Ultrasound Workshop Research Articles

Tele-education in point-of-care ultrasound training

BackgroundTraditionally, ultrasound skills have been taught through a one-on-one approach, where instructors physically guide learners’ hands at the bedside or in the workshop. However, this method is frequently challenged by scheduling and cost limitations. Our objective was to create a tele-education model for point-of-care ultrasound training and evaluate its effectiveness and its impact on learners’ perceived workload compared to conventional education and self-directed learning methods.MethodsWe conducted a 3-arm randomized trial, comparing tele-education (TE), conventional education (CE) and self-directed learning (SL) methods. All subjects underwent online didactic lectures prior to a hands-on ultrasound workshop. The TE group utilized an ultrasound machine equipped with a speakerphone, a webcam for direct visualization of learner’s hand maneuvers, and an analog-to-video converter for the real-time streaming of ultrasound images. This configuration enabled remote instructors to provide immediate verbal feedback to learners. In contrast, the CE group received in-person coaching, while the SL group had no instructors present. Following the coaching session, subjects completed a scenario-based skill test and a survey on the National Aeronautics and Space Administration task load index (NASA-TLX) to measure their ultrasound competency and perceived workload, respectively.ResultsTwenty-seven ultrasound novices were randomly allocated into 3 groups. The median skill test score of TE, CE, and SL was 22 [interquartile range (IQR): 18–28], 24 [IQR: 21–31], and 16 [IQR: 15–18], respectively (p < 0.01). Pairwise comparisons of median test scores of 3 groups demonstrated a statistical significance in comparisons of TE vs. SL (22 vs. 16, p = 0.01) and CE vs. SL (24 vs. 16, p < 0.01), but not in TE vs. CE (22 vs. 24, p = 0.56). There was no statistical significance observed in the median NASA-TLX scores among the 3 groups; 54 [IQR:47–61] in TE, 57 [IQR:22–64] in CE, and 66 [IQR: 66–72] in SL (p = 0.05).ConclusionsOur tele-education model was more effective than self-directed learning. There was no statistically significant difference in effectiveness between the tele-education and the conventional education groups. Importantly, tele-education did not impose a significantly higher workload on learners compared to conventional education or self-directed learning. Tele-education has a substantial potential as an alternative to conventional ultrasound training.

The Impact of a Student-Taught Point-of-Care Ultrasound Workshop on Confidence in Medical and Pre-Medical Students

Background: The vast utilization of Point-of-Care Ultrasound (POCUS) across medical specialties has increased the need for enhanced undergraduate medical education in image acquisition and interpretation among medical students. However, challenges such as the need for a standardized medical school curriculum and limited trained faculty preceptors restrict its implementation. The literature highlights the potential of student-taught POCUS workshops in expanding access and enhancing learning. This study seeks to evaluate the efficacy of a student-run POCUS workshop for medical and pre-medical students. Methods: A prospective, cross-sectional study assessed the efficacy of first and second-year medical students teaching a POCUS workshop on the Focused Assessment with Sonography for Trauma (FAST) exam. Student workshop participants were asked to complete pre- and post-workshop surveys to assess their confidence in utilizing POCUS and identifying relevant organs and landmarks. Surveys employed a standardized five-point Likert Scale. Results: Of the 43 initial participants, 29 completed both surveys. Results showed a significant increase in self-reported ultrasound experience (1.7 to 3.2, p &lt; 0.001) and confidence in performing the FAST exam and organ identification (2.2-fold increase, p &lt; 0.001). Both medical and pre-medical student cohorts exhibited similar confidence improvements in confidence. Conclusion: This study supports the literature that student-taught POCUS programs may be a viable adjunct to an institution's ultrasound curriculum. Implementing medical student-led workshops could help address current training gaps, enhance students' teaching and leadership skills, and improve confidence in utilizing and interpreting ultrasound images.

Using Simulation Models to Train Clinicians in the Use of Point-of-Care Ultrasound.

