Ultrasound Skills Research Articles

Assessing the Use of Telepresence-Guided Video-Based Head and Neck Ultrasound Training: A Step towards Minimizing Dependence on Human Resources?

The acquisition of ultrasound skills is an essential part of any medical student's education. University access restrictions in the context of the COVID-19 pandemic have highlighted the need for digitization in teaching. However, teaching manual skills in online courses has proven to be challenging, not least in terms of human resources. Therefore, the aim of this study was to set up a hybrid head and neck ultrasound course consisting of a preface of video-based self-study followed by supportive instruction by a tutor in telepresence and to evaluate the quality, effectiveness, and feasibility of this teaching method. Thirty-five students were shown video tutorials on systematic ultrasound of the neck course. Learning outcomes were analyzed using self-assessment questionnaires and external assessment by an experienced ultrasonographer. All participants demonstrated statistically significant learning improvement (p < 0.001) when comparing self-assessment scores before and after training. The mean self-assessment scores increased from 13.8 to 26.6 for the telepresence-guided group, from 16.6 to 27.3 for the web-based group, and from 14.0 to 26.2 for the in-person group. The external observer assessment also showed improvement, with mean scores of 46.7, 48.1, and 46.5, respectively. Overall results did not significantly differ when comparing different instruction modalities. A telepresence-guided video-based ultrasound course is well suited to teaching ultrasound skills similar to in-person courses and allows a more resource-efficient targeting of student needs.

516 Ultrasound Cannulation Training: A Hit or a Miss

Abstract As a junior doctor, familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts, as well as preserving venous access. In our District General Hospital (DGH), there was no teaching on ultrasound-guided venous access available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors. Discussions were held with the medical education team at our DGH in order to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete pre and post-course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation before and after the session, and usefulness of the session. Of the 16 participants, only 81% (n=13) filled in the pre-session form, therefore data was only analysed from these individuals. 54% of participants (n=7) had previous experience using an ultrasound machine. 100% (n=13) felt more confident performing ultrasound-guided venous access after attending the session. The average confidence score pre versus post-session was 1.69/5 vs 4.08/5. This programme has the potential to improve confidence in procedural skills amongst junior doctors whilst also minimising the stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results from this study will be critical in continuing this training programme in our hospital and hopeful roll out to a wider audience.

Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards

BackgroundA thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.MethodsTwo different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.ResultsA total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor’s didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).ConclusionThese results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.

Learning curves for point-of-care ultrasound image acquisition for novice learners in a longitudinal curriculum

BackgroundA learning curve is graphical representation of the relationship between effort, such as repetitive practice or time spent, and the resultant learning based on specific outcomes. Group learning curves provide information for designing educational interventions or assessments. Little is known regarding the learning curves for Point-of-Care Ultrasound (POCUS) psychomotor skill acquisition of novice learners. As POCUS inclusion in education increases, a more thorough understanding of this topic is needed to allow educators to make informed decisions regarding curriculum design. The purpose of this research study is to: (A) define the psychomotor skill acquisition learning curves of novice Physician Assistant students, and (B) analyze the learning curves for the individual image quality components of depth, gain and tomographic axis.ResultsA total of 2695 examinations were completed and reviewed. On group-level learning curves, plateau points were noted to be similar for abdominal, lung, and renal systems around 17 examinations. Bladder scores were consistently good across all exam components from the start of the curriculum. For cardiac exams, students improved even after 25 exams. Learning curves for tomographic axis (angle of intersection of the ultrasound with the structure of interest) were longer than those for depth and gain. Learning curves for axis were longer than those for depth and gain.ConclusionBladder POCUS skills can be rapidly acquired and have the shortest learning curve. Abdominal aorta, kidney, and lung POCUS have similar learning curves, while cardiac POCUS has the longest learning curve. Analysis of learning curves for depth, axis, and gain demonstrates that axis has the longest learner curve of the three components of image quality. This finding has previously not been reported and provides a more nuanced understanding of psychomotor skill learning for novices. Learners might benefit from educators paying particular attention to optimizing the unique tomographic axis for each organ system.

Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study.

Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses. From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum". Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills. Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.

