- Email: [email protected]
71 Integration of Asynchronous Ultrasonographic Education Into a 4-Week Medical Student Emergency Medicine Clerkship: A Pilot Program
CORD Abstracts important dimensions of simulation (cognitive knowledge, critical thinking, psychomotor skills, clinical performance, and kinesthetics). The Q-set consisted of 36 statements. The set of statements was validated by expert consensus. Participants consisted of third-year EM residents from a single institution, all with 2⫹ years’ exposure to simulation as a teaching modality. Participants arranged the statements along a spectrum based on a Likert scale, ranging from ⫺5 (“most disagree”) to ⫹5 (“most agree”). The Q-sort data were analyzed with PCQ analysis software. Results: Seventeen residents in their third year of training completed the Q sorts. Four factors explained 35% of variance and were approximately equal in explanatory power based on eigen values. Five statements from the Q-set were ranked either predominantly negative or positive on the Likert scale, but there was no specific grouping of statements observed. Conclusion: Based on the results, no single dimension of simulation appears to be predominantly valued by learners. Effective simulation-based education requires attention to all 5 dimensions.
69
An Inexpensive and Easy-to-Make Simulation Model of Biliary Ultrasonography That Mimics Normal Anatomy, as Well as Abnormal Biliary Conditions
He C, Wright LM, Saul T, Lewiss RE/St. Luke’s–Roosevelt Hospital Center, New York, NY
Study Objective: Emergency physicians and physicians-in-training are increasingly being relied on to demonstrate competency in bedside biliary ultrasonography. This allows for improvement in patient care by allowing the physician to more efficiently determine patient disposition and the need for timely surgical consultation. Given the importance of simulation training and the lack of gallbladder-specific phantoms on the commercial market, we have developed an inexpensive and easy-to-make simulation model of biliary ultrasonography that mimics both normal anatomy and abnormal biliary conditions. Methods: Our gallbladder phantom was created using readily available materials. The medium surrounding the gallbladder was made using water, psyllium powder, and unflavored gelatin, based on previously described methods for creating phantom models. The normal gallbladder was created by cutting off the index finger of a latex glove at the base and filling it with olive oil before knotting it. Cholelithiasis was simulated by adding a few small stones or whole peppercorns to the glove before the olive oil was added. Biliary sludge was simulated by adding a small amount of sand or dirt to the glove before the olive oil was added. Simulation of a thickened gallbladder wall was accomplished by rolling the normal gallbladder model in olive oil and psyllium powder. Conclusion: The low cost and simplicity of creating these phantoms make them an attainable and highly useful educational tool that can be utilized to train users to obtain and interpret ultrasonographic images of the gallbladder. Informal residency education sessions have demonstrated that our models increase the comfort level and proficiency of student sonographers in the diagnosis of biliary pathology.
70
Constructing an Effective, Inexpensive Soft-Tissue Mimicking Phantom for Training Ultrasonographically Guided Central Line Placement
Berrett O, Josephson E/Lincoln Medical and Mental Health Center, New York, NY
Background: Ultrasonography has become an increasingly important modality in the emergency department for both diagnostic and procedural functions. It has been demonstrated that the use of ultrasonographic guidance for placement of central lines has many benefits, and it is therefore important to develop ultrasonographic competency in EM residents through teaching and training. There are many excellent commercial simulation models for training and practice, but most are prohibitively expensive for residency programs. Study Objectives: To construct an inexpensive phantom model that mimics soft tissue and vessels to the degree that it could serve as an effective tool for training EM residents to use ultrasonography for central line cannulation. Methods: Setting: Emergency medicine residency program 2, 3, 4 format within a busy urban, Level I trauma center. Design: (1) A recipe was compiled from several research articles, and the model was constructed using organic ingredients and Penrose drains. Approximate cost per unit was $5.00. Each unit tolerated 20 to 50 uses. (2) A 2-hour training session was prepared on the subject of ultrasonographically guided placement of central venous cannulation, with a focus on IJ placement. The session included 1 hour of didactic learning in the form of lectures and an instructional video. The second hour consisted of hands-on practice with ultrasonography on live volunteers and technical practice on homemade phantoms. An anonymous, voluntary, 6-question presession survey was administered to participants prior to the session, and a postsession survey was administered at completion of the session. Conclusions: We found that participants (16/16, 100%) felt that the hands-on training using the phantoms improved confidence and skill with ultrasonographically guided central line placement. The subjective comfort level of placing an ultrasonographically guided central line improved from 44% to 63%. However, we did find that the majority of residents still preferred SCV placement without ultrasonography.
