Ultrasound Curriculum Research Articles

American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships.

The following sports ultrasound (SPORTS US) curriculum is a revision of the curriculum developed by the American Medical Society for Sports Medicine (AMSSM) in 2010. Several changes have been made to the curriculum with the primary aim of providing a pathway by which a sports medicine fellow can obtain sufficient SPORTS US training to become proficient in the core competencies of SPORTS US. The core competencies of SPORTS US are outlined in the learning objectives section of this document. The term "SPORTS US" was purposefully chosen rather than "musculoskeletal ultrasound" (MSK US) because it was recognized by the panel that the evolving field of SPORTS US encompasses non-MSK applications of ultrasound such as the FAST examination (focused assessment with sonography for trauma). Although the SPORTS US core competencies in this curriculum are all MSK in nature, they represent the minimum SPORTS US knowledge a sports medicine fellow should acquire during fellowship. However, additional training in more advanced MSK and non-MSK applications of ultrasound can be provided at the fellowship director's discretion. Completion of this SPORTS US curriculum fulfills the American Institute of Ultrasound in Medicine's (AIUM) requirements to perform an MSK US examination and the prerequisites for the American Registry for Diagnostic Medical Sonography's (ARDMS) MSK sonography certification examination.

American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships

The American Medical Society for Sports Medicine (AMSSM) developed a musculoskeletal ultrasound curriculum for sports medicine fellowships in 2010. As the use of diagnostic and interventional ultrasound in sports medicine...

Comparison of the didactic lecture with the simulation/model approach for the teaching of a novel perioperative ultrasound curriculum to anesthesiology residents

Study ObjectiveTo expose residents to two methods of education for point-of-care ultrasound, a traditional didactic lecture and a model/simulation-based lecture, which focus on concepts of cardiopulmonary function, volume status, and evaluation of severe thoracic/abdominal injuries; and to assess which method is more effective. DesignSingle-center, prospective, blinded trial. SettingUniversity hospital. SubjectsAnesthesiology residents who were assigned to an educational day during the two-month research study period. MeasurementsResidents were allocated to two groups to receive either a 90-minute, one-on-one didactic lecture or a 90-minute lecture in a simulation center, during which they practiced on a human model and simulation mannequin (normal pathology). Data points included a pre-lecture multiple-choice test, post-lecture multiple-choice test, and post-lecture, human model-based examination. Post-lecture tests were performed within three weeks of the lecture. An experienced sonographer who was blinded to the education modality graded the model-based skill assessment examinations. Participants completed a follow-up survey to assess the perceptions of the quality of their instruction between the two groups. Main Results20 residents completed the study. No differences were noted between the two groups in pre-lecture test scores (P = 0.97), but significantly higher scores for the model/simulation group occurred on both the post-lecture multiple choice (P = 0.038) and post-lecture model (P = 0.041) examinations. Follow-up resident surveys showed significantly higher scores in the model/simulation group regarding overall interest in perioperative ultrasound (P = 0.047) as well understanding of the physiologic concepts (P = 0.021). ConclusionsA model/simulation-based based lecture series may be more effective in teaching the skills needed to perform a point-of-care ultrasound examination to anesthesiology residents.

Poster 251 Resident-Perceived Benefit of a Musculoskeletal Ultrasound Curriculum: A Multifaceted Approach Using Self-Directed Learning, Peer Teaching, and Interdisciplinary Collaboration

Poster 251 Resident-Perceived Benefit of a Musculoskeletal Ultrasound Curriculum: A Multifaceted Approach Using Self-Directed Learning, Peer Teaching, and Interdisciplinary Collaboration

Bedside ultrasound curriculum for medical students: report of a blended learning curriculum implementation and validation.

