Point-of-care ultrasound in urology: Design and evaluation of a feasible introductory training program for Canadian residents

Abstract

Introduction: Point-of-care ultrasound (POCUS) is an increasingly used bedside tool. Applications in urology include the assessment of an undifferentiated acute scrotum, renal colic, and the guidance of suprapubic catheter placement. However, the user-dependent nature of this modality necessitates appropriate use and competence. The objective of this study was to develop and evaluate a low-cost, feasible, and guideline-based introductory POCUS program for Canadian urology residents.
 Methods: Residents from McMaster University’s urology program completed a three-hour online course, followed by a three-hour hands-on seminar. Course material was developed by ultrasound educators based on national guidelines. Low-cost testicular phantoms and suprapubic catheter insertion models were constructed. Pre- and post-course surveys focused on participant skill confidence, while multiple-choice questionnaires assessed theoretical knowledge.
 Results: Fourteen residents participated in the course. Theoretical knowledge in POCUS improved significantly (p<0.001, d=2.2) and mean confidence scores improved for all skills, including performing kidney, bladder, and testicular POCUS (all p<0.001; d=3.4, 1.9, 2.9, respectively). Participants indicated that the course increased their confidence and likelihood of using POCUS in clinical practice, and that POCUS training should be integrated into urology training curricula.
 Conclusions: This novel study included the development of an inexpensive, feasible, guideline-based introductory training program for urological POCUS, developed in collaboration with ultrasound educators. Participants significantly improved in theoretical knowledge and skill confidence. Although this study was limited to one residency program, the basis of this course may serve as a foundation for the development of competency-based training for urological POCUS in Canada.

Evaluating the perceptions of Canadian urology residents and program directors regarding the current training in genitourinary imaging

“…In addition, all residents demonstrated an interest in pocus and stated that pocus training should be integrated into Canadian urology residency programs. 13 Considering the positive outcomes of this study, urologists can refer to this training model to create their own educational programs for residents. Fortunately, the study used homemade imaging simulators instead of simulated patients, which renders it cost-effective and reproducible at any academic urology center.…”

“…It has a variety of applications in urology, including the timely diagnosis of an undifferentiated acute scrotum, the assessment of hydronephrosis in renal colic, and guidance for suprapubic catheter placement; however, operator competence is critical as it is a user-dependent modality. 13 Lack of training can lead to misdiagnosis, poor clinical management, and adverse patient outcomes. 14,15 Our study demonstrated that most residents did not think they would have the knowledge to perform their own pocus by the end of their residency.…”

“…In 2020, Uy et al developed and evaluated a low-cost, feasible introductory pocus program for Canadian urology residents. 13 The course comprised two main components: a 3-hour online module with recorded lectures and assessment forms and a 3-hour hands-on session facilitated by licensed sonographers. The residents who participated in the program significantly improved in theoretical knowledge and skill confidence.…”

Development and initial validation of a cost-effective, re-usable, ultrasound-compatible suprapubic catheter insertion training simulator

“…14 We also plan to evaluate the model during our urology residency program's annual point of care US (POCUS) course, which currently does not have a SPC evaluation component. 30 This course is conducted during an academic half-day and all urology residents in our program attend, which allows for evaluation of residents at different levels of training. To explore options, during the most recent course, we used a thin pork chop with a bone (to simulate the pubic symphysis) to simulate the skin layer and subcutaneous tissue on the SPC model, which worked very well for US training, 30 indicating a potential improvement to the model.…”

“…30 This course is conducted during an academic half-day and all urology residents in our program attend, which allows for evaluation of residents at different levels of training. To explore options, during the most recent course, we used a thin pork chop with a bone (to simulate the pubic symphysis) to simulate the skin layer and subcutaneous tissue on the SPC model, which worked very well for US training, 30 indicating a potential improvement to the model. This variation will need to be tested before any training for evaluation purposes occurs.…”