The use of point-of-care ultrasound (POCUS) has shown to be a beneficial non-invasive vascular access assessment method by clinicians, which can provide critical elements of visual and measurable information that proves to be useful in the context of vascular access cannulation, in combination with the practical skill of the clinician performing the cannulation. However, the use of POCUS in this context is to practically train and enable individuals who are novices in using this technique to become proficient in performing this task subsequently on patients in a careful and successful way. The simulation of these vascular conditions may be useful to help healthcare professionals learn, understand, apply, and establish such practical skills for vascular cannulation safely to achieve the desired outcomes. This project intended, through the attendance of a half-day workshop, to establish skills to use POCUS in connection with simulation models and perform specific tasks to enable clinicians to use this method in their clinical practice for vascular access cannulation in patients. A mixed-methods longitudinal study design was used to evaluate the effect of a point-of-care ultrasound workshop for peripheral intravenous cannula insertion, including specific tasks for the participants to be performed on simulation models. A total of 81 individuals participated in 11 half-day workshops through 2021 and 2022. Offering a workshop that uses simulation models in combination with various POCUS devices is useful in establishing this newly learned skill in clinicians, such as measurements of depth, caliper, and direction of a vein with POCUS prior to cannulation providing essential anatomical facts to the operator, which increases the likelihood of first-time success in cannulation.

Using Ultrasound to Improve Diagnostic Confidence and Management of Psoriatic Disease: Highlights From the GRAPPA 2023 Ultrasound Workshop.

The sensitivity of ultrasound (US) to detect, characterize, and monitor the relevant pathologies of psoriatic arthritis (PsA), including synovitis, enthesitis, tenosynovitis, and dactylitis, has made it an attractive tool for informing clinical decisions. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) US working group ran 2 sessions during the annual GRAPPA meeting held in July 2023 in Dublin, Ireland. During the first workshop, the group presented 2 topics, followed by a live demonstration and a group discussion. The 2 topics were (1) an overview of the Diagnostic Ultrasound Enthesitis Tool (DUET) enthesitis scoring methodology, and (2) small hand-held probes-will the promise deliver? The live demonstration that followed compared the performance of 2 hand-held US (HHUS) devices vs a console US machine in patients with PsA, and the interactive group discussion considered gaps in the literature and future research suggestions relating to HHUS and its application in psoriatic disease. During the second session, the US working group provided further updates regarding the GRAPPA US studies currently underway or recently completed.

Integration of Cardiac Point of Care Ultrasound (POCUS) in a Medical Physiology Course During the Preclinical Curriculum

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of cardiac POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess cardiac output. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner. Data obtained during the 2023-2024 winter quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the cardiac physiology workshop administered during the first year of medical school. Survey questions will be generated using Likert 5-point scales, ratings of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the cardiac POCUS workshop can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate cardiac output) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize that student perceptions of these workshops will be largely positive and improve student confidence in POCUS use. No funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Integration of Bladder Point of Care Ultrasound (POCUS) in a Medical Physiology Course During the Preclinical Curriculum