Medical students on clinical rotations rarely receive formal bedside ultrasound (BUS) training. We designed, implemented, and evaluated a standardized BUS curriculum for medical students on their Emergency Medicine (EM) rotation. Teaching was aimed toward influencing four cognitive and psychomotor learning domains: BUS instrumentation knowledge, image interpretation, image acquisition, and procedural guidance. Participants viewed three instructional Web-based tutorials on BUS instrumentation, the Focused Assessment for Sonography in Trauma (FAST) examination and ultrasound-guided central venous catheter (CVC) placement. Subsequently, participants attended a 3-hour hands-on training session to discuss the same content area and practice with faculty coaches. A Web-based, multiple-choice questionnaire was administered before and after the session. During the final week of the rotation, students returned for skills assessments on FAST image acquisition and CVC placement. Forty-five medical students on an EM rotation were enrolled. Sonographic knowledge overall mean score improved significantly from 66.6% (SD ±11.2) to 85.7% (SD ±10.0), corresponding to a mean difference of 19.1% (95% CI 15.5-22.7; p < 0.001). There were high pass rates for FAST (89.0%, 40/45) and CVC (96.0%, 43/45) skills assessments. There was no significant difference between medical student posttest and EM resident test scores 85.7% (SD ±10.0) and 88.1% (SD ± 7.6) (p = 0.40), respectively. A formal BUS curriculum for medical students on EM rotation positively influenced performance in several key learning domains. As BUS competency is required for residency in EM and other specialties, medical schools could consider routinely incorporating BUS teaching into their clinical rotation curricula.

Using ultrasound to teach anatomy in the undergraduate medical curriculum: an evaluation of the experiences of tutors and medical students.

This paper describes the experiences of staff and students at two UK medical schools, who introduced portable ultrasound (PU) as an imaging technology to deliver clinical anatomy teaching and to aid skill development in interpretation of cross-sectional anatomy (CSA). A sonographer contributed to curriculum design and teaching, but mostly anatomy tutors delivered the teaching. This case study method evaluates staff and student perspectives on the ultrasound-based anatomy teaching. Quantitative data and qualitative data were collected and analysed. Staff were positive about the experience. They described their expectations for students and solutions for practical issues regarding the teaching, but were concerned about their competency in scanning and wanted bespoke training for sonoanatomy teaching. Curriculum development was accelerated through engagement with a sonographer and an ultrasound champion. Students were extremely positive about their experience; they valued the expertise of a sonographer who taught more challenging sonoanatomy, but were equally positive regarding teaching sessions led by well-trained anatomy tutors who taught more simple sonoanatomy. Students affirmed most tutors' expectations that ultrasound could reinforce existing anatomical knowledge, added clinical contextualisation, but not that use of ultrasound (US) assisted in interpreting CSA. Students valued the introduction to the technology and found sonoimage interpretation challenging, but not insurmountable. Students wanted more instruction on ultrasound physics, an expansion of ultrasound curriculum, with smaller groups and opportunities to scan volunteers. These data support the case for the use of PU to deliver anatomy teaching and to prime medical students for later clinical encounters with PU.

Ultrasound competency assessment in emergency medicine residency programs.

In the Model of the Clinical Practice of Emergency Medicine (EM), bedside ultrasound (US) is listed as one of the essential procedural skills. EM milestones released by Accreditation Council for Graduate Medical Education and American Board of Emergency Medicine require residents to demonstrate competency in bedside US. The purpose of this study was to assess the current methods used by EM residency training programs to evaluate resident competency in bedside US. This was a cross-sectional survey study. A questionnaire on US education and competency assessment was electronically sent to all EM residency program directors and emergency US directors. The survey consisted of questions regarding the US rotation, structure of US curriculum, presence of US fellowship, image archiving, quality assurance methods, feedback, competency assessment tools, and frequency of assessment. The survey responses are reported as the percentages of total respondents along with 95% confidence intervals (CIs). A total of 124 of 161 EM residency programs participated in this study, representing a 77% response rate. Twenty-six percent (95% CI = 18% to 34%) of programs assess competency only at the end of the US rotation. Eight percent (95% CI = 3% to 13%) assess competency only every 6 months, and 13% (95% CI = 7% to 19%) assess competency only annually. Eight percent (95% CI = 3% to 13%) assess competency only during the final year of training. Thirty percent (95% CI = 22% to 38%) of programs assess competency with a combination of the above intervals, and 16% (95% CI = 10% to 22%) do not assess US competency. Fourteen percent (95% CI = 8% to 20%) use objective structured clinical examinations (OSCEs), and 21% (95% CI = 14% to 28%) use standardized direct observation tools (SDOTs) to assess resident competency in US. Approximately one-third (33%, 95% CI = 24% to 41%) of standardized testing for US competency is conducted with multiple-choice questions. Thirty percent (95% CI = 21% to 38%) administer practical examinations to assess US skills. Currently, a majority of EM residency programs assess resident competency in bedside US. However, there is significant variation in the methods of competency assessment.

