Building a bigger tent in point-of-care ultrasound education: a mixed-methods evaluation of interprofessional, near-peer teaching of internal medicine residents by sonography students

Abstract

BackgroundPoint-of-care-ultrasound (POCUS) training is expanding in undergraduate and graduate medical education, but lack of trained faculty is a major barrier. Two strategies that may help mitigate this obstacle are interprofessional education (IPE) and near-peer teaching. The objective of this study was to evaluate a POCUS course in which diagnostic medical sonography (DMS) students served as near-peer teachers for internal medicine residents (IMR) learning to perform abdominal sonography.MethodsPrior to the IPE workshop, DMS students participated in a train-the-trainer session to practice teaching and communication skills via case-based simulation. DMS students then coached first-year IMR to perform POCUS examinations of the kidney, bladder, and gallbladder on live models. A mixed-methods evaluation of the interprofessional workshop included an objective structured clinical exam (OSCE), course evaluation, and qualitative analysis of focus group interviews.ResultsTwenty-four of 24 (100%) IMR completed the OSCE, averaging 97.7/107 points (91.3%) (SD 5.2). Course evaluations from IMR and DMS students were globally positive. Twenty three of 24 residents (96%) and 6/6 DMS students (100%) participated in focus group interviews. Qualitative analysis identified themes related to the learning environment, scanning technique, and suggestions for improvement. IMR felt the interprofessional training fostered a positive learning environment and that the experience complimented traditional faculty-led workshops. Both groups noted the importance of establishing mutual understanding of expectations and suggested future workshops have more dedicated time for DMS student demonstration of scanning technique.ConclusionAn interprofessional, near-peer workshop was an effective strategy for teaching POCUS to IMR. This approach may allow broader adoption of POCUS in medical education, especially when faculty expertise is limited.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1437-2) contains supplementary material, which is available to authorized users.

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part II: recommendations

“…Collaborative, interprofessional teaching by a local abdominal sonographer or radiologist can be utilized where an anesthesiologist expert in gastric ultrasound is not available. [67][68][69] The hands-on acquisition should subsequently be practiced with supervision in the clinical setting while incorporating the I-AIM framework. 26 Exposure to subjects reflective of clinicians' practice demographics (eg, obstetrics, bariatric, and pediatric patients) is encouraged.…”

“…43 71 Thus, in addition to numerical benchmarks, the competency assessment must include observation of learner skills, 11 72-74 ideally guided by a validated assessment tool. 3 4 6 11 28 37 40 43 49 58 60-66 [68][69][70][71][72][73][74][75][76][77][78][79] Since a validated scoring tool does not yet exist for gastric ultrasound, we recommend adopting a structured assessment checklist from another ultrasound application such as the one developed by Skaarup et al for LUS. 80 The assessment should include: indication, systematic approach, technical skills, identification and differentiation of normal anatomy and antral contents, documenting and reporting, and diagnostic conclusion.…”

The PEGASUS Games: Physical Exam, Gross Anatomy, phySiology and UltraSound Games for Preclinical Medical Education

“…POCUS, particularly when taught using hand-held portable US devices, is well-suited to teaching US as an adjunct to the preclinical medical school curriculum. It can be incorporated easily through the use of trained senior medical student peer instructors [27] or interprofessional near-peers [28], especially when access to expert faculty is limited. While US education in the United States has no standardization, this study provides additional evidence to the increasingly growing body of research that medical students desire an US education prior to graduation [7,8,10].…”

Operating bedside cardiac ultrasound program in emergency medicine residency: A retrospective observation study from the perspective of performance improvement

“…Improvements in practitioners’ skills, including in acquiring proper images and interpreting the results, have not been well investigated in previous studies. The evaluation tools are usually limited to objective structured clinical exams (OSCEs) or knowledge tests [ 16 , 17 ]. In several studies, the diagnostic performance of clinical competency has usually been used to evaluate practitioner performance [ 7 , 18 ].…”