Background: The early integration of hands-on point-of-care ultrasound (POCUS) during medical students' preclinical curriculum has expanded the utilization of this tool which can provide rapid and effective bedside diagnosis in clinical practice. Many medical schools that have incorporated POCUS into their curriculum allude to the limitations of a large class size, learning retention, and applying these skills to aid in diagnosing pathologic conditions. Indeed, it is interesting that there is currently no consensus as to what and how much hands-on ultrasound training should be included in the medical school curriculum. At Midwestern University (MWU), we introduced a 4-year inclusion of ultrasound training throughout the medical curriculum. The core Physiology courses taken in winter and spring quarter of first year medical school, incorporate several mandatory ultrasound workshops taken by osteopathic medical students and podiatry students together. This study hypothesizes that the incorporation of bladder POCUS in small group physiology workshops increases student confidence in their ability to measure the parameters to effectively assess bladder volume. Moreover, we hypothesize that this hands-on teaching tool reinforces the concepts taught in the didactic lectures, applying the material in a clinically relevant manner Data obtained during the 2023-2024 spring quarter will be presented at the APS meeting. Methods: This study aims to utilize a brief survey administered via REDCap, in a questionnaire format to first year osteopathic medical students and podiatric medical students after the bladder physiology workshop administered during the first year of medical school. Survey questions will be generated using a Likert 5-point scale, a rating of (strongly agree to strongly disagree, very comfortable to very uncomfortable, high level of competence to no level of competence, and very confident to very unconfident). Survey questions will seek to assess confidence level using POCUS, ease of quantifying assessments, and differences in perceptions between podiatry and osteopathic medical students. Associations between two question responses will be assessed using the Chi-square test for independent responses and McNemar test to compare responses that were paired. A p-value &lt;0.05 for both tests will indicate statistical significance. Furthermore, we aim to determine whether retention and application of the information taught during the bladder POCUS workshops can be evaluated by student performance on POCUS-specific exam questions. IRB approval is currently pending. Results: We plan to share: (1) the survey questions, (2) data obtained using POCUS from the last academic years class cohort and the current class (specifically relating to their use of POCUS to calculate and interpret bladder volume) to highlight the variability in these assessments, (3) exam question analyses for the last 2-years (as assessment outcomes), (4) survey responses from the current class, (5) correlations of student perceived confidence and determined understanding. Conclusion: The introduction of POCUS utilization during the physiology courses in the first year of Osteopathic and Podiatry pre-clinical years reinforces key concepts covered in didactic lectures. We hypothesize student perceptions of these workshops will be largely positive and will improve student confidence in POCUS use. No Funding. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The Development, Implementation, and Evolution of an Emergency Medicine Ultrasound-guided Regional Anesthesia Curriculum.

Despite the inclusion of both diagnostic and procedural ultrasound and regional nerve blocks in the original Model of the Clinical Practice of Emergency Medicine (EM), there is no recommended standardized approach to the incorporation of ultrasound-guided regional anesthesia (UGRA) education in EM training. We developed and implemented a structured curriculum for both EM residents and faculty to learn UGRA in a four-hour workshop. Each Regional Anesthesia Anatomy and Ultrasound Workshop was four hours in length and followed the same format. Focusing on common UGRA blocks, each workshop began with an anatomist-led cadaveric review of the relevant neuromusculoskeletal anatomy followed by a hands-on ultrasound scanning practice for the blocks led by an ultrasound fellowship-trained EM faculty member, fellow, or a postgraduate year (PGY)-4 resident who had previously participated in the workshop. Learners identified the relevant anatomy on point-of-care ultrasound and reviewed how to conduct the blocks. Learners were invited to complete an evaluation of the workshop with Likert-scale and open-ended questions. In the 2020 academic year, six regional anesthesia anatomy and ultrasound workshops occurred for EM faculty (two sessions, N = 24) and EM residents (four sessions, N = 40, including a total of five PGY4s, 10 PGY3s, 12 PGY2s, and 13 PGY1s). Workshops were universally well-received by both faculty and residents. Survey results found that 100.0% of all responding participants indicated that they were "very satisfied" with the session. All were likely to recommend this session to a colleague and 95.08% of participants believed the session should become a required component of the EM curriculum. The use of UGRA is increasing, and and it critical in EM. An interdisciplinary approach in collaboration with anatomists on an interactive, nerve block workshop incorporating both gross anatomy review and hands-on scanning was shown to be well-received and desired by both EM faculty and residents.

E-FAST Ultrasound Training Curriculum for Prehospital Emergency Medical Service (EMS) Clinicians.