Proactive medicine: the "UCI 30," an ultrasound-based clinical initiative from the University of California, Irvine.

This article discusses the benefits of integrating point-of-care diagnostic ultrasound into the four-year medical school curriculum. Handheld ultrasound devices have been used to teach medical students at the University of California (UC), Irvine, since August 2010, and the article explains how the use of this inexpensive, safe, and noninvasive tool enhances the ability of a physician conducting a standard physical exam to confirm suspected findings and uncover other suspected pathology at a reasonable cost. The authors describe the ultrasound curriculum at UC Irvine and the process of its implementation. In the appendix to the article, the authors describe the specific diagnostic benefits of using a handheld ultrasound device for each element of the Stanford 25 physical exam. Their ultrasound-enhanced approach to the physical exam is referred to as the "UCI 30." They make recommendations for how and when to integrate ultrasound into the physical exam. The article points out that early training of medical students in the use of ultrasound can avoid the diagnostic problems of ultrasound by maximizing students' comfort and ability to obtain accurate ultrasound images for diagnostic and procedural purposes.

Development and Preliminary Assessment of a Critical Care Ultrasound Course in an Adult Pulmonary and Critical Care Fellowship Program

The focused ultrasound examination has become increasingly recognized as a safe and valuable diagnostic tool for the bedside assessment of the critically ill patient. We implemented a dedicated on-site critical care ultrasonography curriculum with the goal of developing a model for teaching ultrasound skills to pulmonary and critical care medicine fellows. The program was comprised of blended didactic and bedside sessions in the following topic domains: fundamentals; vascular access and diagnosis; and abdominal, thoracic, and cardiac ultrasonography. Formal knowledge and image acquisition assessments were performed before and after the program to assess success in meeting predefined learning objectives. Participants completed surveys (on Likert scale 1-5) before and after the program to assess their confidence in ultrasonography knowledge and skills as well as their perception as to training effectiveness. The preintervention knowledge and bedside image acquisition scores were 71 and 32%, respectively. The global preintervention score was 51%. All postintervention measures demonstrated significant improvement: 89% (P < 0.01), 86% (P < 0.0001), and 87% (P < 0.0001). Preintervention participant confidence in their ultrasound knowledge and skill was 2.9/5, which improved to 4.3/5 (P = 0.007) after intervention. Participants rated the curriculum as meeting course objectives at a mean of 4.8/5. At one academic medical center, the knowledge of eight adult pulmonary and critical care fellowship trainees regarding critical care ultrasound was high at baseline; however, bedside image acquisition skills were poor. A dedicated 6-week educational intervention resulted in highly significant improvements in subject knowledge and image acquisition skills. These preliminary results warrant validation studies at other medical centers.

Designing a multi-disciplinary undergraduate medical school ultrasonography curriculum

