is inadequate, including the musculoskeletal exam skills of PM&R residents . This deficiency is attributed partially to increased reliance on laboratory tests and imaging, and decreased teaching at bedside …”

Section: Introductionmentioning

confidence: 99%

“…Three studies used ultrasound to check the accuracy of PM&R residents' musculoskeletal palpation. Mehta et al assessed the ability of 18 residents to palpate the medial joint line of the knee, medial patellar tendon, and posterior tibialis tendon, and they found their accuracy to be 14%, 36%, and 28%, respectively. Rho et al evaluated the accuracy of 24 residents in palpating the acromioclavicular joint and the lateral joint line of the knee.…”

Section: Introductionmentioning

confidence: 99%

Brief Ultrasound‐Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation

Sederberg

Liem

Tarkhan

et al. 2019

PM&R

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Background Multiple studies demonstrate poor musculoskeletal palpation accuracy of physiatry residents. With the growing use of ultrasound clinically, it could serve as a powerful educational tool. However, there are no published studies examining the efficacy of ultrasound‐aided education at the bedside, where much learning takes place during postgraduate training. Objective To determine if brief ultrasound‐aided teaching improves residents' accuracy and confidence of musculoskeletal palpation. Design Before/After Trial. Setting Academic Institution. Participants Ten physical medicine and rehabilitation residents were voluntary participants. Intervention Each resident was given a survey to assess confidence in palpating the hook of the hamate and medial calcaneal tubercle. They then attempted to palpate and place a marker over these two structures in a model patient. Marker placement accuracy was verified by ultrasound. Faculty spent less than 1 minute per landmark, sonographically teaching its correct localization. The resident, after moving to a new model patient, was then re‐tested on accurate marker placement for both landmarks. A repeat survey to assess confidence was administered. Main Outcome Measurements Preintervention and postintervention accuracy and confidence of correct localization of both landmarks. Results We used McNemar's and Wilcoxon's tests to determine whether the intervention improved the location accuracy and confidence of successful palpation, respectively. Confidence level of correct localization of two landmarks improved on average from 4.3 to 8.15 on a scale of 10 after intervention. Of 20 palpation attempts, 11 correctly placed the marker postintervention after an incorrect placement, 8 made no change, and one changed from correct to incorrect placement. The odds of improvement in accuracy was 11 (95% confidence interval [CI] 1.60‐473.47, P < .01). Both tests showed significant improvements after the intervention at the significance level of .05. Conclusions Brief, ultrasound‐aided teaching increases accuracy and confidence of residents' musculoskeletal palpation.

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Resident Accuracy of Musculoskeletal Palpation With Ultrasound Verification

Cited by 16 publications

References 14 publications

Identification and Analysis of Bacterial Contamination of Ultrasound Transducers and Multiuse Ultrasound Transmission Gel Bottle Tips Before and After the Aseptic Cleansing Technique

Identification and Analysis of Bacterial Contamination of Ultrasound Transducers and Multiuse Ultrasound Transmission Gel Bottle Tips Before and After the Aseptic Cleansing Technique

Evaluation of Resident Palpation Skills in Foot and Ankle Anatomic Structures Using Bedside Ultrasound

Brief Ultrasound‐Aided Teaching to Improve the Accuracy and Confidence of Resident Musculoskeletal Palpation

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