Audience and type of curriculum: This hybrid, asynchronous curriculum is designed for prehospital clinician colleagues, including but not limited to emergency medical technicians (EMT), advanced EMTs (AEMT), EMT-paramedics (EMT-P), critical care EMT-Ps (CCEMTP), critical care transport nurses (CCTN), and certified flight registered nurses (CFRN) to learn and practice ultrasound fundamentals in the setting of a standardized extended focused assessment with sonography in trauma (E-FAST) exam. Over a five-month curriculum, learners will perform a pre-test, review online module lectures, attend an ultrasound scanning workshop, and perform post-test examinations. The extended-focused assessment with sonography in trauma (E-FAST) exam can identify intrathoracic and intraabdominal free fluid, as well as pneumothoraces. The E-FAST ultrasound exam has previously been taught to clinicians of various backgrounds in healthcare including emergency medical service (EMS). However, an open-access, systemized curriculum for teaching E-FAST exams to EMS clinicians has not been published. By the end of these training activities, prehospital EMS learners will be able to demonstrate foundational ultrasound skills in scanning, interpretation, and artifact recognition by identifying pertinent organs and anatomically relevant structures for an E-FAST examination. Learners will differentiate between normal and pathologic E-FAST ultrasound images by identifying the presence of free fluid and lung sliding. Learners will also explain the clinical significance and application of detecting free fluid during an E-FAST scan. The educational strategies used in this curriculum include a hybrid, asynchronous curriculum encompassing 2.5 hours of lectures derived from online learning modules and in-person review. In addition, learners will attend 2 hours of hands-on proctored ultrasound scanning practicing E-FAST examinations. An online 13-question pre-test was administered prior to the study. An online post-test and in-person scanning OSCEs were administered at least eight weeks after their scheduled workshop consisting of an online 13-question multiple-choice post-test, a confidence survey, and a hands-on E-FAST Objectively Structured Clinical Exam (OSCE) session. A non-parametric Wilcoxon signed-rank test was performed between each pre-test and post-test metric to examine the statistical differences of paired data. Post-test scores demonstrated statistically significant improvement in both image interpretation exams and ultrasound self-efficacy from the pre-test. The mean pre-test and post-test scores were 55.46% (7.21 ± 1.99) and 84.23% (10.89 ± 1.59) correct out of 13 questions, respectively (p < 0.0001). Participants surveyed an increase in self-efficacy reflected by a Likert scale for ultrasound usage and image interpretation (p < 0.005). The average post-test OSCE E-FAST exam score was 37.89 ± 2.76 out of 42 points (90.21%). This 4.5-hour hybrid asynchronous model demonstrates an effective curriculum for teaching E-FAST ultrasound to prehospital clinicians. Ultrasound, sonography, prehospital clinicians, emergency medical services (EMS), paramedics, critical care transport, extended focused assessment with sonography in trauma (E-FAST), free fluid, sliding lung sign, elective, pain.

The inauguration of point-of-care ultrasound (POCUS) workshops to frontline NHS medical trainees in the Wessex Deanery: a quality improvement initiative

The inauguration of point-of-care ultrasound (POCUS) workshops to frontline NHS medical trainees in the Wessex Deanery: a quality improvement initiative

A88Designing a Multidisciplinary Chest Drain Course

In 2008 the National Patient Safety Agency reported 12 patient deaths directly related to chest drain insertion over a 3-year period. Since then there have been calls from publications highlighting the need for better education for clinicians [1]. Simulation has been shown to improve chest drain insertion technique [2], and multi-disciplinary simulation can encourage teamwork and communication skills [3]. Given that this procedure is an essential requirement for anaesthetic, intensive care, emergency medicine and internal medicine trainees, we decided to introduce a multi-disciplinary simulation course for the insertion of chest drains. A basic needs analysis was carried out with stakeholders. Initially the course was designed to run for half a day, with a maximum of 12 candidates and a minimum of 3 faculty. A course timetable, course manual, equipment list and pre- and post-course feedback questionnaires were created. The course begins with a lecture, followed by three simulation-based workshops, which the candidates rotate between. These cover seldinger and surgical chest drain insertion, and the basics of chest ultrasound, using ultrasoundable chest drain manikins. Feedback from the first course in July 2022 suggested that there should be a designated faculty team leader and healthy volunteers for the ultrasound workshop. We implemented this feedback and ran the course again in December 2022. Candidates were asked to rate their post course confidence at performing the procedure, with a score ranging between 1 and 7 (each number was assigned a qualitative value with 1 being unable to perform the procedure and 7 being extremely confident in performing the procedure). After the first course, the average score was 5 points. After the second, the average increased to 5.5. The course ran for a third time in April 2023, during which the duration of the workshops was increased and a lecture on aftercare was added. The average post course confidence score was 5.7. All candidates felt that the session fully met the learning objectives and would recommend the course to others. After implementing changes to our course including assigning a faculty team leader, recruiting healthy volunteers, increasing the time spent in workshops and adding a session on aftercare, there has been an improvement in the candidates’ average post course confidence at performing chest drains and qualitative candidate feedback was positive. We would recommend our course structure to others designing a chest drain course. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Nephrologist-Led Simulation-Based Focused Cardiac Ultrasound Workshop for Medical Students: Insights and Implications