Objectives: Although there is increasing demand for physicians from various specialties to be trained in ultrasonography (US), it is currently not being taught at most Canadian undergraduate medical schools in a comprehensive manner. The purpose of this study was to develop objectives to form the foundation of a comprehensive undergraduate US curriculum. Methods: After completing an environmental assessment, which included a review of our current undergraduate objectives, a literature review was performed to identify published undergraduate US objectives. Using this information, a preliminary list of objectives was developed. The list was distributed electronically to 12 content experts from 10 disciplines and, using a two-round modified Delphi process, consensus about the inclusion of educational objectives was obtained. An a priori consensus criterion of 75% agreement was used to determine objectives that would be included in the curriculum. Objectives that met consensus in the first round of the survey were excluded from second round evaluation. Results: Review of our undergraduate curriculum revealed that there were already 10 objectives relating to US. Combining existing objectives with those found during the literature review, an initial list of 79 objectives was produced. Sixteen of these were approved during the first Delphi round, while the remaining 63 objectives required rating during a second round. A final list of 25 objectives was produced. Conclusions: Using a modified Delphi process, physicians from diverse backgrounds reflecting current and future use of US developed 25 multi-disciplinary objectives for a comprehensive undergraduate medical school US curriculum. RÉSUMÉObjectifs: Bien qu’on demande de plus en plus que les médecins de diverses disciplines suivent une formation en échographie, cette méthode d’exploration n’est pas encore enseignée de façon exhaustive dans la plupart des programmes d’études de premier cycle des facultés de médecine canadiennes. Le but de cette étude est d’élaborer des objectifs qui serviront de fondation à la création d’un programme d’enseignement de l’échographie au premier cycle. Méthodes: Après avoir terminé une analyse de contexte qui incluait une revue de nos objectifs d’apprentissage actuels, une revue de la littérature a été effectuée afin de faire ressortir les objectifs publiés pour l’enseignement de l’échographie au premier cycle de médecine. Avec cette information, une liste préliminaire d’objectifs a ensuite été élaborée. La liste a été envoyée électroniquement à 12 experts de contenu dans 10 disciplines différentes. Utilisant un processus de Delphi modifié en deux étapes, un consensus a été établi pour l’inclusion des objectifs d’apprentissage. Un consensus à priori de 75 % approuvant les objectifs a été utilisé pour choisir ceux qui seraient inclus dans le cursus. Les objectifs qui avaient satisfait au consensus lors de la première étape ont été exclus des évaluations lors de la deuxième étape. Résultats: La revue de notre programme d’études de premier cycle a démontré qu’il y avait déjà dix objectifs portant sur l’échographie. En combinant les objectifs actuels et ceux qui ont été relevés lors de la revue de la littérature, une liste initiale de 79 objectifs a été produite. Seize de ces objectifs ont été approuvés lors du premier tour Delphi. Les 63 autres objectifs ont dû être évalués dans le cadre du deuxième tour. Une liste finale de 25 objectifs a été produite. Conclusion: À l’aide d’un processus de Delphi modifié, des médecins provenant de diverses disciplines reflétant l’utilisation courante et éventuelle de l’échographie ont élaboré 25 objectifs multidisciplinaires pour offrir un programme complet de formation en échographie dans le cursus du programme de premier cycle de médecine.

The mini ultrasound institute: does incorporating ultrasound in the anatomy curriculum increase students’ understanding of living anatomy and comfort with new technology? (211.4)

Despite increase in residency programs including ultrasound training, few medical schools have incorporated it into their curricula. The Gross Anatomy course at Mayo Medical School has introduced ultrasound in the curriculum. Cadaver dissection teaches students static anatomical relationships, but ultrasound offers dynamic display of how those relationships can change with movement. Ultrasound curriculum consists of four 1 hour didactic sessions and five 30 minute hands‐on modules, covering Carpal tunnel, Heart, Abdominal viscera, and Doppler imaging of blood flow. Each module is guided by a checklist of techniques and structures. Students are graded using ARS system, and ultrasound objectives are incorporated into the final exam.This study aimed to assess effectiveness of ultrasound curriculum in a 7 week anatomy course. Students were asked to complete pre‐ and post‐ test surveys that assessed whether ultrasound sessions allowed them to better appreciate living anatomy, learn the basics of operating a portable ultrasound machine, and become more comfortable with medical technology. Pre and post surveys showed that ultrasound helped students appreciate living anatomy, and that they were comfortable with technology. There was an increase in students’ perception of their ability to interpret ultrasound images with a p‐value of 0.000026. Ultrasound was a successful addition to the anatomy curriculum.

