Abstract
ABSTRACTIntroduction:To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement.Materials and methods:University of California, San Francisco (UCSF) urology residents completed a time trial, placing a needle into a phantom model target under ultrasound guidance. Participants were randomized into three educational exposure groups: Group 1's time trial occurred prior to any teaching intervention, group 2's after experiencing a hands-on training module, and group 3's after exposure to both the training module and one-on-one attending feedback. Needle placement speed and accuracy as well as trainees' perceived confidence in utilizing ultrasound were measured.Results:The study cohort consisted of 15 resident trainees. Seven were randomized to group 1, three to group 2, and five to group 3. All residents reported minimal prior ultrasound experience. Their confidence in using ultrasound improved significantly after completing the training module with the most significant improvement seen among junior residents. Time to needle placement was fastest after receiving attending feedback (46.6sec in group 3 vs. 82.7sec in groups 1 and 2, p<0.01). Accuracy also improved with attending feedback, though the number of repositioning attempts did not differ significantly between groups.Conclusions:A hands-on training module and use of an abdominal phantom trainer increased resident confidence and skill in their use of ultrasound to guide percutaneous needle positioning. Attending feedback is critical for improving accuracy in needle guidance toward a target. Ultrasound-guided needle positioning is a teachable skill and can be applicable to multiple urologic procedures.
Highlights
To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement
While ultrasound guidance is commonly used by interventional radiologists and nephrologists to position needles into the kidney for nephrostomy tube placement, renal biopsy, and tumor ablation [3], urologists may be less familiar with using renal ultrasonography to guide procedures
Neither the distribution of junior (PGY1-3) and senior (PGY4-6) residents nor trainee experience with US within group 1 differed significantly compared to groups 2 and 3. 100% of trainees reported doing less than five percutaneous renal procedures under US guidance during their training. 87% (N=13) of trainees reported using US for suprapubic tube placement less than five times
Summary
To assess the effect of a hands-on ultrasound training session to teach urologic trainees ultrasound-guided percutaneous needle placement. Percutaneous needle placement into the kidney is a skill of great utility for the practicing urologist It is commonly used for percutaneous renal access to facilitate nephrostomy tube placement and percutaneous nephrolithotomy (PCNL) and is applicable for renal biopsies and percutaneous ablation of renal masses [1, 2]. Distinguishing posterior from anterior calyces is an easier task using ultrasonography compared to fluoroscopy given the orientation of the US probe relative to the renal collecting system [5] Despite these benefits, the majority of urologists in the United States and around the world do not utilize ultrasound to guide needle placement for renal access during PCNL. This is likely due in part to the minimal emphasis placed on teaching renal US imaging during residency training [6]. We examined trainee experience level with US use for urologic procedures and evaluated the effect of an implementable teaching module on residentsaccuracy and precision in guiding a needle toward a target under US guidance in a simulated learning environment using an abdominal phantom trainer
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