BackgroundPoint-of-care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination. However, limited availability of trained faculty in specialties other than emergency medicine and lack of universal training standards remain key barriers to its widespread integration into undergraduate and graduate medical curricula. In this study, we sought to explore the effectiveness of a short simulation-based workshop for medical students teaching basic cardiac ultrasound led by a nephrologist. MethodsWorkshops were conducted for 2 different groups of 4th-year medical students with a total of 25 attendees. The workshop consisted of a 1-hour lecture followed by 15 minutes of cardiac anatomy simulation and a 2- to 2.5-hour hands-on session in the simulation laboratory. An anonymous precourse questionnaire comprising 10 questions assessing the interpretation of common grayscale ultrasound findings encountered in patients with undifferentiated hypotension was performed. After the workshop, a postcourse exam and survey were conducted, retesting the same concepts and seeking the students’ feedback on the course. ResultsIn total, 23 and 20 students answered the pre- and postcourse surveys, respectively. The mean total score on the pretest was 63.8% ± 13.6%, which significantly increased to 91.5% ± 10.5% on the posttest (P < .001). About 90% of the respondents strongly agreed that the cardiac anatomy simulation improved their understanding of the cardiac sonographic anatomy; 75% strongly agreed that the hands-on simulation enhanced their confidence in image acquisition and interpretation; and 70% said they would choose nephrology elective if POCUS training was integrated with it. ConclusionsA nephrologist-led diagnostic POCUS workshop using simulation techniques is effective in improving the learners’ knowledge, understanding of the sonographic cardiac anatomy, and confidence in image acquisition. Integration of POCUS training may increase medical student interest in nephrology elective rotations.

The Effectiveness of Student-Led Musculoskeletal and Vascular Ultrasound Workshops at a Single Institution: A Retrospective Survey Analysis.

