Psychomotor skill transfer between non-patient and patient training: a point-of-care ultrasound use case

While it's commonplace in medical education to train learners using simulated patient encounters, task trainers, or by practicing skills on healthy volunteers, little is known about how well learning and skills transfer to patient care. The purpose of this research is to quantify Point-of-Care Ultrasound (POCUS) skill transfer to patient care through performance assessment. A quantitative analysis of aggregated data consisting of image quality of student-performed POCUS examinations from one midwestern Physician Assistant program was performed. Probabilities for scores of 1-2, 3, 4, and 5 were estimated using a multivariable cumulative logit model. Forty-six PA students were included in the study. A total of 6,218 POCUS examinations were included; 4,506 on non-patients, and 1,712 on patients. When evaluating skill transfer from non-patients to patients, the probability of obtaining a high-quality examination decreases significantly, with a more substantial decrease in performance on more complex skills. The probability of a high-quality examination on the twenty-fifth examination was the highest when learning transfer happened earlier. While training medical providers using non-patient experiences is common, educators must understand the significant loss of quality upon skills transfer to patient care. More complex or higher risk skills likely require close monitoring at the point of skill transfer, to support the learner and ensure patient safety. Based on the findings of this research, earlier skill transfer is associated with worse immediate performance but better long-term re-learning outcomes. Increased deliberate practice prior to skill transfer is associated with better first-time performance on actual patients.