title: A Comparison of Web-Based with Traditional Classroom-Based Training of Lung Ultrasound for the Exclusion of Pneumothorax.
abstract: Lung ultrasound (LUS) is a well-established method that can exclude pneumothorax by demonstration of pleural sliding and the associated ultrasound artifacts. The positive diagnosis of pneumothorax is more difficult to obtain and relies on detection of the edge of a pneumothorax, called the "lung point." Yet, anesthesiologists are not widely taught these techniques, even though their patients are susceptible to pneumothorax either through trauma or as a result of central line placement or regional anesthesia techniques performed near the thorax. In anticipation of an increased training demand for LUS, efficient and scalable teaching methods should be developed. In this study, we compared the improvement in LUS skills after either Web-based or classroom-based training. We hypothesized that Web-based training would not be inferior to "traditional" classroom-based training beyond a noninferiority limit of 10% and that both would be superior to no training. Furthermore, we hypothesized that this short training session would lead to LUS skills that are similar to those of ultrasound-trained emergency medicine (EM) physicians.
  
  
  
  After a pretest, anesthesiologists from 4 academic teaching hospitals were randomized to Web-based (group Web), classroom-based (group class), or no training (group control) and then completed a posttest. Groups Web and class returned for a retention test 4 weeks later. All 3 tests were similar, testing both practical and theoretical knowledge. EM physicians (group EM) performed the pretest only. Teaching for group class consisted of a standardized PowerPoint lecture conforming to the Consensus Conference on LUS followed by hands-on training. Group Web received a narrated video of the same PowerPoint presentation, followed by an online demonstration of LUS that also instructs the viewer to perform an LUS on himself using a clinically available ultrasound machine and submit smartphone snapshots of the resulting images as part of a portfolio system. Group Web received no other hands-on training.
  
  
  
  Groups Web, class, control, and EM contained 59, 59, 20, and 42 subjects. After training, overall test results of groups Web and class improved by a mean of 42.9% (±18.1% SD) and 39.2% (±19.2% SD), whereas the score of group control did not improve significantly. The test improvement of group Web was not inferior to group class. The posttest scores of groups Web and class were not significantly different from group EM. In comparison with the posttests, the retention test scores did not change significantly in either group.
  
  
  
  When training anesthesiologists to perform LUS for the exclusion of pneumothorax, we found that Web-based training was not inferior to traditional classroom-based training and was effective, leading to test scores that were similar to a group of clinicians experienced in LUS.
authors.affiliation: From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; †Department of Anesthesiology, University Hospital Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany; ‡Department of Anesthesiology, University Hospital rechts der Isar, Technical University Munich, Munich, Germany; §Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; ‖Department of Anesthesiology, Perioperative Medicine and General Intensive Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria; and ¶Ludwig-Maximilians-University Medical School, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Edrich
authors.forename: Matthias
authors.initials: M
authors.lastname: Stopfkuchen-Evans
authors.forename: Patrick
authors.initials: P
authors.lastname: Scheiermann
authors.forename: Markus
authors.initials: M
authors.lastname: Heim
authors.forename: Wilma
authors.initials: W
authors.lastname: Chan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Stone
authors.forename: Daniel
authors.initials: D
authors.lastname: Dankl
authors.forename: Jonathan
authors.initials: J
authors.lastname: Aichner
authors.forename: Dominik
authors.initials: D
authors.lastname: Hinzmann
authors.forename: Pingping
authors.initials: P
authors.lastname: Song
authors.forename: Ashley L
authors.initials: AL
authors.lastname: Szabo
authors.forename: Gyorgy
authors.initials: G
authors.lastname: Frendl
authors.forename: Kamen
authors.initials: K
authors.lastname: Vlassakov
authors.forename: Dirk
authors.initials: D
authors.lastname: Varelmann
mesh_terms: D000328:Adult; D000368:Aged; D000072080:Anesthesiologists / Q000193:education*; D000776:Anesthesiology / Q000193:education*; D001317:Austria; D001900:Boston; D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D004503:Education, Medical, Graduate / Q000379:methods*; D005858:Germany; D006784:Hospitals, Teaching; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D013647:Task Performance and Analysis; D014463:Ultrasonography; D014741:Video Recording