Introduction Point-of-care ultrasound (POCUS) is a rapidly evolving field of diagnostic medicine as its low cost, portability, and versatility have made handheld ultrasound (US) probes an invaluable tool for many modern physicians. Despite US's benefits as a bedside evaluative tool, many medical schools have not integrated POCUS into their pre-clerkship medical education due to a lack of equipment and faculty. The first objective of our study was to determine whether student tutors (STs) would be effective resources to teach musculoskeletal (MSK) and vascular US to preclinical medical students. The second objective of our study was to determine whether students who previously attended ST-run MSK US workshops perform better in vascular US than those who did not. Methods Six POCUS workshops were led by STs after approval from experienced US faculty. These included US workshops on gastrointestinal structures, forearm structures, joint structures, basic echocardiography, and US-guided IV access. We collected data from two of our six workshops. We developed surveys to gauge the confidence and ability of students to perform US after an MSK workshop and US-guided IV access workshop led by STs. We also measured students' US abilities and collected student feedback after our US-guided IV access workshop.We evaluated students' US competency in US-guided IV access via their ability to correctly position the US probe, angle the needle of insertion, move the probe with the needle, and access the vein based on the accuracy of the movements. We divided student results into two groups: students who previously attended the MSK workshop before attending the US-guided IV access workshop and students who did not attend the MSK workshop before attending the US-guided IV access workshop. We used averages, frequencies, and two-tailed t-tests to analyze the survey responses and US-guided IV access skill assessments. Results Fifty percent of first- and second-year surveyed students "agreed," and 32.4% "strongly agreed" that they felt confident using US after an ST-run MSK workshop. About 29.4% of surveyed students "agreed" and 41.2% "strongly agreed" that they felt comfortable explaining basic US concepts, such as proper probe positioning and echogenicity. The group of students who attended the MSK workshop prior to the peripheral IV workshop scored similarly to the students who did not attend the MSK workshop (14.33±1.03 versus 14.20±0.84 points). Both groups of students had an average of over 94% accuracy in technique, positioning, angling, moving the US probe, and achieving US-guided venous access after being taught by STs. Qualitative surveying noted positive student feedback, such as "Teacher was great at guiding us through the procedure." Survey responses also included suggestions on adding and diversifying equipment, such as "[It would be useful to have a] different type of needle to see the difference on ultrasound." Conclusion Based on the high percentages of accuracy and confidence, we found that STs were effective resources to teach MSK and vascular POCUS and that students who attended previous MSK ST-run US workshops had stronger vascular US ability over time compared to those who did not. Our data supportthe use of STs as US educational resources, especially in institutions without an existing pre-clerkship US curriculum and limited US resources.

Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation

BackgroundPoint-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.MethodsA mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop.ResultsA total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop.ConclusionsGlobally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.

The Utility of a Hospital System-Specific Emergency Medicine Residency Orientation

Introduction:The transition to residency is a challenging time in the medical trainee’s career. In addition to learning and implementing knowledge specific to emergency medicine, logistics and system nuances can initially impede a learner’s ability to begin the process of mastering their profession. In an attempt to ameliorate this transition to residency an orientation was created to introduce concepts of local ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits.Method:Interns were given a pre-workshop survey on comfort level (1-5 Likert) of ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits. They rotated through four workshop stations in small groups. The first was an ultrasound workshop showcasing our commonly used ultrasound and how we capture images and videos into our medical system for review. The next was institution specific protocols for medical and trauma resuscitation using simulation. Third was a workshop on how to navigate our electronic medical record with simple overviews of documentation and order entry. Lastly, they went through arterial and central line kits to familiarize themselves with the contents. A post-workshop survey was given.Results:Comfort with ultrasound documentation pre-workshop mean was 4.0 with a post-workshop mean of 4.45 (p=0.068). Comfort with resuscitation pre-workshop mean of 2.91 increased to 3.91 (p=0.008). Electronic medical record documentation comfort rose from a mean of 3.5 to 4.27 (p=0.007). Comfort navigating procedural kits increased to a mean of 4.09 from 3 (p=0.002).Conclusion:There was a statistically significant increase in comfort level with ultrasound documentation, resuscitation protocols, EMR navigation, and procedural kits after completion of the workshops. Only ultrasound documentation had a p value less than 0.05. It can be reasonably deduced that focusing on institutionally specific aspects of workflow can help interns expedite their education by familiarizing them with these nuances prior to their first shift.

Ultrasound Workshop in Gynecology

Ultrasound Workshop in Gynecology

Ultrasound Workshop in Obstetrics

Ultrasound Workshop in Obstetrics

Evaluation of antenatal point-of-care ultrasound training workshops for rural/remote healthcare clinicians: a prospective single cohort study