Integration of ultrasound simulation to improve medical student knowledge and satisfaction on the obstetrics and gynecology clerkship

There has been increased use of ultrasound in contemporary medical education. Students tend to report a higher sense of satisfaction when ultrasound is incorporated into medical education, but little is known about whether its use leads to an improvement in medical knowledge acquisition independent of the ultrasound skill. In addition, there is no consensus among obstetrics and gynecology clerkships on the most effective way to incorporate ultrasound into the clerkship curriculum. This project described a method to integrate ultrasound simulation into an obstetrics and gynecology clerkship curriculum. Our hypothesis was that the incorporation of ultrasound simulation in the obstetrics and gynecology clerkship curriculum will lead to an increase in standardized assessments of obstetrics and gynecology knowledge. A prepost study at a single institution with multiple methods design was employed. Of note, 10 high-yield pathology topics commonly tested on the Association of Professors of Gynecology and Obstetrics quizzes and National Board of Medical Examiners examinations were summarized into study sheets and associated with a representative ultrasound simulation module. All students were provided access to the summary sheets. Students with instruction in ultrasound simulation consisted of the postintervention group and were compared with students that did not have ultrasound simulation (preintervention group). Quiz and examination scores were compared between the groups. In addition, students who accessed the ultrasound simulator were given a survey at the end of their rotation to obtain qualitative information regarding satisfaction and the incorporation of ultrasound into the clerkship curriculum. There was no significant difference in quiz or examination scores between students who had access to the ultrasound simulation and those who did not. Most students found the integration of ultrasound simulation into the obstetrics and gynecology clerkship to be beneficial, to enhance their learning, to boost their confidence in ultrasound skills, and to be a potential substitute for clinical ultrasounds during the rotation. Integration of ultrasound simulation into obstetrics and gynecology clerkships and medical school education is understudied but can be a valuable educational tool. The incorporation of ultrasound into the medical education system is a topic of current studies. This study found that integration was viewed favorably by students, although integration was not associated with an improvement in medical knowledge measured via quiz and examination performance. Our research provided students with a standardized ultrasound education experience, which improved student satisfaction with the obstetrics and gynecology clerkship but did not correlate to increased demonstrated medical knowledge and understanding of examinations. Moving forward, student participants provided various suggestions on how we can continue to enrich medical students' education with the implementation of ultrasound.

Solid validity evidence for two tools assessing competences in musculoskeletal ultrasound: a validity study.

Musculoskeletal ultrasound (MSUS) is increasingly used by rheumatologists in daily clinical practice. However, MSUS is only valuable in trained hands, and assessment of trainee competences is therefore essential before independent practice. Thus, this study aimed to establish validity evidence for the EULAR and the Objective Structured Assessment of Ultrasound Skills (OSAUS) tools used for assessing MSUS competences. Thirty physicians with different levels of MSUS experience (novices, intermediates, and experienced) performed four MSUS examinations of different joint areas on the same rheumatoid arthritis patient. All examinations were video recorded (n = 120), anonymized, and subsequently assessed in random order by two blinded raters using first the OSAUS assessment tool followed by the EULAR tool 1 month after. The inter-rater reliability between the two raters was high for both the OSAUS and EULAR tools, with a Pearson correlation coefficient (PCC) of 0.807 and 0.848, respectively. Both tools demonstrated excellent inter-case reliability, with a Cronbach's alpha of 0.970 for OSAUS and 0.964 for EULAR. Furthermore, there was a strong linear correlation between the OSAUS and the EULAR performance scores and the participants' experience levels (R2 = 0.897 and R2 = 0.868, respectively) and a significant discrimination between different MSUS experience levels (P < 0.001 for both). MSUS operator competences can be assessed reliably and valid using either the OSAUS or the EULAR assessment tool, thereby allowing a uniform competency-based MSUS education in the future. Although both tools demonstrated high inter-rater reliability, the EULAR tool was superior to OSAUS. ClinicalTrials.gov, http://clinicaltrials.gov, NCT05256355.

Training Requirements in Point of Care Ultrasonography of the Upper Airway: A Feasibility Study.

