What are some best practices in real-time education for hands-on skills?Posted on by
Within the Canadian context, access to specialized clinical skills courses in a real-time virtual, remote educational model remains limited. Point of Care Ultrasound (PoCUS) has opened doors for rural physicians to gain specific training such as Emergency Department Targeted Ultrasound (EDTU), Emergency Department Echo (EDE), and Emergency and Critical Care Ultrasound (ECCU) have become an important aspect of emergency medicine training and skills development. Current evidence supports POCUS in the ED as a means of reducing patient length of stay and improving diagnostic accuracy, however a lack of equipment, training, funding, quality assurance, and inability to maintain skills progression exist as barriers to such training for rural physicians (9, 1). The following summarizes the current evidence related to leading practices in the delivery of point of care training for physicians.
I. Evidence for Teaching POCUS remotely
- In a study on simulation-delivered POCUS training with medical student participants, it was found that there was no difference in the acquisition of skills related to image acquisition and interpretation to ultrasound trainees using a multimedia simulator or normal human subjects with respect to the Focused Assessment with Sonography for Trauma (FAST) exam (8).
- One Canadian study delivered the Abdominal and Cardiothoracic Evaluation by Sonography (ACES) protocol (POCUS training) to medical students/residents, and later found that they were highly effective at generating ultrasound windows (99.7%) and interpreting goal-directed scans (93%) (10).
- One study found that a key factor for success of remote POCUS training and developing competence was the ability to receive real-time feedback (3). Another study found the benefits related to simulation training were most pronounced in the setting of a structured training program rather than in a self-directed learning method (10).
- Several studies have noted enhanced improvement to technical competences as well as clinical competence levels after clinicians completed high fidelity simulation sonography using Vimidex simulators (10, 7).
- Evidence shows that simulator training can result in significant improvement in cognitive and motor skills that is largely sustained over time (5).
II. Current PoCUS Training in Canada
- Surveys have found that 98.8 % of rural physicians in Canada believed that PoCUS was important to EM practice, however 77.3% felt they had inadequate training in it (9) .
- The Canadian Association of Emergency Physicians (CAEP) has endorsed physician access to PoCUS 24/7/365 in the emergency department (9).
- In one Canadian study, 33 ICUs were able to complete sonography training with transthoracic echocardiographic simulator using REACTS video conferencing software (4).
- Psychomotor skills were enhanced via telemetry and remote instruction through telemonitoring. It was suggested that other types of POCUS examinations for procedures such as regional anesthesia could be utilized.
III. Remote options for PoCUS Training
- Simulation Canada (SIM-oneTM) – provides introductory courses to simulation-based training (2)
- EDTUXTM – Advanced point of care ultrasound course, including resuscitative, diagnostic, and procedural applications.
- PoCUSTM (Point of Care Ultrasound Certificate) – Simulation-based training with expanded modules in lung, deep vein thrombosis, urinary system, and abdominal free fluid ultrasound (6).
- FoCUSTM (Focused Cardiac Ultrasound) – Simulation-based training directed at improving skills in image acquisition (5).
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- Garcia, J., et al., Comparison of the accuracy of emergency department-performed point of care ultrasound (POCUS) in the diagnosis of lower-extremity deep vein thrombosis. Ultrasound in Emergency Medicine. 2018. 54(5). [Online] https://www.jem-journal.com/article/S0736-4679(17)31186-1/fulltext. Accessed: May 27, 2020
- Simulation Canada. Introduction to Simulation: The Essentials of Simulation-Based Learning. [Online] http://www.sim-one.ca/courses/course/introduction-simulation-essentials-simulation-based-learning. Accessed May 10, 2020
- Mackay, F., et al., Can you Teach Yourself Point of Care Ultrasound to a level of Clinical Competency? Evaluation of a Self-Directed simulation-based Training program. Cureus 10(9). 2018. [Online] https://www.cureus.com/articles/14836-can-you-teach-yourself-point-of-care-ultrasound-to-a-level-of-clinical-competency-evaluation-of-a-self-directed-simulation-based-training-program Accessed: May 27, 2020
- Choo, E., et al., Remote Solutions for telementoring point-of-care ultrasound echocardiography: The RESOLUTE study. Can J Anesth. 64:1077-1078. 2017. [Online] https://link.springer.com/content/pdf/10.1007/s12630-017-0927-8.pdf Accessed: May 27, 2020
- Morgan, R., et al., Simulator-Based Training in FoCUS with Skill-Based Metrics for Feedback: An Efficacy Study. POCUS Journal. 4(2). November, 2019. [Online] http://pocusjournal.com/article/2019-04-02p33-36/. Accessed May 10, 2020
- ACP Internist. New Online Collection of Point of Care Ultrasound Modules Available. October 8, 2019. [Online] https://acpinternist.org/weekly/archives/2019/10/08/6.htm. Accessed May 10, 2020
- Thoirs, K., et al., Skill development of beginner sonography students using high fidelity simulators: initial experiences. Sonography. 2015 3(1). [Online] https://onlinelibrary.wiley.com/doi/full/10.1002/sono.12043. Accessed: May 27, 2020
- 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(4). [Online] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1553-2712.2011.01037.x Accessed: May 27, 2020
- Micks, T., Sue, K., Rogers, P. Barriers to point -of-care ultrasound use in emergency departments. Canadian Association of Emergency Physicians (CJEM). 2016; 18(6): 475-479. [Online] https://www.researchgate.net/profile/Kyle_Sue/publication/305643568_Barriers_to_point-of-care_ultrasound_use_in_rural_emergency_departments/links/5a45d2db0f7e9ba868a944fa/Barriers-to-point-of-care-ultrasound-use-in-rural-emergency-departments.pdf. Accessed: May 27, 2020
- Parks, A., Atkinson, P., Verheul, G., LeBlanch-Duchin, D., Can medical learners achieve point-of-care ultrasound competency using a high-fidelity ultrasound simulator?: a pilot study. Critical Ultrasound Journal. 2013. 5(9). DOI: 10.1186/2036-7902-5-9. Accessed: May 27, 2020
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