BackgroundThere is limited access to life-saving antenatal ultrasound in low-resource rural and remote settings worldwide, including Australia, mainly due to shortages in skilled staff. Point-of-care ultrasound (PoCUS) offers a viable solution to this service deficit, however, rural clinicians face many barriers accessing training and professional development critical to advancing their clinical practice. Standards for PoCUS training and competency assessment are unclear. Regulation is lacking globally, allowing untrained and inexperienced clinicians to practice PoCUS clinically.MethodsThis prospective single cohort study aimed to evaluate antenatal PoCUS training workshops for General Practitioners (GPs) and Midwives/Nurses (M/Ns) from rural/remote Australia, assessing the impact of the training on trainees’ knowledge, confidence and translation of PoCUS into clinical practice. Two-day antenatal ultrasound workshops were delivered at the University of South Australia (UniSA) in 2018 and 2019 to 41 rural/remote clinicians . The training was designed and evaluated using the New world Kirkpatrick Evaluation Framework. Sixteen GPs and 25 M/Ns with mixed prior ultrasound experience were funded to attend. The course consisted of lectures interspaced with hands-on training sessions using high-fidelity simulators and live pregnant models. Pre- and post-knowledge assessments were performed. Post-workshop evaluation and follow-up surveys (3- and 6-month post-training) assessed the workshops and changes to trainees’ clinical practice. A 2-day follow-up training session was conducted 12 months after the workshops for 9 trainees.ResultsPre/post knowledge testing demonstrated a 22% mean score improvement (95% CI 17.1 to 27.8, P < 0.0001). At 6 months, 62% of trainees were performing PoCUS that had assisted in patient management and clinical diagnosis, and 46% reported earlier diagnosis and changes to patient management. 74% of trainees had increased scanning frequency and 93% reported improved scanning confidence.ConclusionThis study demonstrated intensive 2-day workshops can equip clinicians with valuable antenatal PoCUS skills, offering a viable solution to assist in the assessment and management of pregnant women in the rural/resource-poor setting where access to ultrasound services is limited or non-existent. Geographical isolation and lack of onsite specialist supervision poses an ongoing challenge to the continuing professional development of remote trainees and the implementation of PoCUS.

Finding the bubbles in therapeutic ultrasound—For better or for worse

Cavitation has played a variety of roles in therapeutic ultrasound since the field began. Bubble activity has been seen as both a harmful side effect and the means to the therapeutic end. Throughout this range, the monitoring of bubble activity has been an important goal for numerous reasons including safety considerations, progression of treatment, and determining therapeutic efficacy. Methods of cavitation monitoring have been summarized in various contexts including the ASA effort led by Wesley Nyborg, PhD that generated the American National Standards Institute (ANSI) S1.24 TR-2002 (R2007) entitled ANSI Technical Report—Bubble Detection and Cavitation Monitoring. More recently a six-part virtual series, The Detecting, Mapping, and Quantifying Bubble Activity in Therapeutic Ultrasound workshop (https://www.fusfoundation.org/posts/bubble-activity-in-therapeutic-ultrasound-workshop-series/) was held in 2021, sponsored by The Focused Ultrasound Foundation, in partnership with the American Institute of Ultrasound in Medicine’s Future Fund. A summary was released as a white paper. This presentation will provide an introduction to the field of bubble and cavitation detection and monitoring and a summary of this most recent workshop and associated follow-on efforts.

Atypical gastric ultrasound appearance immediately after food intake.