Point-of-care ultrasonography of the upper airway can be a useful supplement to conventional pre-anesthetic clinical evaluations. However, the reliability of such examinations is highly operator-dependent and proper training in sonoanatomy and ultrasound operational skills are required. The objective of this study aims to assess the minimum training requirements for applying a predefined upper airway scanning protocol in healthy volunteers by anesthesia trainees. Twenty-two healthy volunteer members of the Operating Room staff participated in the study. A predefined scanning protocol that included the identification of specific structures (hyoid bone, vocal cords, thyrohyoid membrane/epiglottis/pre-epiglottic space, cricothyroid membrane, and thyroid gland), as well as the performance of specific measurements (distance from the hyoid bone to skin, anterior commissure to skin, epiglottis to skin, and thyroid isthmus to skin) was taught in a single-day training course. The trainees' competence was assessed after multiple scanning repetitions performed over a week. Mixed effects regression models were applied for the trainee-instructor differences in all ultrasound measurements. Cricothyroid membrane visualization had the lowest success rate (88%). Trainee-instructor differences were statistically significant for hyoid bone-to-skin (P < .001) and epiglottis-to-skin distances (P = .016). Measurement of the distance from the epiglottis to the skin required more scanning repetitions to achieve minimum deviance compared with other measurements. Ten or fewer scanning repetitions were sufficient to achieve minimum deviance for all four measurements. At least 10 scanning repetitions of a pre-defined upper airway scanning protocol can be used as the minimum standard for training.

Principles for teaching sonography - current status.

Since many young medical residents require sonographic skills early on during training, increased attention has been paid to including sonography classes in undergraduate medical education, among both professional societies and medical educators responsible for medical licensing exams. Medical schools worldwide have developed and implemented a variety of ultrasound teaching formats.This article addresses evidence-based solutions to crucial challenges in planning and implementing undergraduate sonography education. In order to achieve a sustainable increase in practical sonographic competence, we suggest small-group classes with sufficient individual hands-on scanning time for each student. We recommend concentrating on a circumscribed topic and teaching it thoroughly and practically rather than superficially outlining a broad subject area. Provided that peer teachers undergo adequate training, student peer teachers are not inferior to physicians as teachers, as far as student satisfaction, theoretical knowledge and practical skills acquisition are concerned. The assessment of acquired practical skills should consist of practical examinations, such as an objective structured clinical examination (OSCE) or a direct observation of procedural skills (DOPS). In contrast to using healthy volunteers as training models, simulation trainers allow the demonstration of pathological findings in authentic sonographic images, with the disadvantages of unrealistically easy image acquisition, as well as the lack of interaction with the patient.

Virtual Supervision of Third Year Medical Students Using Handheld POCUS Devices and Cloud-based Image Archiving Provides Opportunity for Feedback and Skill Improvement.

Background : Feedback on Point of Care Ultrasound (POCUS) skills is essential for skill development. Providing feedback can be difficult in a large province with several distributed medical education sites. Use of handheld POCUS devices and a cloud-based image archiving enables virtual supervision. We evaluated the quality of uploaded images as well as feedback provided to students. Methods: Volunteer third year students were given access to handheld POCUS devices at various training sites. Students were encouraged to upload educational POCUS scans to their accounts where they would then receive feedback from faculty. Subsequently, images that met inclusion criteria were randomized and reviewed by a blinded expert using a global rating scale. Feedback was also analyzed. Finally, students completed a questionnaire on their technology-enhanced POCUS learning experience. Results: An independent-sampled t-test comparing mean ratings for initial images submitted prior to any feedback with those submitted after three rounds of feedback showed significant effect on image scores (2.60 vs 3.50, p = .040, d = .93). Feedback included 4 performance domains (indications, image generation, interpretation, and integration). Students found the technology easy to use and felt feedback was tailored to their learning needs. Conclusions: We observed that virtual feedback provided to medical students through a cloud-based work platform can be effective for enhancing POCUS skills.

Development of an anatomical breast phantom from polyvinyl chloride plastisol with lesions of various shape, elasticity and echogenicity for teaching ultrasound examination.