71
Integration of Asynchronous Ultrasonographic Education Into a 4-Week Medical Student Emergency Medicine Clerkship: A Pilot Program
Duran P, Font R, Kalynych CJ, Kumar V, Landmann R/University of Florida College of Medicine, Jacksonville, FL
Background: The integration of ultrasonography into the clinical area allows physicians to acquire vital information during time-sensitive scenarios. Bedside
S186 Annals of Emergency Medicine
Volume , . : November
CORD Abstracts and retention of ultrasonographic skills and has been well received. Moreover, training medical students in ultrasonography in the ED can assist in an increased number of scanned patients, potentially expediting care and critical interventions. Study Objective: Determine if medical students could effectively be taught basic emergency ultrasonographic skills through asynchronous learning combined with a skills laboratory and clinical application during a 4-week emergency medicine clinical clerkship. Methods: Medical students received a pretest in regard to ultrasonography (15 questions) at their ED orientation. Within the first 4 days, students were expected to access the online ultrasonographic educational modules (1 on FAST; 1 on RUSH) prior to skills laboratory within their first week of rotating. Students were then expected to complete and log real applications during clinical hours in the ED. Students were sent a posttest 1 week after their rotation, and a random sample of students completed a postrotation bedside FAST skills assessment prior to checking out. Student technique and images were compared to a standard text in emergency ultrasonography. Results: To date, 23 medical students have participated in the program. Seven students who were administered a pretest returned a completed posttest. The average pretest score was 63% and the posttest, 78%. Eleven people have taken the postskills laboratory assessment, with an average score of 86%. Conclusion: This pilot educational program preliminarily suggests that asynchronous didactic education and skills laboratory can teach important ultrasonographic skills in a brief span.
72
A Novel Approach to Emergency Medicine Ultrasonographic Education During Medical Student Clerkships and Its Impact on Testing: A Pilot Program
Wei G, Geria RN, McCoy JV, Church AF, Kapitanyan R, Ohman-Strickland PA, Wormann D, Eisenstein RM, Riggs RL/UMDNJ–Robert Wood Johnson Medical School, Camden, NJ; UMDNJ-School of Public Health, Piscataway, NJ
ultrasonography has become very common in the emergency department (ED) and has led to research assessing resident and medical student knowledge and skill in ultrasonography. The addition of ultrasonographic education to medical students has been shown to improve student understanding of pathophysiology, knowledge,
Volume , . : November
Background: Expertise in bedside ultrasonography is a skill that is essential to emergency physicians. Our department used a combination of live didactic lectures and hands-on practice using models to teach medical students (MS) in a fourth-year clerkship. While seemingly effective, this method required a significant amount of financial and faculty resources. Study Objectives: The objective of this study is to determine the impact on test scores if video podcasts and bedside performance replace didactic teaching sessions and live models for MS learning ultrasonography during their EM clerkship. Methods: This was a retrospective before-after pilot study of fourth-year MS ultrasonographically related EM clerkship examination scores for the 2 years prior to and the 5 months after the curriculum change. The 4-hour didactic and 2hour live model training sessions were replaced by video podcasts created by the EM ultrasonography director. The podcasts required 4 hours total to make and included introduction to ultrasonography, physics, and the focused assessment in trauma (FAST) and aorta examinations. Test questions were unchanged during the study period. Descriptive statistics were used to analyze deidentified data. Results: Ninety-eight students from July 2009 to May 2010 (academic year [AY] 2010), 98 students from July 2010 to May 2011 (AY 2011), and 49 students from July 2011 to November 2011 (AY 2012) were evaluated. None were excluded. AY 2012 scored 89.8% of the ultrasonographic questions correctly compared to AY 2010 (77.55%) and AY 2011 (88.3%). The overall examination grades were similar between groups, with means of 84.54 for AY 2012, 84.05 for AY 2011, and 83.18 for AY 2010. Conclusions: Video podcasts are not inferior to classroom didactics as a means of providing ultrasonographic education during an emergency medicine clerkship. Our findings are limited by only having 2 ultrasonographic questions on the clerkship examination. Video podcasts are a cost-effective alternative to providing ultrasonographic education during an EM clerkship.