Gastric point-of care-ultrasound (POCUS) is an emerging clinical tool. Its utility in guiding clinical decision-making relies on the ability to differentiate between the appearance of an empty stomach; fluid-filled stomach (clear versus particulate fluid); ‘early solid’ content; and ‘late solid’ content, with the most accurate imaging obtained when the patient is scanned in the right lateral decubitus (RLD) position [1]. The typical appearance of early solids is often referred to as a ‘frosted glass’ pattern, where the anterior wall of the antrum is visible with large acoustic shadowing posteriorly (Fig. 1a). This appearance is caused by air swallowed during eating, creating a mucosa-air interface indicated by multiple ‘ring-down’ artefacts on the anterior gastric wall which blur the posterior wall [1-4]. In contrast, the appearance of late solids occurs after the air is displaced, and a distended antrum with mixed echogenicity is seen (Fig. 1b). To our knowledge, all published descriptions of gastric ultrasound to date describe the frosted glass appearance immediately after food intake. In a study of six healthy volunteers, all volunteers demonstrated a late solid sonographic appearance when scanned 90 min after ingesting a solid meal [3]. However, the time period over which this occurs is described within the literature as “variable” [2]. Here, we present and discuss atypical gastric ultrasound images captured during a gastric POCUS workshop, immediately after food ingestion in a healthy woman in her early 20s with no relevant medical or surgical history. Initial ultrasound images of a fasted stomach were as expected (Fig. 1c). However, images captured immediately after a small meal showed a late solids appearance (Fig. 1d). This unexpected finding was again confirmed on repeat imaging of the same individual some weeks later. To our knowledge, this is the first report of the complete absence of the characteristic frosted glass appearance immediately after ingestion of food, giving the false appearance of a late solids state. We hypothesise that this is due to a lack of air being swallowed during ingestion. External observation of the subject's chewing and swallowing pattern did not reveal any obvious deviation from normal. It is difficult to comment on the true incidence of this finding, given that studies investigating the sonographic transition from early to late solids appearance have small sample sizes. Coupled with the lack of previous case reports, we believe this atypical appearance to be a rare finding. The clinical significance of this report is that a late solids appearance may be seen immediately after ingestion of food, giving the false impression that approximately 60–90 min has passed since ingestion. Adverse impact on patient care can be avoided if gastric POCUS is subsequently used to confirm an empty antrum, rather than relying on a specific timeframe after ingestion of food. This observation adds to the knowledge base of gastric sonography as it emerges as a routine clinical tool. This report was published with the written consent of the subject. The authors obtained additional written consent for the use of the ‘typical’ gastric ultrasound images. NS is the convener of the POCUS North Shore gastric ultrasound workshop. No external funding declared. Open access publishing was facilitated by The University of Auckland, as part of the Wiley - The University of Auckland agreement via the Council of Australian University Librarians.

Enhanced confidence and ultrasound‐performance skills of medical students: A comparative study with and without prior videographic ultrasound exposure

INTRODUCTIONPoint‐of‐care ultrasonography (POCUS) is commonly used in many modalities of medicine. However, there is a lack of standardized protocol for integrating POCUS into preclinical medical education. Previous literature has detailed the benefits of POCUS in clinical diagnoses and reasoning, but many medical students still lack exposure to POCUS. At California University of Science and Medicine (CUSM), medical students will be exposed to POCUS in their preclinical years. We aim to compare the confidence levels and ultrasound‐performance skills of medical students with and without prior videographic ultrasound exposure.HypothesisPrior videographic ultrasound exposure will improve the confidence and ultrasound‐performance skills of medical students during a live ultrasound workshop compared to those without videographic exposure.MethodsParticipants will be divided into two groups. One group will watch a 5–10‐minute procedural video about ultrasound‐guided peripheral intravenous (IV) access prior to ultrasound training, while the other group will be ultrasound‐naive prior to ultrasound training. Ultrasound training will be led by three other medical students who are trained and approved by ultrasound physicians. After demonstrations, participants will practice ultrasound‐guided IV access on a practice pad. Instructors will grade students on the spot on their ability to perform ultrasound‐guided IV access correctly. The parameters measured will be proper positioning of the ultrasound probe, insertion of the needle, ultrasound probe movement, puncturing of the vein, and overall technique. The two study groups will then take surveys on their perceived performance and overall confidence levels.ResultsResults from participants will be scored using two measures. Firstly, their self‐reflection surveys will measure their level of confidence and perceived ultrasound‐performance skills. Secondly, on‐the‐spot grading by instructors will provide information on participants’ actual ultrasound‐performance skills. A standardized grading scheme will ensure fairness among different instructors and participants.ConclusionComparison of the effectiveness of an additional videographic ultrasound component prior to live demonstration will be elucidated. This study will help create elements within existing ultrasound curriculae that will enhance the confidence and ultrasound‐performance skills of preclinical medical students.