title: Limitations of Condensed Teaching Strategies to Develop Hand-Held Cardiac Ultrasonography Skills in Internal Medicine Residents.
abstract: Advances in ultrasonographic technology have allowed for hand-held cardiac ultrasonography (HHCU) units that fit into a physician's laboratory coat. Recently, studies to educate internal medicine residents have shown promise. The optimal duration and methodology for teaching HHCU skills has not been established. Over a 1-year period, internal medicine residents were recruited during their cardiology ward rotation into a single-centre nonblinded randomized trial. The 2 condensed teaching strategies were (1) a conventional ward-based program and (2) a technology-driven simulation-based strategy. Outcomes were evaluated by (1) an objective structured clinical examination (OSCE) to evaluate interpretation ability (assessing both type I and type II error rates) and (2) demonstration of HHCU skills graded by 2 level III echocardiographers. Twenty-four internal medicine residents were randomized. After teaching, the conventional teaching group had a significant absolute increase in the ability to make a singular correct diagnosis (20%; P < 0.001). In the technology arm, making a singular correct diagnosis increased 24% from baseline (P = 0.001). Interpretation skill was not significantly different between groups. The false-positive rate increased by an absolute 14% and 17% in the conventional and technology groups, respectively (P = 0.079 and P = 0.008). Our findings suggest that HHCU interpretation skills improve after either a conventional ward-based or a technology-driven approach. However, our study emphasizes the important limitations of both teaching programs, because we detected a trend toward an increase in the false-positive rate after both approaches. This suggests that a short duration of training may not be sufficient for HHCU to be performed in a safe manner.
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors: Jeffrey S
authors: JS
authors: Wilkinson
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors: Walid
authors: W
authors: Barake
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors: Chris
authors: C
authors: Smith
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors: Amar
authors: A
authors: Thakrar
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada. Electronic address: amerschedule@gmail.com.
authors: Amer M
authors: AM
authors: Johri
mesh_terms: D000328:Adult; D002170:Canada; D004452:Echocardiography; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D019095:Point-of-Care Systems; D000066908:Simulation Training; D013663:Teaching