Microlearning as an Adjunct to a 4-Hour Hands-On POCUS Curriculum for Paramedics: A Pilot Study

Pre-hospital point-of-care ultrasound (POCUS) by paramedics is not widely used in the United States. Its use is limited to a handful of ground and air ambulance emergency medical service (EMS) programs and military medics in combat. Technical advancements have increased the portability and image quality, while decreasing the cost of ultrasound, making pre-hospital POCUS a viable diagnostic and therapeutic tool. These improvements enhance the deployability of POCUS devices that can be utilized in austere, far-forward environments. At present, there is no standardized educational curriculum for pre-hospital POCUS education. This study aimed to evaluate an alternative modality for teaching POCUS to paramedics, through microlearning. This novel educational intervention could be adapted to teach POCUS and other educational content to military medics such as combat medics and corpsmen.

This prospective cohort pilot study recruited POCUS naive paramedics from 2 hospital based suburban EMS agencies in Southern New Jersey, United States. Two 4-hour POCUS sessions were conducted (weekday evening and weekend morning). Participants enrolled based on availability and were unaware at registration which session would include adjunct microlearning. One session used traditional in-person instruction alone, while the other incorporated microlearning. The microlearning curriculum consisted of daily lessons designed to be completed in 5-10 minutes, which were delivered for 5 days preceding the in-person course. Lessons included: (1) an introduction; (2) a visual aid; and (3) a multiple-choice question (MCQ) to assess comprehension and encourage engagement. Microlearning POCUS content was delivered directly to the paramedic's phones through text messages. Both traditional and microlearning curriculums covered the Extended Focused Assessment for Sonography in Trauma (eFAST) exam, ultrasound basics, and anatomy. All educational content, including the microlearning curriculum, was developed by the study team. We evaluated knowledge on image interpretation, confidence, and attitudes regarding perceived usefulness and impact of POCUS using pre-/post-test assessments and surveys. Paired t-tests and ANOVA were used for statistical analysis, where appropriate. Our institution deemed this study to be IRB-exempt.

A total of 25 paramedics completed the study including pre/post-tests of knowledge, confidence, and attitudes. Thirteen paramedics (52%) participated in the microlearning curriculum. Regardless of their cohort, participants scored significantly higher on their knowledge test after the training from a baseline of 46% to 78% (P < .001). POCUS confidence showed a large increase after the training, and the perceived usefulness and positive impact of POCUS had a moderate increase. The paramedics who received the microlearning curriculum scored higher on the pre-test (54% vs. 38%) and on the post-test (81% vs. 74%) than those who did not, though not statistically significant (P = .435).

Microlearning is a teaching modality that may complement traditional learning. This customizable, low cost, easy to deploy solution can be employed for teaching POCUS and other educational content to paramedics. It is also as well suited for the military where medics must learn a variety of skills based on their deployed environment. Future efforts should evaluate microlearning with a larger sample size, engage directly with military medics, and incorporate long-term engagement with knowledge retention.