Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures
Camacho, Luis D
Ringleberg, Jeannie K
Patanwala, Asad E
Situ-LaCasse, Elaine H
AffiliationUniv Arizona, Dept Emergency Med
Univ Arizona, Coll Med
Univ Arizona, Dept Mol & Cellular Biol
KeywordsPoint of care ultrasound
internship and residency
regional nerve block
MetadataShow full item record
PublisherSAGE PUBLICATIONS LTD
CitationAmini, R., Camacho, L. D., Valenzuela, J., Ringleberg, J. K., Patanwala, A. E., Stearns, J., ... & Adhikari, S. (2019). Cadaver Models in Residency Training for Uncommonly Encountered Ultrasound-Guided Procedures. Journal of Medical Education and Curricular Development, 6, 2382120519885638.
RightsCopyright © The Author(s) 2019. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/).
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractBackground: Arthrocentesis of the ankle and elbow and brachial plexus nerve blocks are infrequently performed procedures; however, clinicians in specialties such as emergency medicine are required to be proficient in these procedures in the event of emergent or urgent necessity. Objectives: The objective of this study was to create, implement, and assess a fresh cadaver-based educational model to help resident physicians learn how to perform ultrasound-guided arthrocentesis of the ankle and elbow and ultrasound-guided regional nerve blocks. Methods: This was a single-center cross-sectional study conducted at an academic medical center. After a brief didactic session, 26 emergency medicine residents with varying levels of clinical and ultrasound experience rotated through 4 fresh cadaver-based stations. The objective of each station was to understand the sonographic anatomy and to perform ultrasound-guided arthrocentesis or regional nerve block with hands-on feedback from ultrasound fellows and faculty. Participants were subsequently asked to complete a questionnaire which evaluated participants' experience level, opinions, and procedural confidence regarding the 4 stations. Results: A total of 26 residents participated in this study. All 26 residents agreed that the cadaver model (compared with clinical anatomy) was realistic regarding ultrasound quality of the joint space, ultrasound quality of the joint effusion, ultrasound quality of nerves, tissue density, needle guidance, and artifacts. Finally, there was a statistically significant difference between mean scores for pre-simulation and post-simulation session participant procedural confidence for all 4 procedures. Conclusions: This fresh cadaver-based ultrasound-guided educational model was an engaging and well-received opportunity for residents to gain proficiency and statistically significant confidence in procedures which are uncommonly performed in clinical settings.
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VersionFinal published version
Except where otherwise noted, this item's license is described as Copyright © The Author(s) 2019. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/).
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Multimodular Ultrasound Orientation: Residents' Confidence and Skill in Performing Point-of-care UltrasoundStolz, Lori A; Amini, Richard; Situ-LaCasse, Elaine; Acuña, Josie; Irving, Steven C; Friedman, Lucas; Fiorello, Albert B; Stea, Nicholas; Fan, Heinrich; Adhikari, Srikar; et al. (CUREUS INC, 2018-11-15)Introduction The objectives of this study were to determine if a multimodular introductory ultrasound course improved emergency medicine intern confidence in performing a point-of-care ultrasound and if our educational objectives could be met with our chosen structure. Methods This is a prospective, observational study evaluating three consecutive incoming emergency medicine residency classes from three residency programs. A one-day introductory ultrasound course was delivered. The course consisted of 1) flipped classroom didactics, 2) in-person, case-based interactive teaching sessions, and 3) check-listed, goal-driven, hands-on instruction. Results Over three years, 73 residents participated in this study. There was no significant difference in performance on the written test (p = 0.54) or the skills assessment (p = 0.16) between years. Performance on the written pre-test was not a predictor of performance on the skills test (R2 = 0.028; p = 0.19). Prior to training, residents were most confident in performing a focused assessment with sonography for trauma examination (median confidence 5.5 (interquartile range (IQR): 3 - 7) on a 10-point Likert scale where 1 represents low confidence and 10 represents high confidence). They reported the lowest confidence in performing a cardiac ultrasound (3 (IQR: 2 - 6)). Following training, residents reported increased confidence with all applications (p < 0.001). Eighty-five percent (confidence interval (CI): 73, 92) of residents agreed that the online ultrasound lectures effectively teach point-of-care ultrasound applications and 98% (CI: 88, 100) agreed that case-based interactive sessions helped them understand how ultrasound changes the management of acutely ill patients. Conclusions A written test of knowledge regarding the use of point-of-care ultrasound does not correlate with procedural skills at the start of residency, suggesting that teaching and evaluation of both types of skills are necessary. Following a multimodular introductory ultrasound course, residents showed increased confidence in performing the seven basic ultrasound applications. Residents reported that an asynchronous curriculum and case-based interactive sessions met the learning objectives and effectively taught point-of-care ultrasound applications.
Improving Healthcare Professionals’ Ultrasound-Guided Peripheral Vascular Access Ability Utilizing Homemade Ultrasound PhantomsHerring, Christopher; Bullington, Phillip Wade; Reed, James R.; Owens, Derek L. (The University of Arizona., 2023)Purpose: The primary objective of this quality improvement project was to improve healthcare workers' confidence, competence, knowledge, and skills in placing ultrasound-guided peripheral intravenous catheters using homemade ultrasound phantom models.Background: Ultrasound guidance can reduce the number of attempts to gain peripheral IV access while improving the success rate and satisfaction in patients with difficult IV access. Education and simulation is an effective tool for improving the skills and knowledge related to ultrasound-guided peripheral IV access. Ultrasound phantom models allow for skill development without the risk of patient harm. Methods: Twenty-nine registered nurses and nurse practitioners were recruited for education and simulation regarding ultrasound-guided peripheral IV placement. Participants completed pre- and post-intervention confidence, perceived competence, and knowledge surveys in addition to a Directly Observed Procedural Skills Evaluation (DOPSE). The intervention included an educational PowerPoint and open practice session using the phantom models. Participants provided demographic information and completed a survey evaluating the efficacy of the phantom models. Results: Statistically significant improvements were found in participants’ confidence (p<.001; 95% CI: 5.287, 9.499; d=1.31), perceived competence (p<.001; 95% CI: 1.231, 2.742; d=1.20), knowledge (p<.001; CI: 1.079, 2.163; d=1.47), and skills (p<.001; CI: 2.499; 5.501; d=1.29). Participants improved in maintaining needle visualization (p<.001; 95% CI: 0.272, 0.9; d=0.79) and decreasing their cannulation attempts (.045; CI: .013, 1.022; d=0.48). Participants with no and novice experience saw statistically significant improvement across all categories (p<.02) compared to those with intermediate, advanced, or expert experience. Participants with 4-6 years of nursing experience found improvement across all categories, while those with > 15 years improved in confidence, perceived competence, and skills. 96.5% of participants could perform ultrasound-guided peripheral IV cannulation independently or with indirect supervision following the intervention. Conclusions: At a cost of $36.52 per model, the homemade ultrasound phantom models provided a cost-effective solution to teaching ultrasound-guided peripheral IV cannulations. Education and simulation for ultrasound-guided peripheral vascular access may benefit individuals with no or novice ultrasound experience. Years of nursing experience may influence but not reliably predict participant improvement, with 4-6 years showing the most significant improvement, followed by those with > 15 years.