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Effect of a point-of-care ultrasound protocol on the diagnostic performance of medical learners during simulated cardiorespiratory scenarios

  • Adam R. Parks (a1), Glenn Verheul (a1) (a2) (a3), Denise LeBlanc-Duchin (a3) (a4) and Paul Atkinson (a1) (a2) (a3)

Abstract

Background

Goal-directed point-of-care ultrasound (PoCUS) protocols have been shown to improve the diagnostic accuracy of the initial clinical assessment of the critically ill patient. The diagnostic impact of the Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) protocol was assessed in simulated emergency medical scenarios.

Methods

Following a focused PoCUS training program, the diagnostic accuracy, confidence, and precision of 12 medical learners participating in standardized scenarios were tested using high-fidelity clinical and ultrasound simulators. Participants were assessed during 72 simulated cardiorespiratory scenarios. Differential diagnoses were collected from participants before and after PoCUS in each scenario, and confidence surveys were completed. Data were analysed using R software.

Results

Prior to PoCUS, 45 (62.5%) correct primary diagnoses were made compared with 64 (88.9%) following PoCUS (χ2=14, 1df, p=0.0002). PoCUS was also shown to increase participants’ confidence in their diagnoses. The mean confidence in diagnosis score pre-PoCUS was 52.2 (SD=14.7), whereas post-PoCUS it was 81.7 (SD=9.5). The estimated difference in means (−28.36) was significant (t=−7.71, p<0.0001). Using PoCUS, participants were further able to narrow their differential diagnoses. The median number of diagnoses for each patient pre-PoCUS was 3.5 (interquartile range [IQR]=3.8, 3.0) with a median of 2.3 (IQR=2.9,1.5) diagnoses post-PoCUS. The difference was significant (W=0, p<0.001).

Conclusion

This pilot study suggests that, in medical learners newly competent in PoCUS, the addition of an ACES PoCUS protocol to standard clinical assessment improves diagnostic accuracy, confidence, and precision in simulated cardiorespiratory scenarios. This is consistent with clinical studies and supports the use of ultrasound during medical simulation.

Contexte

C’est un fait avéré, les protocoles relatifs à l’échographie pratiquée au point de service (EPS), et guidés par les buts améliorent l’exactitude diagnostique dans l’évaluation clinique initiale des patients gravement malades. Les auteurs ont donc évalué la portée du protocole Abdominal and Cardiac Evaluation with Sonography in Shock (ACES) en matière de diagnostic dans des simulations de cas en médecine d’urgence.

Méthode

Après un programme de formation ciblée en EPS, les auteurs ont vérifié l’exactitude diagnostique, la confiance et la précision chez 12 étudiants en médecine qui participaient à l’étude de scénarios normalisés, élaborés à l’aide de simulateurs cliniques et échographiques réalistes. Les participants ont fait l’objet d’évaluation durant 72 séances de simulation de troubles cardiorespiratoires. Il y a eu collecte de données sur les diagnostics différentiels posés par les participants, avant et après la formation en EPS, et ce, pour chaque scénario; des questionnaires sur la confiance ont aussi été remplis. Les données ont été analysées à l’aide du logiciel R.

Résultats

Avant la formation en EPS, 45 participants (62,5 %) ont posé le bon diagnostic de départ comparativement à 64 (88,9 %) après la formation en EPS (χ2=14; 1 fonction de distribution; p=0,0002). Il a aussi été démontré que la formation en EPS améliorait la confiance des participants en ce qui concerne l’exactitude diagnostique. Le résultat moyen relatif à la confiance en l’exactitude diagnostique avant la formation en EPS était de 52,2 (écart type [σ]=14,7), tandis qu’après la formation en EPS il était de 81,7 (σ=9,5); l’écart estimé des résultats moyens (−28,36) était significatif (t=−7,71; p<0,0001). Par ailleurs, les participants étaient plus en mesure de rétrécir la plage des diagnostics différentiels à la suite de la formation en EPS. Enfin, le nombre médian de diagnostics posés chez chaque patient avant la formation en EPS était de 3,5 (écart interquartile [EIQ]=3,8 – 3,0) et celui après la formation, de 2,3 (EIQ=2,9 – 1,5); l’écart était considéré comme significatif (w=0; p<0,001).

Conclusions

L’étude pilote décrite ici donne à penser que l’ajout du protocole ACES à l’évaluation clinique courante améliore l’exactitude diagnostique, la confiance et la précision chez les étudiants en médecine nouvellement formés en EPS, dans des simulations de cas de troubles cardiorespiratoires. Les résultats vont dans le même sens que ceux d’études cliniques, et justifient le recours à l’échographie dans des simulations de cas en médecine.

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Copyright

Corresponding author

Correspondence to: Paul Atkinson, Saint John Regional Hospital, 400 University Avenue, Saint John, NB E2L 4L4; paul.atkinson@dal.ca

References

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Effect of a point-of-care ultrasound protocol on the diagnostic performance of medical learners during simulated cardiorespiratory scenarios

  • Adam R. Parks (a1), Glenn Verheul (a1) (a2) (a3), Denise LeBlanc-Duchin (a3) (a4) and Paul Atkinson (a1) (a2) (a3)

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