Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

BackgroundClinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification.MethodsAccording to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment.ResultsOf 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants’ hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%).ConclusionAll educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.

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“…2009##1111?Low Oveland et al [14]. 2013##?000?High Breitkreutz et al [15]. 2013##1011?Low Cuca et al [16].…”

Section: Resultsunclassified

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

et al. 2018

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“…Senior medical students, whose learning objectives have graduated to the diagnosing of disease in real-world patients, have demonstrated significant improvement in their ability to diagnose disease following brief, focused ultrasound teaching programs [64][65][66][67][68]. These benefits are particularly impressive when benchmarked against postgraduate medical practitioners using either physical examination [69,70] or ultrasound [71,72]. The obstetric ultrasound study of Hamza et al is notable for its use German Society of Ultrasound in Medicine (DEGUM) guidelines as the source material for student teaching, and for its use of a standardised teaching approach [73].…”

Section: Learning Category-incorporation Of Ultrasound Into Teaching mentioning

confidence: 99%

A Scoping Review of Ultrasound Teaching in Undergraduate Medical Education

et al. 2017

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Introduction Increasingly, medical schools are integrating Point of Care Ultrasound (POCUS) into their curricula. This review investigated the available literature on how best to integrate POCUS in the teaching of medical students and the benefits of doing so. Methods Given the heterogeneous literature that has emerged on POCUS education, a scoping review was conducted. Relevant medical databases, including PubMed, MEDLINE, PsycINFO, EMBASE and CINAHL, were searched between January 1980 and August 2016, using keywords identified by the authors. Inclusion criteria were as follows: prospective or retrospective studies, observational or intervention studies, and studies describing how medical students learn to use ultrasound. Results The literature search yielded 593 articles, of which 128 met the inclusion criteria. Studies that met the inclusion criteria were sub-categorised under the following headings: those that described or evaluated an ultrasound curriculum, those that employed ultrasound as a means of teaching another topic in the curriculum (i.e., anatomy, physical examination, physiology, invasive procedures), those that investigated the learning curve of ultrasound education and those that employed adjuncts or peer mentoring to teach ultrasound. Conclusions The reviewed literature indicates that the integration of ultrasound in undergraduate medical education is both feasible and beneficial to medical students. This article is intended to inform medical educators aiming to integrate ultrasound into their medical school curricula.

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“…It does not require transfer of patients [ 10 ]. Nevertheless, it is largely operator dependent, and a scientific assessment of the learning curve remains to be assessed [ 11 ]. The main limitation of LUS is that it does not rule out any pulmonary abnormality that does not reach the pleura [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound in internal medicine: training and clinical practice

et al. 2016

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BackgroundLung ultrasound (LUS) represents an emerging technique for bedside chest imaging in different clinical settings. A standardized approach allows the diagnosis, the quantification, and the follow-up of different conditions for which acute respiratory failure is the main clinical presentation. The aim of this study was to test what skill targets could be achieved in LUS, with a short-training course offered to 19 Medical Doctors attending the certification board school in Internal Medicine at the University of Verona, Italy.MethodsThe training course (theoretical and practical) consisted of 9 h subdivided in 4 days. Each trainee examined three healthy volunteers during the first day that was also the day of the theoretical lessons. Moreover, they examined nine patients per day (a total of 27 patients). Trainees were tested in the recognition of the basic signs in LUS, the managing of the Bedside Lung Ultrasound Evaluation (the BLUE protocol), and the recognition of the broad clinical scenarios recognized by the LUS. Kappa statistic was used to calculate the inter-observer agreement (trainees/tutor).ResultsTwenty-seven patients were examined by the 19 trainees (ten trainees had previous limited experience in general ultrasound). The agreement among the trainees and the tutor in the recognition of the LUS basic signs and in the recognition of the BLUE protocol profiles ranged from “fair” to “excellent”. In particular, the agreement among the trainees and the tutor in the final LUS diagnosis was “excellent” for the recognition of the interstitial syndrome and the pleural effusion, “substantial” for the recognition of the normal lung, and “moderate” for the recognition of consolidation and pneumothorax. LUS outcome gave useful information and drove change in therapy in 16 patients. It affected immediate management in nine patients. The concordance between the previous X chest ray and LUS was observed in 21 patients.ConclusionsA short training in LUS provided good proficiency in the recognition only of the main signs of the BLUE protocol, but allowed a correct LUS diagnosis in the Internal Medicine most frequent clinical settings of acute respiratory failure. This study supports incorporating LUS into Internal Medicine fellowship training programs.

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Thorax, Trachea, and Lung Ultrasonography in Emergency and Critical Care Medicine: Assessment of an Objective Structured Training Concept

Cited by 24 publications

References 28 publications

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

A Scoping Review of Ultrasound Teaching in Undergraduate Medical Education

Lung ultrasound in internal medicine: training and clinical practice

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