Introduction: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. Methods: We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasoundguided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. Results: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. Discussion: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.
Objectives: Assessment of competence in technical skills, including point-of-care ultrasound (POCUS), is required before a novice can safely perform the skill independently. Ongoing assessment of competence is also required because technical skills degrade over time, especially when they are infrequently performed or complex. Handmotion analysis (HMA) is an objective assessment tool that has been used to evaluate competency in many technical skills. The purpose of this study was to demonstrate the feasibility and validity of HMA as an assessment tool for competence in both simple and complex technical skills as well as skill degradation over time.Methods: This prospective cohort study included 36 paramedics with no POCUS experience and six physicians who were fellowship trained in POCUS. The novices completed a 4-hour didactic and hands-on training program for cardiac and lung POCUS. HMA measurements, objective structured clinical examinations (OSCE), and written examinations were collected for novices immediately before and after training as well as 2 and 4 months after training. Expert HMA metrics were also recorded.Results: Expert HMA metrics for cardiac and lung POCUS were significantly better than those of novices. After completion of the training program, the novices improved significantly in all HMA metrics, knowledge test scores, and OSCE scores. Novices showed skill degradation in cardiac POCUS based on HMA metrics and OSCE scores while lung POCUS image acquisition skills were preserved. Novices deemed competent by OSCE score performed significantly better in HMA metrics than those not deemed competent. Conclusion:We have demonstrated that HMA is a feasible and valid tool for assessment of competence in technical skills and can also evaluate skill degradation over time. Skill degradation appears more apparent in complex skills, such as cardiac POCUS. HMA may provide a more efficient and reliable assessment of technical skills, including POCUS, when compared to traditional assessment tools.C ompetency-based medical education (CBME) requires valid and reliable methods for the assessment of competence. 1,2 Assessment tools are especially important for technical skills to ensure that providers are competent to safely perform the skill prior to clinical practice. 3 Since technical skills can degrade over time, the same tools used for initial assessment of competence may also be utilized to screen providers
Study Objectives: Shoulder dislocations are common, and most practitioners order pre-and post-reduction plain films. There is evidence that point-of-care shoulder ultrasound (SUS) accurately diagnoses shoulder dislocations and humeral fractures. We determined the accuracy and timeliness of a point-of-care SUS from a posterior approach to detect shoulder dislocations and fractures compared with plain radiography.Methods: We performed a multi-center, prospective, observational study at 2 academic EDs with fellowship-trained ED ultrasonographers. We included all adult patients presenting to the ED for suspected shoulder dislocation or humerus fracture. The SUS was performed from a posterior approach by an ultrasound-trained physician with a curvilinear or high-frequency linear transducer in the transverse plane. Probe choice was at the discretion of the sonographer. Presence or absence of dislocation was determined by measuring the displacement of the humeral head either anteriorly or posteriorly relative to the glenoid rim. Plain radiographs served as the criterion standard and were interpreted by board-certified radiologists blinded to SUS results. We compared continuous variables between radiographs and SUS using paired t-tests. ROC analysis with Youden's Index was used to identify displacement cutoffs for diagnosing dislocations.Results: Of 37 subjects enrolled, 21 (57%) were male, 11 (30%) had a history of shoulder dislocation, and 18 (49%) sustained injuries from ground level falls. We excluded 2 subjects who declined radiography. Of 35 included patients, 23 (66%) had shoulder dislocations on radiography and of these, 21 (91%) were correctly diagnosed by SUS. Compared to the criterion standard, SUS had 91% sensitivity (95% CI 70-98%), 100% specificity (70-100%), 100% positive predictive value (PPV) (81-100%), and 86% negative predictive value (NPV) (56-97%). All 12 of 35 patients (34%) without dislocations were correctly identified by SUS. Thirteen of 35 subjects (37%) had fractures, of which 7 (54%) were detected by SUS, and all 22 (63%) without fractures were correctly ruled-out. Five of 6 missed fractures were Hill-Sachs deformities. For detecting fractures as compared to radiography, SUS had a 54% sensitivity (26-80%), 100% specificity (82-100%), 100% PPV (56-100%), and 79% NPV (59-91%). The optimal cut point for displacement distance was 0.875, resulting in 89% sensitivity (64-98%), 100% specificity (68-100%), 100% PPV (76-100%), and 85% NPV (54-97%). The mean time from triage to SUS was 62 minutes versus 100 minutes for radiography (p < 0.001). Sonographers' confidence in their SUS diagnosis was high.Conclusions: SUS from the posterior approach is a highly accurate method to diagnose shoulder dislocations and humeral fractures. It can be performed faster than radiographs, and sonographers have high confidence levels in their diagnoses. All missed fractures were clinically insignificant, and all patients without dislocations and fractures were correctly identified. SUS should be considered as a routine di...
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