Development of a Competency-based Training in Obstetrics and Gynecology Ultrasound for Undergraduate and Graduate Medical Education

ABSTRACT Advances in technology have made ultrasonography a rapidly evolving concept in the practice of medicine and a valuable component of the competency-based education. American Medical Association (AMA) recently affirms that ‘ultrasound imaging is a safe, effective and efficient tool when utilized by, or under the direction of appropriately trained physicians.’ AMA also supports the educational efforts and widespread integration of ultrasound throughout the continuum of medical education. Training in ultrasonography is rapidly expanding to numerous residency programs of graduate medical education but discrepancies in ultrasound curriculum and criteria for proficiency exist among programs within the same discipline, despite clearly defined objectives recommended by the governing bodies. There is a trend to integrate ultrasonography into the curriculum of undergraduate medical education. However, funding, availability of ultrasound-trained faculty and student time are barriers to the implementation. Ultrasonography is a natural fit for competency-based training and should be introduced early in medical education. We expect that the LCME will soon mandate the integration of ultrasound into the 4-year curriculum. The imminent question that medical educators ask is not when ultrasound will become a required component of the curriculum but how to effectively integrate the teaching and training of ultrasound into the continuum of medical education. How to cite this article Baatar D, Peinado J, Sarmiento J, Ho H. Development of a Competency-based Training in Obstetrics and Gynecology Ultrasound for Undergraduate and Graduate Medical Education. Donald School J Ultrasound Obstet Gynecol 2014;8(1):83-86.

National ultrasound curriculum for medical students.

Ultrasound (US) is an extremely useful diagnostic imaging modality because of its real-time capability, noninvasiveness, portability, and relatively low cost. It carries none of the potential risks of ionizing radiation exposure or intravenous contrast administration. For these reasons, numerous medical specialties now rely on US not only for diagnosis and guidance for procedures, but also as an extension of the physical examination. In addition, many medical school educators recognize the usefulness of this technique as an aid to teaching anatomy, physiology, pathology, and physical diagnosis. Radiologists are especially interested in teaching medical students the appropriate use of US in clinical practice. Educators who recognize the power of this tool have sought to incorporate it into the medical school curriculum. The basic question that educators should ask themselves is: "What should a student graduating from medical school know about US?" To aid them in answering this question, US specialists from the Society of Radiologists in Ultrasound and the Alliance of Medical School Educators in Radiology have collaborated in the design of a US curriculum for medical students. The implementation of such a curriculum will vary from institution to institution, depending on the resources of the medical school and space in the overall curriculum. Two different examples of how US can be incorporated vertically or horizontally into a curriculum are described, along with an explanation as to how this curriculum satisfies the Accreditation Council for Graduate Medical Education competencies, modified for the education of our future physicians.

Society of Radiologists in Ultrasound Resident Curriculum

Society of Radiologists in Ultrasound Resident Curriculum

Obstetrics and Gynecology Residency Ultrasonography Program Curriculum

ABSTRACT Ultrasound skills—technical and interpretive—are essential to the practice of obstetrics and gynecology. The Accreditation Council for Graduate Medical Education provides guidance, though limited, on what an obstetrics and gynecology residency ultrasonography program curriculum should include. A review of several educational institutions’ approaches to the ultrasonography curriculum is presented. A detailed discussion of the Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, obstetrics and gynecology residency ultrasonography program curriculum is provided for additional consideration. How to cite this article Cardwell MS, Mendez M. Obstetrics and Gynecology Residency Ultrasonography Program Curriculum. Donald School J Ultrasound Obstet Gynecol 2014;8(1):16-21.

Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respective systems or organs for a total not less than 125 studies on ICU. The ICU fellows implemented the POC ultrasound curriculum into their daily practice in managing ICU patients, under supervision from ICU staff physicians, who were instructors in POC ultrasound. Impact on patient care including finding a new diagnosis or change in patient management was reviewed over a period of one academic year. Results. 873 POC ultrasound studies in 203 patients admitted to the surgical ICU were reviewed for analysis. All studies included were done through the POC ultrasound curriculum training. The most common exams performed were 379 lung/pleural exams, 239 focused echocardiography and hemodynamic exams, and 237 abdominal exams. New diagnosis was found in 65.52% of cases (95% CI 0.590, 0.720). Changes in patient management were found in 36.95% of cases (95% CI 0.303, 0.435). Conclusions. Implementation of POC ultrasound in the ICU with a structured fellowship curriculum was associated with an increase in new diagnosis in about 2/3 and change in management in over 1/3 of ICU patients studied.

