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Evaluating a Web-based Point-of-care Ultrasound Curriculum for the Diagnosis of Intussusception
Margaret Lin-Martore1, Michael P Olvera2, Aaron E Kornblith1
1Department of Emergency Medicine and Pediatrics University of California San Francisco CA USA.
Insights
Pediatric emergency medicine physicians demonstrated high proficiency and retention of skills in point-of-care ultrasound for intussusception (POCUS-I) after a web-based curriculum. This training improved knowledge and confidence, maintained over three months.
Area of Science:
- Pediatric Emergency Medicine
- Medical Education
- Diagnostic Imaging
Background:
- Intussusception is a critical pediatric condition requiring rapid diagnosis.
- Ultrasound is the preferred diagnostic tool, but availability can cause delays.
- Limited training materials exist for point-of-care ultrasound for intussusception (POCUS-I) in pediatric emergency medicine (PEM).
Purpose of the Study:
- To assess the effectiveness of a primarily web-based POCUS-I curriculum for PEM physicians.
- To evaluate the impact of the curriculum on POCUS-I technical skill, knowledge, and confidence.
- To determine the retention of these skills, knowledge, and confidence over time.
Main Methods:
- A prospective cohort study involving PEM physicians undergoing a web-based POCUS-I curriculum.
- Curriculum development followed Kern's six-step model, including a web module and hands-on practice.
- Assessments included direct observation, multiple-choice tests, and Likert-scale surveys pre- and post-course, and at 3 months.
Main Results:
- Participants maintained high technical skill scores (median 20/22) immediately post-course and at 3 months.
- Knowledge scores significantly improved from 57.4% to 75.3% post-course, maintained at 81.2% at 3 months (p < 0.001).
- Physician confidence in POCUS-I increased from 5.9% to 76.5% post-course and at 3 months (p < 0.001).
Conclusions:
- A primarily web-based POCUS-I curriculum effectively enhances PEM physicians' technical skills.
- The curriculum significantly improves and sustains POCUS-I knowledge and confidence among PEM physicians.
- Web-based POCUS-I training offers a viable solution for improving diagnostic capabilities in pediatric emergencies.
Objectives:
Intussusception is a pediatric medical emergency that can be difficult to diagnose. Radiology-performed ultrasound is the diagnostic study of choice but may lead to delays due to lack of availability. Point-of-care ultrasound for intussusception (POCUS-I) studies have shown excellent accuracy and reduced lengths of stay, but there are limited POCUS-I training materials for pediatric emergency medicine (PEM) providers.
Methods:
We performed a prospective cohort study assessing PEM physicians undergoing a primarily Web-based POCUS-I curriculum. We developed the POCUS-I curriculum using Kern's six-step model. The curriculum included a Web-based module and a brief, hands-on practice that was developed with a board-certified pediatric radiologist. POCUS-I technical skill, knowledge, and confidence were determined by a direct observation checklist, multiple-choice test, and a self-reported Likert-scale survey, respectively. We assessed participants immediately pre- and postcourse as well as 3 months later to assess for retention of skill, knowledge, and confidence.
Results:
A total of 17 of 17 eligible PEM physicians at a single institution participated in the study. For the direct observation skills test, participants scored well after the course with a median (interquartile range [IQR]) score of 20 of 22 (20-21) and maintained high scores even after 3 months (20 [20-21]). On the written knowledge test, there was significant improvement from 57.4% (95% CI = 49.8 to 65.2) to 75.3% (95% CI = 68.1 to 81.6; p < 0.001) and this improvement was maintained at 3 months at 81.2% (95% CI = 74.5 to 86.8). Physicians also demonstrated improved confidence with POCUS-I after exposure to the curriculum, with 5.9% reporting somewhat or very confident prior to the course to 76.5% both after the course and after 3 months (p < 0.001).
Conclusion:
After a primarily Web-based curriculum for POCUS-I, PEM physicians performed well in technical skill in POCUS-I and showed improvement in knowledge and confidence, all of which were maintained over 3 months.
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