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Education, Teaching, and Quality Improvement |

Teaching Lung Ultrasound: An Investigation in Competency-Based Medical Education

Rebecca Sternschein, MD; Paru Patrawalla, MD
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NYU Langone Medical Center, New York, NY


Chest. 2015;148(4_MeetingAbstracts):463A. doi:10.1378/chest.2248500
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Abstract

SESSION TITLE: Education and Simulation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Point-of-care ultrasound is becoming increasingly prevalent in the care of critically ill patients. The use of ultrasound for the detection of pleural effusions has long been established; more recently, ultrasound has been used to assess lung parenchyma for the diagnosis of acute and chronic conditions (Lichtenstein and Mezière. CHEST. 2008; 134: 117-135.) Despite the growing use of lung ultrasound (LUS), an educational approach to teaching LUS has not been the subject of significant study. We developed a pilot curriculum and comprehensive assessment using the principles of competency-based medical education to teach LUS to medical residents.

METHODS: We designed an educational curriculum in our simulation center focused on maximizing hands-on ultrasound use for internal medicine house-staff of varying levels of training. Subjects completed a survey prior to and following the training that addressed attitude, confidence, and knowledge regarding LUS. We developed a behavior-based skills checklist using the modified Delphi method in order to assess each individual’s competency in bedside LUS at the conclusion of the skill session.

RESULTS: Thirty-two internal medicine residents, 31% female and 69% male, participated in our 2-hour educational program. The majority of residents were in their second (37.5%) or third (46.9%) year of post-graduate training. Residents’ confidence at identifying and understanding the clinical implications of specific LUS findings (A-lines, B-lines, lung sliding, pneumothorax, and pleural effusion) all increased significantly following training (p<0.05 for each). Additionally, their performance improved significantly in the following knowledge categories: the technical aspects of ultrasound (medians: Pre-test 60%, Post-test 100%; p<0.05); the identification of ultrasound artifacts and findings (medians: Pre-test 57%, Post-test 86%; p<0.05); clinical interpretation of LUS patterns (medians: Pre-test 50%, Post-test 67%; p<0.05). All participants attained technical skills competence in LUS using the 11-step behavior-based checklist.

CONCLUSIONS: Our competency-based curriculum significantly improves resident confidence and skill in the performance of bedside LUS.

CLINICAL IMPLICATIONS: As bedside lung ultrasound becomes more widespread, it is essential to accurately determine skill competency of medical professionals. We have demonstrated a feasible and effective way to teach and assess skill competency of bedside lung ultrasound to internal medicine residents.

DISCLOSURE: The following authors have nothing to disclose: Rebecca Sternschein, Paru Patrawalla

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