The WHO reported an increasing trend in the number of new cases of breast cancer, making it the most prevalent cancer in the world. This fact necessitates the availability of highly qualified ultrasonographers, which can be achieved by the widespread implementation of training phantoms. The goal of the present work is to develop and test an inexpensive, accessible, and reproducible technology for creating an anatomical breast phantom for practicing ultrasound diagnostic skills in grayscale and elastography imaging, as well as ultrasound-guided biopsy sampling. We used FDM 3D printer and PLA plastic for printing an anatomical breast mold. We made a phantom using a mixture of polyvinyl chloride plastisol, graphite powder, and metallic glitter to simulate soft tissues and lesions. Various degrees of elasticity were imparted using plastisols of stiffness ranging from 3 to 17 on the Shore scale. The lesions were shaped by hand. The materials and methods used are easily accessible and reproducible. Using the proposed technology, we have developed and tested a basic, differential, and elastographic versions of the breast phantom. The three versions of the phantom are anatomical and intended for use in medical education: the basic version is for practicing primary hand-eye coordination skills; the differential one is for practicing the differential diagnosis skills; the elastographic version helps developing the skills needed for assessing the stiffness of tissues. The proposed technology allows the creation of breast phantoms for practicing hand-eye coordination and develop the critical skills for navigation and assessment of the shape, margins, and size of the lesion, as well as performing an ultrasound-guided biopsy. It is cost-effective, reproducible, and easily implementable, and could be instrumental in generating ultrasonographers with crucial skills for accurate diagnosis of breast cancer, especially in low-resource settings.

Lessons Learned from POCUS Instruction in Undergraduate Medicine During the COVID-19 Pandemic.

Point of care Ultrasound (POCUS) has been adopted into clinical practice across many fields of medicine. Undergraduate medical education programs have recognized the need to incorporate POCUS training into their curricula, traditionally done in small groups with in-person sessions. This method is resource intensive and requires sufficient equipment and expertise. These requirements are often cited as barriers for implementation. During the Coronavirus Disease 2019 (COVID-19) pandemic, POCUS education was required to adapt to physical distancing regulations, giving rise to novel teaching methods for POCUS. This article outlines the implementation of a POCUS teaching session before and during the pandemic. It describes how these innovations can scale POCUS teaching and overcome barriers moving forward. A flipped classroom model was implemented for all learners. Learners were given an introductory POCUS module before the scheduled in-person or virtual teaching session. Sixty-nine learners participated in conventional in-person teaching, while twenty-two learners participated in virtual teaching following the pandemic-related restrictions. Learners completed a written test before and following the teaching. In-person learners were assessed using an objective structured assessment of ultrasound skills (OSAUS) pre- and post-learning sessions. A follow-up survey was conducted three years after the teaching sessions were completed. Both in-person and virtual groups demonstrated statistically significant improvement in knowledge scores (p <0.0001). Both groups had similar post-test learning scores (74.2 ± 13.6% vs. 71.8 ± 14.5 %, respectively). On follow-up questionnaires, respondents indicate that they found our online and in-person modes of teaching helpful during their residency. POCUS education continues to face a variety of barriers, including limitations in infrastructure and expertise. This study describes an adapted POCUS teaching model that is scalable, uses minimal infrastructure and retains the interactivity of conventional small-group POCUS teaching. This program can serve as a blueprint for other institutions offering POCUS teaching, especially when conventional teaching methods are limited.

Validity evidence for observational ERCP competency assessment tools: a systematic review.

