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      A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents

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          Abstract

          Purpose

          Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program.

          Patients and methods

          This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment.

          Results

          In total, 42 residents consented for participation. The residents’ monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not.

          Conclusion

          A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.

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          Most cited references31

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          Point-of-care ultrasonography.

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            The state of ultrasound education in U.S. medical schools: results of a national survey.

            To determine the state of ultrasound education in U.S. medical schools and assess curricular administrators' opinions on its integration in undergraduate medical education (UME).
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              Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis.

              Ultrasound guidance enables visualization of the needle insertion site for thoracentesis and paracentesis. The improved accuracy of needle placement using ultrasound may reduce risk of complications and their costs associated with these procedures. Using claims data from the Premier Perspective hospital database from January 1, 2007, through December 31, 2008, we conducted an observational cohort study examining the effect of ultrasound guidance on risk of pneumothorax among patients undergoing thoracentesis and on risk of bleeding complications after paracentesis. Patients at elevated risk of these outcomes for reasons beyond the procedure of interest were excluded. Adjusted risk of events was assessed using multivariate logistic regression controlling for patient and hospitalization characteristics. Hospitalization cost and length of stay (LOS) were estimated using multivariate ordinary least squares regression of log-transformed values. We analyzed 61,261 thoracentesis and 69,859 paracentesis patient records. Approximately 45% of these procedures were ultrasound guided. Pneumothorax occurred in 2.7% (n = 1,670) of patients undergoing thoracentesis. Of patients undergoing paracentesis, 0.8% (n = 565) experienced bleeding complications. After adjustment, ultrasound guidance reduced the risk of pneumothorax after thoracentesis by 19% (OR, 0.81; 95% CI, 0.74-0.90) and by 68% for bleeding complications after paracentesis (OR, 0.32; 95% CI, 0.25-0.41). Pneumothorax increased the total cost of hospitalization by $2,801 (P < .001) and LOS by 1.5 days (P < .001). Bleeding complications increased cost by $19,066 (P < .0001) and LOS by 4.3 days (P < .0001). The data indicate that ultrasound guidance is associated with decreased risk of pneumothorax with thoracentesis and of bleeding complications with paracentesis. These complications resulted in measurable increases in hospitalization costs and LOS.
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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                AMEP
                amep
                Advances in Medical Education and Practice
                Dove
                1179-7258
                04 November 2019
                2019
                : 10
                : 935-942
                Affiliations
                [1 ]Department of Emergency Medicine, Mayo Clinic , Jacksonville, FL, USA
                [2 ]Department of Internal Medicine, Mayo Clinic , Jacksonville, FL, USA
                [3 ]Department of Education, Mayo Clinic , Jacksonville, FL, USA
                [4 ]The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science , Rochester, MN, USA
                Author notes
                Correspondence: Michael J Maniaci Department of Internal Medicine, Mayo Clinic , 4500 San Pablo Road, Jacksonville, FL32224, USAFax +904-953-0007 Email maniaci.michael@mayo.edu
                Author information
                http://orcid.org/0000-0003-4290-2443
                http://orcid.org/0000-0001-7590-2293
                http://orcid.org/0000-0003-2452-0935
                http://orcid.org/0000-0003-0716-9178
                http://orcid.org/0000-0001-5465-5211
                http://orcid.org/0000-0002-2731-1787
                Article
                220153
                10.2147/AMEP.S220153
                6839571
                31807108
                d556cade-c01f-41a9-86c7-c8c6d3d83c14
                © 2019 Boniface et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 20 June 2019
                : 23 October 2019
                Page count
                Figures: 1, Tables: 4, References: 36, Pages: 8
                Categories
                Original Research

                education,resident,procedural skills,diagnostic imaging,ultrasound

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