Annals of Emergency Medicine S187
69
An Inexpensive and Easy-to-Make Simulation Model of Biliary Ultrasonography That Mimics Normal Anatomy, as Well as Abnormal Biliary Conditions
He C, Wright LM, Saul T, Lewiss RE/St. Luke’s–Roosevelt Hospital Center, New York, NY
Study Objective: Emergency physicians and physicians-in-training are increasingly being relied on to demonstrate competency in bedside biliary ultrasonography. This allows for improvement in patient care by allowing the physician to more efficiently determine patient disposition and the need for timely surgical consultation. Given the importance of simulation training and the lack of gallbladder-specific phantoms on the commercial market, we have developed an inexpensive and easy-to-make simulation model of biliary ultrasonography that mimics both normal anatomy and abnormal biliary conditions. Methods: Our gallbladder phantom was created using readily available materials. The medium surrounding the gallbladder was made using water, psyllium powder, and unflavored gelatin, based on previously described methods for creating phantom models. The normal gallbladder was created by cutting off the index finger of a latex glove at the base and filling it with olive oil before knotting it. Cholelithiasis was simulated by adding a few small stones or whole peppercorns to the glove before the olive oil was added. Biliary sludge was simulated by adding a small amount of sand or dirt to the glove before the olive oil was added. Simulation of a thickened gallbladder wall was accomplished by rolling the normal gallbladder model in olive oil and psyllium powder. Conclusion: The low cost and simplicity of creating these phantoms make them an attainable and highly useful educational tool that can be utilized to train users to obtain and interpret ultrasonographic images of the gallbladder. Informal residency education sessions have demonstrated that our models increase the comfort level and proficiency of student sonographers in the diagnosis of biliary pathology.
70
Constructing an Effective, Inexpensive Soft-Tissue Mimicking Phantom for Training Ultrasonographically Guided Central Line Placement
Berrett O, Josephson E/Lincoln Medical and Mental Health Center, New York, NY
Background: Ultrasonography has become an increasingly important modality in the emergency department for both diagnostic and procedural functions. It has been demonstrated that the use of ultrasonographic guidance for placement of central lines has many benefits, and it is therefore important to develop ultrasonographic competency in EM residents through teaching and training. There are many excellent commercial simulation models for training and practice, but most are prohibitively expensive for residency programs. Study Objectives: To construct an inexpensive phantom model that mimics soft tissue and vessels to the degree that it could serve as an effective tool for training EM residents to use ultrasonography for central line cannulation. Methods: Setting: Emergency medicine residency program 2, 3, 4 format within a busy urban, Level I trauma center. Design: (1) A recipe was compiled from several research articles, and the model was constructed using organic ingredients and Penrose drains. Approximate cost per unit was $5.00. Each unit tolerated 20 to 50 uses. (2) A 2-hour training session was prepared on the subject of ultrasonographically guided placement of central venous cannulation, with a focus on IJ placement. The session included 1 hour of didactic learning in the form of lectures and an instructional video. The second hour consisted of hands-on practice with ultrasonography on live volunteers and technical practice on homemade phantoms. An anonymous, voluntary, 6-question presession survey was administered to participants prior to the session, and a postsession survey was administered at completion of the session. Conclusions: We found that participants (16/16, 100%) felt that the hands-on training using the phantoms improved confidence and skill with ultrasonographically guided central line placement. The subjective comfort level of placing an ultrasonographically guided central line improved from 44% to 63%. However, we did find that the majority of residents still preferred SCV placement without ultrasonography.
