Medicus doces te ipsum - Saint John Regional...
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Fraser Mackay 1 David Lewis 1,2 Paul Atkinson 1,2 Dalhousie Medicine New Brunswick, Saint John, New Brunswick 1 Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, New Brunswick 2 Background A major limiting factor to the introduction of point of care ultrasound training into undergraduate medical curricula has been the lack of availability of trained supervisors. Modern medical education has embraced the principle of self directed learning, as well as simulation. This study aimed to assess the ability of pre-clerkship medical students to use self-directed simulation-based training in Point of Care Ultrasound (PoCUS), and to attempt to quantify the number of practice scans required to achieve competence. Methods This was a prospective observational pilot study involving second year medical students with no prior ultrasound experience. Participants studied introductory online learning modules covering basic ultrasound theory and methodology, followed by a period of self-directed ultrasound simulation training at a tertiary care teaching hospital emergency department ultrasound simulation suite. Triggered assessments using live models were performed upon completing 10 and 25 scans in each of 4 core PoCUS areas (cardiac, FAST, aorta, pelvic). No feedback was provided during or after triggered assessments. Upon completion of self directed simulation training (200 scans total), participants were to be tested on live models by qualified staff unaffiliated with this study, using existing competency standards for practicing physicians. Results Of 14 students who began the study, only 9 completed the 2nd of 3 intended tests. In the second triggered assessment (25 scans in each area), two participants had improved in 1 of 4 scans, six did not demonstrate any improvement, and two participants had lower scores than on the earlier test. Structured feedback from all participants (who were not shown their evaluations from the triggered assessments) expressed dissatisfaction with the learning model. Department of Emergency Medicine Research Program, Saint John, NB Medicus doces te ipsum A study in self directed ultrasound learning Conclusion The results and feedback suggest this self-directed learning model would not, if taken to completion, have resulted in competence. A tentative conclusion is that the combination of simulation and self-directed learning is not, without some form of guided mentoring, sufficient to attain competence in point of care ultrasound. This is in contrast to considerable literature supporting, individually, self directed learning and simulation. 1. Royal College of Physicians and Surgeons of Canada 2008, Royal College of Physicians and Surgeons of Canada: Objectives of training in emergency medicine Available from: http:// rcpsc.medical.org/residency/certification/objectives/emergmed_e.pdf Accessed 2013-10-15 2. Woo, M., Nussbaum, C., Lee, A.C., Emergency medicine ultrasonography: National survey of family medicine–emergency medicine program directors Can Fam Physician October 2009 55: 1010-1011.e4 Accessed 3013-09-27 3. American College of Emergency Physicians. Policy Statement: Emergency Ultrasound Guidelines. Dallas, TX: ACEP, 2008 4. IFEM Emergency Ultrasound Subcommittee: Point-of Care Ultrasound Curriculum Guidelines 5. Wong I, Jayatilleke T, Kendall R, Atkinson P. Feasibility of a focused ultrasound training programme for medical undergraduate students. Clin Teach. 8(1):3-7 6. Murad, M., Coto-Yglesias, F., Varkey, P., Prokop, L., Murad, A., The effectiveness of self directed learning in health professions education: a systematic review. Medical Education 2010: 44: 1057–1068 Accessed online 2013-09-28 7. Damewood, S., Jeanmonod, D., Cadigan, B., Comparison of a Multimedia Simulator to a Human Model for Teaching FAST Exam Image Interpretation and Image Acquisition, ACADEMIC EMERGENCY MEDICINE 2011; 18:413–419 Accessed online 2013-10-03 8. Heer, M., Middendorf, K., Muller-Egloff, S., Dugas, M., Strauss, A., Ultrasound training: the virtual patient. Ultrasound Obstet Gynecol 2004; 24: 440–444 Accessed online 2013-09-28 9. Sheehan, F., Otto, C., Freeman, R., Echo Simulator with Novel Training and Competency Testing Tools, Medicine Meets Virtual Reality 20J.D. Westwood et al. (Eds.)IOS Press, 2013 Accessed online 2013-09-17 10. Canadian Emergency Ultrasound Society. CEUS recommended standards. Available at: http://ceus.ca/002-standards/002-00.standards.htm 11. Moore CL, Copel JA. Point of care ultrasonography. N Engl J Med 2011;364:749-57 Accessed online 2013-10-23 Acknowledgements: Jacqueline Fraser Contact: Fraser D. Mackay • [email protected] Figure 1. Numbers of students achieving competency at each stage CAE Vimedix ultrasound simulator SonoSim® Ultrasound Training Solution system
Transcript of Medicus doces te ipsum - Saint John Regional...