419: So you think you can scan? A competency based ultrasound curriculum for MFM fellows

419: So you think you can scan? A competency based ultrasound curriculum for MFM fellows

Society of Radiologists in Ultrasound Resident Curriculum

Society of Radiologists in Ultrasound Resident Curriculum

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Introduction: Bedside ultrasound is effective for accurate point of care assessment and rapid decision-making in the intensive care unit. Critical care medicine fellowship training programs have attendings, fellows and physician extenders from diverse training backgrounds with various levels of ultrasound training. Implementing bedside ultrasonography in the intensive care unit is limited by the training of the Intensivist. National organizations have advocated increasing the use of critical care ultrasonography in the intensive care unit. The purpose of this study was to investigate the feasibility and impact of incorporating focused training in critical care ultrasonography to critical care attendings, fellows and physician extenders. Methods: A four hour ultrasound course was held with focused didactic sessions followed by hands-on image acquisition with human models. Participants were critical care attendings, fellows and physician extenders from surgery, anesthesiology, neurology, internal medicine and emergency medicine backgrounds. Instructors were intensivists with formalized training in critical care ultrasonography. A pre and post course survey regarding current ultrasound experience and comfort was circulated amongst the participants. Results: The course was offered to thirty participants with focused training in the FAST exam (focused assessment with sonography for trauma), limited transthoracic echocardiography, and pulmonary ultrasound. All participants agreed that bedside ultrasound was a useful tool in clinical practice for the intensivist. Sixty-nine percent of participants reported that they were not formally trained in ultrasound during their previous training programs. Seventy-one percent of participants reported that they were uncomfortable with their current experience and knowledge of bedside ultrasound before the course. After the course, seventy-five percent of participants reported that they were comfortable with their current knowledge and experience with bedside ultrasound. Pre course evaluation showed that most participants were uncomfortable obtaining the following ultrasound studies: sixty-eight percent (FAST exam), seventy-five percent (limited transthoracic echocardiography) and sixty-one percent (pulmonary). Comparison of pre and post course surveys showed that comfort in image acquisition and interpretation increased from thirty-two percent to ninety-eight percent in the FAST exam, twenty-five percent to ninety-five percent in limited transthoracic echocardiography, and thirty-nine percent to ninety-five percent in pulmonary ultrasound. Conclusions: Post course evaluation showed that all participants were more comfortable with their knowledge of bedside ultrasound. Participants reported an increase in comfort with image acquisition and familiarity in the FAST exam, limited transthoracic echocardiography, and pulmonary ultrasound. A focused critical care ultrasound training curriculum can be successfully implemented into an existing critical care medicine fellowship training program. Our curriculum represents a useful training model for teaching critical care ultrasound to critical care attendings, fellows and physician extenders.

Faculty staff-guided versus self-guided ultrasound training for internal medicine residents

Ultrasonography is of growing importance within internal medicine (IM), but the optimal method of training doctors to use it is uncertain. In this study, the authors provide the first objective comparison of two approaches to training IM residents in ultrasonography. In this randomised trial, a simulation-based ultrasound training curriculum was implemented during IM intern orientation at a tertiary care teaching hospital. All 72 incoming interns attended a lecture and were given access to online modules. Interns were then randomly assigned to a 4-hour faculty-guided (FG) or self-guided (SG) ultrasound training session in a simulation laboratory with both human and manikin models. Interns were asked to self-assess their competence in ultrasonography and underwent an objective structured clinical examination (OSCE) to assess their competence in basic and procedurally oriented ultrasound tasks. The primary outcome was the score on the OSCE. Faculty-guided training was superior to self-guided training based on the OSCE scores. Subjects in the FG training group achieved significantly higher OSCE scores on the two subsets of task completion (0.9-point difference, 95% confidence interval [CI] 0.27-1.54; p = 0.008) and ultrasound image quality (2.43-point difference, 95% CI 1.5-3.36; p < 0.001). Both training groups demonstrated an increase in self-assessed competence after their respective training sessions and there was little difference between the groups. Subjects rated the FG training group much more favourably than the SG training group. Both FG and SG ultrasound training curricula can improve the self-reported competence of IM interns in ultrasonography. However, FG training was superior to SG training in both skills acquisition and intern preference. Incorporating mandatory ultrasound training into IM residencies can address the perceived need for ultrasound training, improve confidence and procedural skills, and may enhance patient safety. However, the optimal training method may require significant faculty input.