Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules?

Situ-LaCasse et al. BMC Medical Education https://doi.org/10.1186/s12909-021-02612-z (2021) 21:175 RESEARCH ARTICLE Open Access Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules? Elaine Situ-LaCasse1* , Josie Acuña1, Dang Huynh2, Richard Amini3, Steven Irving4, Kara Samsel5, Asad E. Patanwala6, David E. Biffar7 and Srikar Adhikari3 Abstract Background: Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors, and with COVID19, another challenge is the difficulty with social distancing between learners and educators. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules. Methods: This was a prospective study evaluating first-year medical students. Medical students were asked to complete four SonoSim® online modules (aorta/IVC, cardiac, renal, and superficial). They were subsequently asked to perform ultrasound examinations on standardized patients utilizing the learned techniques/skills in the online modules. Emergency Ultrasound-trained physicians evaluated medical students’ sonographic skills in image acquisition quality, image acquisition difficulty, and overall performance. Data are presented as means and percentages with standard deviation. All P values are based on 2-tailed tests of significance. Results: Total of 44 medical students participated in the study. All (100%) students completed the hands-on skills evaluation with a median score of 83.7% (IQR 76.7–88.4%). Thirty-three medical students completed all the online modules and quizzes with median score of 87.5% (IQR 83.8–91.3%). There was a positive association between module quiz performance and the hands-on skills performance (R-squared = 0.45; p < 0.001). There was no statistically significant association between module performance and hands-on performance for any of the four categories individually. In all four categories, the evaluators’ observation of the medical students’ difficulty obtaining views correlated with hands-on performance scores. Conclusions: Our study findings suggest that ultrasound-naïve medical students can develop basic hands-on skills in image acquisition after reviewing online modules. Keywords: Point-of-care ultrasound, Medical student ultrasound education, Simulation, Ultrasound education, Asynchronous learning * Correspondence: 1 University of Arizona, College of Medicine & Banner University Medical Center - Tucson, Department of Emergency Medicine, PO Box 245057, Tucson, AZ 85724, USA Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Situ-LaCasse et al. BMC Medical Education (2021) 21:175 Background Point-of-care ultrasound (POCUS) is rapidly becoming a more ubiquitous diagnostic and treatment tool in various medical specialties. Training in this imaging modality is required in emergency medicine residency education, but POCUS is extending into other specialties and settings. The increasing interest in this modality is driving the earlier integration of ultrasound education into the medical school curriculum. Medical students are learning how to use ultrasound to augment their physical examination skills, and they are seeing the utility in this imaging modality for their future careers [1]. In addition to didactics, one of the critical components of ultrasound education is teaching the psychomotor skills in performing ultrasound examinations. This development of ultrasound muscle memory typically requires hands-on practice in the form of in-person proctoring by an ultrasound expert. However, one of the challenges with educating an ever-growing base of learners is the scarcity of resources, especially qualified teachers and equipment. Methods for addressing this problem vary widely, from flipped classroom instruction to using telemedicine platforms [2]. Fuchs et al. showed that medical students can learn cardiac ultrasound through electronic learning platforms as well as their validated bedside in-person cardiac course [3]. These methods for teaching traditionally hands-on examinations/ procedures are especially important in today’s COVID-19 (Coronavirus Disease 2019) pandemic. With social distancing and cancellation of in-person teaching sessions, direct observation and in-person teaching of novices have become difficult and perhaps, non-existent. Therefore, ultrasound educators must be creative in creating an alternative way to deliver both the medical knowledge-based and psychomotor learning. Ultrasound education platforms are constantly evolving and improving their products to meet the growing demand. Several of these platforms are simulation-based, virtual reality-based, or web-based modules [4–6]. It is unclear if these tools can replace more traditional teaching methods of didactics and in-person hands-on training sessions [7, 8]. Because of this, we wanted to explore the effectiveness of an online training program to learn hands-on skills. This online training program is comprised of various modules for frequently used POCUS examinations. Each module is comprised of a lecture section demonstrating the technique of POCUS examinations and a multiple-choice exam at the end of each module to test knowledge retention. Students’ progression and test scores are viewable by the instructor. To our knowledge, there are no studies exploring learning ultrasound and hands-on skills solely based on online modules, only those that explore purely online modules without a hands-on assessment or more traditional Page 2 of 7 methods of a didactics component and hands-on training [8–10]. Therefore, our objective for this study was to determine if ultrasoun (...truncated)