BACKGROUND : Assessment of competence in endoscopic retrograde cholangiopancreatography (ERCP) is critical for supporting learning and documenting attainment of skill. Validity evidence supporting ERCP observational assessment tools has not been systematically evaluated. METHODS : We conducted a systematic search using electronic databases and hand-searching from inception until August 2021 for studies evaluating observational assessment tools of ERCP performance. We used a unified validity framework to characterize validity evidence from five sources: content, response process, internal structure, relations to other variables, and consequences. Each domain was assigned a score of 0-3 (maximum score 15). We assessed educational utility and methodological quality using the Accreditation Council for Graduate Medical Education framework and the Medical Education Research Quality Instrument, respectively. RESULTS : From 2769 records, we included 17 studies evaluating 7 assessment tools. Five tools were studied for clinical ERCP, one for simulated ERCP, and one for simulated and clinical ERCP. Validity evidence scores ranged from 2 to 12. The Bethesda ERCP Skills Assessment Tool (BESAT), ERCP Direct Observation of Procedural Skills Tool (ERCP DOPS), and The Endoscopic Ultrasound (EUS) and ERCP Skills Assessment Tool (TEESAT) had the strongest validity evidence, with scores of 10, 12, and 11, respectively. Regarding educational utility, most tools were easy to use and interpret, and required minimal additional resources. Overall methodological quality (maximum score 13.5) was strong, with scores ranging from 10 to 12.5. CONCLUSIONS : The BESAT, ERCP DOPS, and TEESAT had strong validity evidence compared with other assessments. Integrating tools into training may help drive learners' development and support competency decision making.

Early Postoperative Recovery after Modified Ultra-Minimally Invasive Sonography-Guided Thread Carpal Tunnel Release.

Thread carpal tunnel release (TCTR) has been reported to be safe and effective for the treatment of carpal tunnel syndrome. The aim of this study is to evaluate the modified TCTR for safety, efficacy, and postoperative recovery. Seventy-six extremities in 67 patients undergoing TCTR were analyzed pre- and postoperatively using clinical parameters and patient-reported outcome measures. Twenty-nine men and 38 women with a mean age of 59.9 ± 18.9 years underwent TCTR. The mean postoperative time to resume activities of daily living was 5.5 ± 5.5 days, analgesia was completed after 3.7 ± 4.6 days, and return to work was achieved after a mean of 32.6 ± 15.6 days for blue-collar workers and 4.6 ± 4.3 days for white-collar workers. The Boston Carpal Tunnel Questionnaire (BCTQ) and Disability of Arm, Shoulder, and Hand (DASH) scores were comparable with previous studies. Overall, two persistent compressions and one recurrence required open reoperation (3.9%). All three had been operated in the initial phase, and none required reoperation after an additional safety step was introduced. No other complications occurred. TCTR surgery appears to be a safe and reliable technique with almost no wound and scarring and a potentially faster recovery time than open techniques. Although our technical modifications may reduce the risk of incomplete release, TCTR requires both ultrasound and surgical skills and has a considerable learning curve.

Development and implementation of a comprehensive ultrasound curriculum for medical students: The Bonn internship point-of-care-ultrasound curriculum (BI-POCUS).

Point-of-care ultrasound (POCUS) is rapidly gaining ground within different areas of applications. Despite the high and increasing relevance of ultrasound, the availability of structured training programs in medical schools is still limited. Therefore, many doctors keep acquiring all their ultrasound skills throughout their postgraduate training. As a result, new residents lack theoretical and practical ultrasound abilities that are critical in everyday clinical practice. In order to improve this, we created and implemented a complete ultrasound curriculum for all medical students throughout their internship year that focuses on hands-on abilities in ultrasound imaging. We used Kern's six-step model of curricular development comprising (1) problem identification and general needs assessment, (2) needs assessment of the targeted learners, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback by board-certified ultrasound experts. A two rounds Delphi process with multilevel, self-completed questionnaires and individual using a 9-point Likert scale and free text comments was used to identify learning objectives and reach agreement on the content of the curriculum. The curriculum developed is aimed at students with no or little experience in their internship year and will be taught as part of their weekly-based internship training courses consisting of 2 hours of theory and 3 hours of practical training. The training will be conducted within a modular framework focusing on the key requirements of POCUS with increasing levels of complexity in accordance with the recommendations of the German Society for Ultrasound in Medicine (DEGUM), the European Federation of Societies for ultrasound in Medicine and Biology (EFSUMB) and the World Federation for ultrasound in Medicine and Biology (WFUMB). A longitudinal e-learning system will be implemented in addition to the practical and theoretical teaching units to track and examine the progress of the students. Early integration of ultrasound training into medical education as part of a structured and standardized broad ultrasound curriculum enables medical students to acquire basic skills and apply them practically. Fundamental scanning skills are acquired by hands-on exercises in small, supervised groups as part of BI-POCUS. BI-POCUS therefore provides an excellent opportunity to improve the clinical skills of future physicians. More research is needed to analyze the learning outcomes for medical students and the improvement of the patient's outcome by establishing such an ultrasound curriculum.