Fraser Mackay1
David Lewis1,2
Paul Atkinson1,2 Dalhousie Medicine New Brunswick,
Saint John, New Brunswick1
Department of Emergency Medicine, Dalhousie University,
Saint John Regional Hospital, Saint John, New Brunswick2
BackgroundA major limiting factor to the introduction of point of care ultrasound training into undergraduate medical curricula has been the lack of availability of trained supervisors. Modern medical education has embraced the principle of self directed learning, as well as simulation. This study aimed to assess the ability of pre-clerkship medical students to use self-directed simulation-based training in Point of Care Ultrasound (PoCUS), and to attempt to quantify the number of practice scans required to achieve competence.
MethodsThis was a prospective observational pilot study involving second year medical students with no prior ultrasound experience. Participants studied introductory online learning modules covering basic ultrasound theory and methodology, followed by a period of self-directed ultrasound simulation training at a tertiary care teaching hospital emergency department ultrasound simulation suite. Triggered assessments using live models were performed upon completing 10 and 25 scans in each of 4 core PoCUS areas (cardiac, FAST, aorta, pelvic). No feedback was provided during or after triggered assessments. Upon completion of self directed simulation training (200 scans total), participants were to be tested on live models by qualified staff unaffiliated with this study, using existing competency standards for practicing physicians.
ResultsOf 14 students who began the study, only 9 completed the 2nd of 3 intended tests. In the second triggered assessment (25 scans in each area), two participants had improved in 1 of 4 scans, six did not demonstrate any improvement, and two participants had lower scores than on the earlier test. Structured feedback from all participants (who were not shown their evaluations from the triggered assessments) expressed dissatisfaction with the learning model.
Department of Emergency Medicine Research Program, Saint John, NB
Medicus doces te ipsumA study in self directed ultrasound learning
Conclusion The results and feedback suggest this self-directed learning model would not, if taken to completion, have resulted in competence. A tentative conclusion is that the combination of simulation and self-directed learning is not, without some form of guided mentoring, sufficient to attain competence in point of care ultrasound. This is in contrast to considerable literature supporting, individually, self directed learning and simulation.
1. Royal College of Physicians and Surgeons of Canada 2008, Royal College of Physicians and Surgeons of Canada: Objectives of training in emergency medicine Available from: http://rcpsc.medical.org/residency/certification/objectives/emergmed_e.pdf Accessed 2013-10-15
2. Woo, M., Nussbaum, C., Lee, A.C., Emergency medicine ultrasonography: National survey of family medicine–emergency medicine program directors Can Fam Physician October 2009 55: 1010-1011.e4 Accessed 3013-09-27
3. American College of Emergency Physicians. Policy Statement: Emergency Ultrasound Guidelines. Dallas, TX: ACEP, 2008
4. IFEM Emergency Ultrasound Subcommittee: Point-of Care Ultrasound Curriculum Guidelines
5. Wong I, Jayatilleke T, Kendall R, Atkinson P. Feasibility of a focused ultrasound training programme for medical undergraduate students. Clin Teach. 8(1):3-7
6. Murad, M., Coto-Yglesias, F., Varkey, P., Prokop, L., Murad, A., The effectiveness of self directed learning in health professions education: a systematic review. Medical Education 2010: 44: 1057–1068 Accessed online 2013-09-28
7. Damewood, S., Jeanmonod, D., Cadigan, B., Comparison of a Multimedia Simulator to a Human Model for Teaching FAST Exam Image Interpretation and Image Acquisition, ACADEMIC EMERGENCY MEDICINE 2011; 18:413–419 Accessed online 2013-10-03
8. Heer, M., Middendorf, K., Muller-Egloff, S., Dugas, M., Strauss, A., Ultrasound training: the virtual patient. Ultrasound Obstet Gynecol 2004; 24: 440–444 Accessed online 2013-09-28
9. Sheehan, F., Otto, C., Freeman, R., Echo Simulator with Novel Training and Competency Testing Tools, Medicine Meets Virtual Reality 20J.D. Westwood et al. (Eds.)IOS Press, 2013 Accessed online 2013-09-17
10. Canadian Emergency Ultrasound Society. CEUS recommended standards. Available at: http://ceus.ca/002-standards/002-00.standards.htm
11. Moore CL, Copel JA. Point of care ultrasonography. N Engl J Med 2011;364:749-57 Accessed online 2013-10-23
Acknowledgements: Jacqueline Fraser
Contact: Fraser D. Mackay • [email protected]
Figure 1. Numbers of students achieving competency at each stage
CAE Vimedix ultrasound simulator
SonoSim® Ultrasound Training Solution system
