Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students' procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p < 0.05). Students' overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p < 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p < 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students' confidence and technical skill at performing US-guided procedures.

BackgroundGoal-directed ultrasound protocols have been developed to facilitate efficiency, throughput, and patient care. Hands-on instruction and training workshops have been shown to positively impact ultrasound training.ObjectivesWe describe a novel undifferentiated chest pain goal-directed ultrasound algorithm-focused education workshop for the purpose of enhancing emergency medicine resident training in ultrasound milestones competencies.MethodsThis was a cross-sectional study performed at an academic medical center. A novel goal-directed ultrasound algorithm was developed and implemented as a model for teaching and learning the sonographic approach to a patient with undifferentiated chest pain. This algorithm was incorporated into all components of the 1-day workshop: asynchronous learning, didactic lecture, case-based learning, and hands-on stations. Performance comparisons were made between postgraduate year (PGY) levels.ResultsA total of 38 of the 40 (95%) residents who attended the event participated in the chest pain objective standardized clinical exam, and 26 of the 40 (65%) completed the entire questionnaire. The average number of ultrasounds performed by resident class year at the time of our study was as follows: 19 (standard deviation [SD]=19) PGY-1, 238 (SD=37) PGY-2, and 289 (SD=73) PGY-3. Performance on the knowledge-based questions improved between PGY-1 and PGY-3. The application of the novel algorithm was noted to be more prevalent among the PGY-1 class.ConclusionThe 1-day algorithm-based ultrasound educational workshop was an engaging learning technique at our institution.

BACKGROUND: Traditionally performed using a subxiphoid approach, the increasing use of pointof-care ultrasound in the emergency department has made other approaches (parasternal and apical) for pericardiocentesis viable. The aim of this study is to identify the ideal approach for emergency-physicianperformed ultrasound-guided pericardiocentesis as determined by ultrasound image quality, distance from surface to pericardial fl uid, and likely obstructions or complications. METHODS:A retrospective review of point-of-care cardiac ultrasound examinations was performed in two urban academic emergency departments for the presence of pericardial eff usions. The images were reviewed for technical quality, distance of eff usion from skin surface, and predicted complications.RESULTS: A total of 166 pericardial effusions were identified during the study period. The mean skin-to-pericardial fl uid distance was 5.6 cm (95% confi dence interval [95% CI] 5.2-6.0 cm) for the subxiphoid views, which was signifi cantly greater than that for the parasternal (2.7 cm [95% CI 2.5-2.8 cm], P<0.001) and apical (2.5 cm [95% CI 2.3-2.7 cm], P<0.001) views. The subxiphoid view had the highest predicted complication rate at 79.7% (95% CI 71.5%-86.4%), which was signifi cantly greater than the apical (31.9%; 95% CI 21.4%-44.0%, P<0.001) and parasternal (20.2%; 95% CI 12.8%-29.5%, P<0.001) views. CONCLUSIONS:Our results suggest that complication rates with pericardiocentesis will be lower via the parasternal or apical approach compared to the subxiphoid approach. The distance from skin to fl uid collection is the least in both of these views.

We present a unique anatomic cause of encephalocele, and describe appropriate diagnosis. Two patients underwent stereotactic image-guided sinus surgery for presumed chronic rhinosinusitis with intraoperative findings of a sinus encephalocele. The first patient underwent a conservative 2-stage management that included an initial cerebrospinal fluid (CSF) leak repair followed by encephalocele resection. The second patient underwent a 1-stage encephalocele resection and CSF leak repair with a septal graft. The sinus surgeon needs to consider the possibility of encephalocele when the ethmoid, sphenoid, or, rarely, frontal sinuses present with an isolated opacification that does not improve with conservative medical therapy.

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