Expert Versus Peer-Led Hands-on Training for Army Medics: A Non-Inferiority Study of Focused Assessment with...

For traumatic injuries, prehospital ultrasound by medics impacts triage and management early in the clinical course; however, the limited availability of ultrasound experts may be a barrier to application across forward aid stations. This study aimed to assess medics' Focused Assessment with Sonography in Trauma (FAST) performance after hands-on training by an ultrasound expert versus a peer instructor.

This was a single-blind, randomized controlled noninferiority study completed with ultrasound novice U.S. Army combat medics. After training by an expert or peer, participants performed a FAST. The primary outcome compared image quality scores using a 24-point Task Specific Checklist (TSC). Secondary outcomes included an objective skills assessment with a 40-point Global Rating Scale (GRS), exam duration, and self-confidence scores.

Thirty-two medics received training and performed a FAST. Investigators performed a one-tailed t-test for non-inferiority, demonstrating image quality scores among peer-trained medics were non-inferior to those trained by experts (18.25 vs. 18.31; one-sided 95% confidence interval [CI], -3.08; P = .002). Investigators found no significant difference in the GRS scores (29.69 vs. 26.75; 95% CI, -2.75 to 0.08; P = .20) or exam duration (306.86 seconds vs. 279.64 seconds; 95% CI, -1.97 to 0.86; P = .75). The pre and post participation confidence survey scores also demonstrated no difference between the 2 groups.

The image quality of peer-trained medics performing the FAST exam was non-inferior to that of expert-trained medics, with no other differences observed. These findings support the feasibility of a hybrid training model that combines expert didactics with hands-on instruction led by either experts or peers, suggesting peer instruction may serve as a viable complement to expert-led training for ultrasound-novice medics.