Teaching Accuracy Through Repeated Gamified Echography Training (TARGET): Assessment of an Ultrasound Skill Simulator in Teaching Ultrasound-Guided Needle Placement, a Prospective Observational Study.

The increasing use of ultrasound in veterinary private practice and demand for skilled operators upon graduation has placed an increased burden on the ever-dwindling number of academic radiologists. Simulation-based medical education can help prepare for and consequently reduce this burden, allowing for the acquisition of clinical skills through deliberate practice in a safe, controlled, and low-stakes environment. Ultrasound-guided fine needle placement is the foundation for more advanced interventions such as ultrasound-guided fine needle aspirates and centeses. A reusable novel ultrasound skill simulator consisting of metal targets wired to a circuit and suspended in ballistics gel was created to teach ultrasound-guided fine needle placement. Forty-seven second-year veterinary students watched an instructional video and performed two ultrasound-guided fine needle placement skill tests on the simulator with a period of practice between. Significant improvement in time to task completion (p = .0021) was noted after the period of practice. The majority of student feedback was positive with 89% (42/47) indicating they would use the simulator again to practice and that it should be incorporated into the curriculum, 74% (35/47) indicating their basic skills, knowledge, and confidence using ultrasound improved using the simulator, and 55% (26/47) indicating they could now teach this skill to a peer. The authors suggest further development of this model for ease of manufacture and increased variation in difficulty, and veterinary curriculum incorporation for basic ultrasound-guided fine needle placement training.

Subinternship in Diagnostic Radiology: Bringing the Shadowers Out of the Shadows

Diagnostic radiology subinternships are uncommon. We started a diagnostic radiology subinternship at our institution in 2020 and present 3 years of data assessing the impact of the course on students' perceptions of and interest in diagnostic radiology. The initial course design consisted of daily shadowing shifts, small group lectures with attending radiologists, asynchronous self-paced learning assignments, an ultrasound skills session, multidisciplinary tumor board attendance, and completion of 2 formal case presentations. "Junior resident" shifts, where students dictated studies under attending supervision, an emergency radiology call shift, and an ultrasound procedures shift were subsequently added in response to student feedback. Students were asked to complete surveys before and after completing the course. Forty-seven fourth-year medical students completed the course over 3 years. The first 2 groups were predominantly male, whereas the third group showed near even gender representation (54% male). 21 (45%) chose to apply to diagnostic radiology for residency. Student reported interest in diagnostic radiology as a career, valuation of diagnostic radiology as a specialty, comfort with imaging interpretation, and perceptions of the availability of patient interaction and procedures in diagnostic radiology all significantly increased after participation in the course. Students ranked the junior resident shifts and small group attending lectures as the most valuable course components. Implementation of a diagnostic radiology subinternship significantly improved students' interest in and perceptions of the field. We encourage the creation of similar courses in other radiology departments and stress the importance of active learning experiences.

Objective structured assessment ultrasound skill scale for hyomental distance competence – psychometric study

BackgroundUltrasound assessment of the airway recently integrates the point-of-care approach to patient evaluation since ultrasound measurements can predict a difficult laryngoscopy and tracheal intubation. Because ultrasonography is performer-dependent, a proper training and assessment tool is needed to increase diagnostic accuracy. An objective, structured assessment ultrasound skill (OSAUS) scale was recently developed to guide training and assess competence. This work aims to study the psychometric properties of OSAUS Scale when used to evaluate competence in ultrasound hyomental distance (HMD) measurement. Methods: Prospective and experimental study. Volunteers were recruited and enrolled in groups with different expertise. Each participant performed three ultrasonographic HMD evaluation. The performance was videorecorded and anonymized. Five assessors blindly rated participants’ performance using OSAUS scale and a Global Rating Scale (GRS). A psychometric study of OSAUS scale as assessment tool for ultrasound HMD competence was done. Results: Fifteen voluntaries participated on the study. Psychometric analysis of OSAUS showed strong internal consistency (Cronbach’s alpha 0.916) and inter-rater reliability (ICC 0.720; p < 0.001). The novice group scored 15.4±0.18 (mean±SD), the intermediate 14.3±0.75 and expert 13.6±0.1.25, with a significant difference between novice and expert groups (p = 0.036). The time in seconds to complete the task was evaluated: novice (90±34) (mean±SD), intermediate (84±23) and experts (83±15), with no significant differences between groups. A strong correlation was observed between OSAUS and global rating scale (r = 0.970, p < 0.001).ConclusionThe study demonstrated evidence of validity and reliability. Further studies are needed to implement OSAUS scale in the clinical setting for training and assessment of airway ultrasound competence.

