Board 221 - Program Innovations Abstract Ultrasound Guided Procedures Curriculum

Abstract

Introduction/Background Ultrasound guidance for complex procedures has been shown to increase patient safety.1, 2 Additionally, deliberate simulated practice emphasizing procedural familiarity enhances learner confidence.3, 4 At UC Davis Medical Center, faculty and residents from multiple departments participate in ultrasound guided procedural skills training. Currently, instruction in procedural techniques and ultrasound guidance is not standardized, leading to confusion from learners regarding the appropriate application of ultrasound and understanding of procedural risks, complications and optimal techniques. To address these disparities, we developed a layered ultrasound guided procedures curriculum using a standardized format that emphasizes deliberate hands on simulated practice. Methods The first educational layer, the Ultrasound Basics module, addresses the knowledge differential by first gauging the learner’s baseline with an online pretest. Then an online curriculum is presented that teaches ultrasound physics and "knobology", reinforcing the techniques to obtain interpretable images. This material is delivered through an interactive online lecture with audio overlay. Additional videos and journal articles are provided as supplemental information. At the completion of the online curriculum, the learner must pass a post test addressing the covered material (score > 80%). The pre and post test are comprised of randomly generated multiple choice questions obtained from a larger question bank developed for the module. Learners must complete the Ultrasound Basics module prior to beginning the next layer, comprised of individual ultrasound guided procedure modules. Each procedure module consists of a pre test, online curriculum and a post test, following the same format as Ultrasound Basics. Online modules must be completed prior to simulated practice. Module curriculum includes background information, indications, contraindications, risks, complications, and detailed ultrasound guided technique. Supplemental material includes ultrasound videos, journal articles and other References. The curriculum is presented in a slide set format with an audio lecture overlay, discussing the critical steps required to perform the procedure safely and correctly. A checklist of these critical steps is provided as a reference and is also used by simulation session facilitators. Only after successful completion of the online module and passing the post test, may learners then access the simulation center for deliberate hands on practice. Learners practice both basic ultrasound skills from the prerequisite module and specific procedural skills on task trainers, utilizing the checklist as a guide. Faculty facilitators demonstrate and review ultrasound and procedural techniques as needed. Learners may arrange for additional practice as desired. For the final layer, learners must demonstrate procedural competency by performing the procedure accurately on a task trainer. Faculty facilitators use the procedure checklist as the learner assessment tool. To normalize assessments, we held train-the-trainer sessions with all facilitators to review the checklist and discuss variable interpretations of critical steps. Online materials remain accessible to the learner throughout training to be reviewed as needed. Senior internal medicine residents piloted this program in Spring 2013. Feedback was solicited about curriculum delivery and utility of the simulated practice sessions. Overall subjective feedback was positive. Residents reported the curriculum exceeded expectations, was easy to follow, provided standardized delivery and emphasized deliberate hands on practice. Results: Conclusion To date, ultrasound basics, thoracentesis and paracentesis modules have been developed. Based on feedback, an ultrasound guided needle localization module will be developed as an additional prerequisite. Incoming interns will now be required to complete this curriculum prior to patient contact. Senior residents with a supervisory role will also complete the course to ensure standardized teaching of junior residents. Refresher simulation sessions will continue to be offered to those desiring additional practice. In summary, our layered approach to ultrasound guided procedures has been well received and serves as a template for future curricular development at UC Davis Medical Center.