- 作者：Hamid Shokoohi ; MD ; MPH ; RDMS ; RDCS* ; hshokoohi@mfa.gwu.edu" class="auth_mail" title="E-mail the corresponding author ; hshokoohi@gmail.com" class="auth_mail" title="E-mail the corresponding author ; Keith Boniface ; MD ; RDMS ; RDCS* ; Parisa Kaviany ; MD&dagger ; ; Paige Armstrong ; MD ; MHS* ; Kathleen Calabrese ; MD* ; Ali Pourmand ; MD ; MPH ; RDMS*
- 关键词：experiential learning ; medical students ; ultrasound ; focused assessment with sonography for trauma
- 刊名：Journal of Surgical Education
- 出版年：2016
- 出版时间：March-April 2016
- 年：2016
- 卷：73
- 期：2
- 页码：208-214
- 全文大小：420 K
Methods
The study was conducted in 2 phases. In phase 1, first- and second-year medical students participated in a 45-minute didactic presentation and subsequent 1-hour hands-on practice followed by 3-5 precepted FAST examinations in the emergency department. A pretest or posttest design was used to examine the participants’ knowledge interpreting ultrasound images of the FAST examination.
In phase 2, students performed FAST scans on patients with abdominal complaints under the supervision of emergency ultrasound faculty over a 1-year period. The participants were scored based on window acquisition, quality of images, accuracy of FAST scan interpretation, confidence level rated by participant, and supervising attending physician.
Results
In phase 1, 68 novice medical students participated in 11 training sessions offered over a 1-year period. Students showed significant improvement in basic ultrasound and abdominal anatomy knowledge. The mean score improved from a pretest score of 5.8 of 10 (95% CI: 5.3-6.2) to a posttest score of 7.3 of 10 (95% CI: 7-7.6). The students also demonstrated a significant improvement in FAST image interpretation (pretest of 6.2 [95% CI: 5.9-6.6] and posttest of 7.6 [95% CI: 7.1-7.9]).
In phase 2, 22 students performed 304 FAST examinations on patients. At the beginning of their training when they performed less than 10 FAST scans, students were able to complete the right upper quadrant view in 88.9%, left upper quadrant view in 69.7%, subxiphoid in 64.7%, and pelvic view in 70% of scans. Across all views of the FAST examination, increasing level of practice was associated with improvement in successfully completing the examination. The absolute increase in the proportion experiencing success in the right upper quadrant view was 1.6%, 3.6%, and 6.2% for the 10-19, 20-29, and >30 groups, respectively, of which none were statistically significant. However, the improvements in the left upper quadrant view was 12.7%, 11.6%, 15.7% for the 10-19, 20-29, and >30 groups, respectively. In all views, performing >30 examinations more than doubled the odds of successfully completing the examination.
Conclusion
An experiential learning model of ultrasound training consisting of brief didactic presentation, practice FAST examinations on normal models, and proctored examinations on patients is an effective way to teach preclinical medical students basic ultrasound skills.