E-learning and practical performance in musculoskeletal ultrasound: a multicenter randomized study.

To examine the effect of pre-course e-learning on residents' practical performance in musculoskeletal ultrasound (MSUS). Multicentre, randomized controlled study following the CONSORT statement. Residents with no or little MSUS experience were randomized to either an e-learning group or a traditional group. One week before a 2-day face-to-face MSUS course, the e-learning group received access to an interactive platform consisting of online lectures, assignments, and practical instruction videos aligned with the content of the course. The traditional group only received standard pre-course information (program, venue, and time). All participants performed a pre- and post-course practical MSUS examination and were assessed by two individual raters, blinded to the group allocation, using the validated Objective Structured Assessment of Ultrasound skills (OSAUS) tool. Twenty-eight participants completed the study. There were no statistically significant differences in the pre- or post-course practical MSUS performance between the e-learning group and the traditional group; the mean pre-course OSAUS score (±SD) in the e-learning group was 5.4 ± 3.7 compared with 5.2 ± 2.4 in the traditional group, p= 0.8, whereas the post-course OSAUS score in the e-learning group was 11.1 ± 2.8 compared with 10.9 ± 2.4 in the traditional group, p= 0.8. There was a significant difference between the mean pre- and post-course scores (5.74-point p< 0.001). The OSAUS assessment tool demonstrated good inter-rater reliability (ICC = 0.84). We found no significant impact of pre-course e-learning on novices' acquisition of practical MSUS skills. Hands-on training is of utmost importance and improves MSUS performance significantly. The OSAUS assessment tool is an applicable tool with high interrater reliability. https://clinicaltrials.gov/ NCT04959162.

Hands-On Ultrasound Training for Radiology Residents: The Impact of an Ultrasound Scanning Curriculum

Radiologists are responsible for interpreting ultrasound (US) images accurately, troubleshooting, aiding sonographers, and advancing technology and research. Despite this, most radiology residents do not feel confident performing US independently. The purpose of this study is to evaluate the impact of an abdominal US scanning rotation and digital curriculum on radiology residents' confidence and skills in performing US. All residents who were rotating in pediatric US at our institution for the first time were included (PGY 3-5). Those who agreed to participate were recruited sequentially from July 2018 to 2021 into (A) control and (B) intervention. B had a 1-week US scanning rotation and US digital course. Both groups completed a pre-and post-confidence self-assessment. Pre-and post-skills were objectively assessed by an expert technologist while participants scanned a volunteer. At completion, B completed an evaluation of the tutorial. Descriptive statistics summarized the demographics and closed questions. Pre-and post-test results were compared using paired-T tests, and effect size (ES) with Cohen's d. Open-ended questions were thematically analyzed. PGY-3 and 4 residents participated, and were enrolled in A (N=39) and B (N=30). Scanning confidence significantly improved in both groups, with a greater ES in B (p < 0.01). Scanning skills significantly improved in B (p < 0.01) but not A. Eighty per cent of questionnaire responders used the integrative US tutorial and found it helpful. Free text responses were grouped into themes: 1) Technical issues, 2) Didn't complete course, 3) Didn't understand project, 4) Course was detailed and thorough. Our scanning curriculum improved residents' confidence and skills in pediatric US and may encourage consistency in training, thus promoting stewardship of high-quality US.