71
Integration of Asynchronous Ultrasonographic Education Into a 4-Week Medical Student Emergency Medicine Clerkship: A Pilot Program
Duran P, Font R, Kalynych CJ, Kumar V, Landmann R/University of Florida College of Medicine, Jacksonville, FL
Background: The integration of ultrasonography into the clinical area allows physicians to acquire vital information during time-sensitive scenarios. Bedside
S186 Annals of Emergency Medicine
Volume , . : November
CORD Abstracts and retention of ultrasonographic skills and has been well received. Moreover, training medical students in ultrasonography in the ED can assist in an increased number of scanned patients, potentially expediting care and critical interventions. Study Objective: Determine if medical students could effectively be taught basic emergency ultrasonographic skills through asynchronous learning combined with a skills laboratory and clinical application during a 4-week emergency medicine clinical clerkship. Methods: Medical students received a pretest in regard to ultrasonography (15 questions) at their ED orientation. Within the first 4 days, students were expected to access the online ultrasonographic educational modules (1 on FAST; 1 on RUSH) prior to skills laboratory within their first week of rotating. Students were then expected to complete and log real applications during clinical hours in the ED. Students were sent a posttest 1 week after their rotation, and a random sample of students completed a postrotation bedside FAST skills assessment prior to checking out. Student technique and images were compared to a standard text in emergency ultrasonography. Results: To date, 23 medical students have participated in the program. Seven students who were administered a pretest returned a completed posttest. The average pretest score was 63% and the posttest, 78%. Eleven people have taken the postskills laboratory assessment, with an average score of 86%. Conclusion: This pilot educational program preliminarily suggests that asynchronous didactic education and skills laboratory can teach important ultrasonographic skills in a brief span.
72
A Novel Approach to Emergency Medicine Ultrasonographic Education During Medical Student Clerkships and Its Impact on Testing: A Pilot Program
Wei G, Geria RN, McCoy JV, Church AF, Kapitanyan R, Ohman-Strickland PA, Wormann D, Eisenstein RM, Riggs RL/UMDNJ–Robert Wood Johnson Medical School, Camden, NJ; UMDNJ-School of Public Health, Piscataway, NJ
ultrasonography has become very common in the emergency department (ED) and has led to research assessing resident and medical student knowledge and skill in ultrasonography. The addition of ultrasonographic education to medical students has been shown to improve student understanding of pathophysiology, knowledge,
Volume , . : November
Background: Expertise in bedside ultrasonography is a skill that is essential to emergency physicians. Our department used a combination of live didactic lectures and hands-on practice using models to teach medical students (MS) in a fourth-year clerkship. While seemingly effective, this method required a significant amount of financial and faculty resources. Study Objectives: The objective of this study is to determine the impact on test scores if video podcasts and bedside performance replace didactic teaching sessions and live models for MS learning ultrasonography during their EM clerkship. Methods: This was a retrospective before-after pilot study of fourth-year MS ultrasonographically related EM clerkship examination scores for the 2 years prior to and the 5 months after the curriculum change. The 4-hour didactic and 2hour live model training sessions were replaced by video podcasts created by the EM ultrasonography director. The podcasts required 4 hours total to make and included introduction to ultrasonography, physics, and the focused assessment in trauma (FAST) and aorta examinations. Test questions were unchanged during the study period. Descriptive statistics were used to analyze deidentified data. Results: Ninety-eight students from July 2009 to May 2010 (academic year [AY] 2010), 98 students from July 2010 to May 2011 (AY 2011), and 49 students from July 2011 to November 2011 (AY 2012) were evaluated. None were excluded. AY 2012 scored 89.8% of the ultrasonographic questions correctly compared to AY 2010 (77.55%) and AY 2011 (88.3%). The overall examination grades were similar between groups, with means of 84.54 for AY 2012, 84.05 for AY 2011, and 83.18 for AY 2010. Conclusions: Video podcasts are not inferior to classroom didactics as a means of providing ultrasonographic education during an emergency medicine clerkship. Our findings are limited by only having 2 ultrasonographic questions on the clerkship examination. Video podcasts are a cost-effective alternative to providing ultrasonographic education during an EM clerkship.
Annals of Emergency Medicine S187