Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods

PoSaw, Leila L.; Wubben, Brandon; Bertucci, Nicholas; Bell, Gregory K.; Healy, Heather; Lee, Sangil

doi:10.1002/emp2.12439

Cited by 8 publications

(3 citation statements)

References 107 publications

(286 reference statements)

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“…Proctored bedside scanning as a mechanism, which incorporates the traditional apprentice-style education of clinical ultrasound within EM that learners have reported as most impactful, was reported by 93% of programs. 8,9 Other areas of success are the required attendance of a QA session, having dedicated ultrasound faculty within programs, and having training from internal sources that can be adapted to the individual learners.…”

Section: Discussionmentioning

confidence: 99%

Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies

Junker,

Vakkalanka,

Wittrock

2023

J Physician Assist Educ

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Introduction Clinical ultrasound training is essential to any emergency medicine (EM) clinician's skill set. We aim to understand the current training patterns of clinical ultrasound training within Advanced Practice Provider (APP) residencies. Methods In a survey sent electronically to 17 active EM APP residencies, data were obtained from 21 responses to questions about structure of ultrasound faculty, quality assessment, feedback, and competency evaluation. Results We had a response rate of 88%. Of programs surveyed, 93% were associated with EM physician residencies with 87% led by an ultrasound fellowship-trained EM physician. Ninety-three percent of programs required proctored scanning. Sixty percent of programs do not have any required number of scans to graduate. Conclusion We found that most EM APP residencies share clinical ultrasound faculty, structures, and processes with associated EM physician residencies. We believe that quality training within clinical ultrasound is attainable; however, proficiency guidelines across EM APP residency programs are lacking.

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Section: Discussionmentioning

confidence: 99%

Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies

Junker,

Vakkalanka,

Wittrock

2023

J Physician Assist Educ

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“…Cadaver patients offer trainees an additional stepping stone to learn USGRA before performing blocks on a living patient. A prior scoping review found that cadaver-based education was relatively infrequently used in resident ultrasound education [10]. However, some studies have shown cadaver-based models to improve resident confidence in performing forearm, brachial plexus, and fascia iliaca nerve blocks [8,11].…”

Section: Discussionmentioning

confidence: 99%

Exploring a Cadaver-Based Model for Teaching Emergency Medicine Residents Ultrasound-Guided Serratus Anterior Plane Blocks

Wubben,

Wallum,

Wittrock

2023

Cureus

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BackgroundUltrasound-guided regional anesthesia (USGRA) is increasingly being incorporated into ED clinical practice to provide pain control for a variety of traumatic injuries. The serratus anterior plane block (SAPB) has been shown to be effective at reducing intravenous opioid use and improving pulmonary function for patients with rib fractures, but there is limited prior research about how to safely teach this procedure to emergency medicine (EM) residents. Our goal was to examine the effect of a cadaver-based education model on EM residents' confidence in performing USGRA and provide a review of commonly encountered errors. MethodsEM residents participated in a half-day cadaver-based education session that included a variety of lesscommonly performed procedures including SAPB and fascia iliaca compartment block (FICB) USGRA. Residents received a didactic lecture and hands-on simulation practice during the month prior to the session. During the session, residents performed a SAPB and FICB on the cadaver patient using the same nerve block kit and ultrasound machine they would use for a living patient, with 1:1 supervision by an emergency ultrasound fellowship-trained physician who provided real-time feedback during the procedure. Representative ultrasound video clips were saved and reviewed. Surveys that were completed by residents after the session were analyzed. ResultsThere were 23 residents who participated, and most had not performed any FICB (74%) or SAPB (87%) previously. The percentage of residents comfortable with general USGRA increased from 8.7% to 91.3% (p<0.001). Comfort with FICB increased from 9.1% to 77.3% (p<0.001), and comfort with SAPB increased from 9.1% to 77.3% (p<0.001). Instructors identified and corrected several common errors, such as overly aggressive needle insertion, instillation of air, and instillation of anesthetic into muscle rather than the fascial plane. ConclusionWe found that a cadaver-based education model for teaching EM residents the SAPB and the FICB was associated with significant increases in resident confidence in performing the procedure and facilitated identification and correction of common procedural errors that may otherwise have gone undetected.

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“…Despite recommendations for the utilization of standardized assessment measures from multiple organizations, there are also practical reasons why checklists have not yet been incorporated more widely. 1,4,18 Checklist completion places an additional demand on already limited EUS faculty and resident education time.…”

Section: Reflec Tive Discussionmentioning

confidence: 99%

Development of an expert consensus checklist for emergency ultrasound

Bailitz

O’Brien

McCauley

et al. 2022

AEM Education and Training

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Background: Within today's competency-based medical education, traditional set number proficiency benchmarks have been called into question. Checklists may help guide individualized training and standardized outcomes. However, multicenter expert consensus checklists based on established guidelines with supporting validity evidence have not been published for specific emergency ultrasound (EUS) applications. We describe a robust national EUS expert consensus methodology for developing a checklist for the extended focused assessment with sonography in trauma (eFAST examination).Methods: Utilizing the ACEP imaging compendium as a primary reference, 10 national EUS experts iteratively refined and agreed upon a final checklist. To obtain initial reliability and validity evidence, two different EUS experts blinded to resident experience then assessed 24 residents performing an eFAST in a simulated environment.Inter-rater reliability of the checklist was assessed using Cohen's kappa coefficient.Validity was assessed by comparing mean performance with the Student's t-test and discriminant ability of individual checklist items using item-total correlation. Results:The 10 EUS experts agreed on the final checklist items after two rounds of iterations. When evaluating 24 emergency medicine (EM) PGY-1 to -4 residents, the kappa correlation between two blinded EUS faculty raters was moderate at 0.670. Kappa and agreement were near-perfect or perfect in right and left chest image optimization, right upper quadrant (RUQ) probe placement, RUQ anatomy identification, and pelvic first-view anatomy identification. The difference in checklist performance between junior and senior EM residents was significant at −8.1% (p = 0.004).Identification of pelvic structures and placement of the probe for pelvic views were found to have an excellent item-total correlation with values of >0.4. Conclusions:We have described a robust national EUS expert consensus methodology for developing an eFAST checklist based on the ACEP imaging guidelines. Based on this encouraging initial reliability and validity evidence, further research and checklist development is warranted for additional EUS applications.

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Teaching emergency ultrasound to emergency medicine residents: a scoping review of structured training methods

Cited by 8 publications

References 107 publications

Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies

Clinical Ultrasound Training in Emergency Medicine Advanced Practice Provider Residencies

Exploring a Cadaver-Based Model for Teaching Emergency Medicine Residents Ultrasound-Guided Serratus Anterior Plane Blocks

Development of an expert consensus checklist for emergency ultrasound

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