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Assessment of ultrasound-guided procedures in preclinical years

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Abstract

Medical graduates entering residency often lack confidence and competence in procedural skills. Implementation of ultrasound (US)-guided procedures into undergraduate medical education is a logical step to addressing medical student procedural competency. The objective of our study was to determine the impact of an US teaching workshop geared toward training medical students in how to perform three distinct US-guided procedures. Cross-sectional study at an urban academic medical center. Following a 1-h didactic session, a sample of 11 students out of 105 (10.5 %) were asked to perform three procedures each (total 33 procedures) to establish a baseline of procedural proficiency. Following a 1-h didactic session, students were asked to perform 33 procedures using needle guidance with ultrasound to establish a baseline of student proficiency. Also, a baseline survey regarding student opinions, self-assessment of skills, and US procedure knowledge was administered before and after the educational intervention. After the educational workshop, students’ procedural competency was assessed by trained ultrasound clinicians. One-hundred-and-five third-year medical students participated in this study. The average score for the knowledge-based test improved from 46 % (SD 16 %) to 74 % (SD 14 %) (p < 0.05). Students’ overall confidence in needle guidance improved from 3.1 (SD 2.4) to 7.8 (SD 1.5) (p < 0.05). Student assessment of procedural competency using an objective and validated assessment tool demonstrated statistically significant (p < 0.05) improvement in all procedures. The one-day US education workshop employed in this study was effective at immediately increasing third-year medical students’ confidence and technical skill at performing US-guided procedures.

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Acknowledgments

Authors thank Blue Phantom (Ontario, Canada) for the use of their vascular access phantoms, and Mindray Medical International (Shenzhen, China) for providing ultrasound machines for this event.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Arizona, Tucson, AZ, USA

    Richard Amini, Lori Ann Stolz, Nicholas Stea, Nicolaus Hawbaker, Matthew Thompson, Arthur Barry Sanders & Srikar Adhikari

  2. College of Medicine, University of Arizona, Tucson, AZ, USA

    Elliot Breshears

  3. Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA

    Asad E. Patanwala

Authors
  1. Richard Amini
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  2. Lori Ann Stolz
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  3. Elliot Breshears
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  4. Asad E. Patanwala
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  5. Nicholas Stea
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  6. Nicolaus Hawbaker
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  7. Matthew Thompson
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  8. Arthur Barry Sanders
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  9. Srikar Adhikari
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Corresponding author

Correspondence to Richard Amini.

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Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent from participants was not required per our IRB.

Appendix: Questionnaire

Appendix: Questionnaire

1. I am confident that I can perform Ultrasound-guided procedures by myself without any assistance with simultaneous probe manipulation and needle advancement.

  1. a.

    Strongly agree

  2. b.

    Somewhat agree

  3. c.

    Somewhat disagree

  4. d.

    Strongly disagree

2. Please rank your confidence in performing or assessing the following procedures, from Low (1) to High (10).

  1. a.

    Ultrasound-guided Peripheral IV Placement

  2. b.

    Ultrasound-guided Needle Aspiration

  3. c.

    Ultrasound-guided Peripheral Nerve Block

  4. d.

    Needle guidance with Ultrasound

3. When performing ultrasound-guided peripheral IVs, the metallic needle creates which of the following artifacts?

  1. a.

    Shadowing artifact

  2. b.

    Reverberation artifact

  3. c.

    Edge artifact

  4. d.

    Propagation error artifact

4. When using ultrasound, what technique can be performed to differentiate a vein from an artery?

  1. a.

    Short axis compression

  2. b.

    Color doppler

  3. c.

    Pulse wave doppler

  4. d.

    All of the above

5. When measuring a cylindrical structure (blood vessel) in long axis, it is possible to underestimate the diameter of said cylinder. What is this measurement error called?

  1. a.

    Cylinder tangent effect

  2. b.

    Cylinder sinus effect

  3. c.

    Cylinder cosign effect

  4. d.

    Slip sign

6. To improve needle visibility during ultrasound-guided procedures, the angle of needle insertion should be __________ to ultrasound beams.

  1. a.

    Perpendicular

  2. b.

    Parallel

  3. c.

    Stronger

  4. d.

    Symmetric

7. In regards to abscess evaluation and management, how can the operator distinguish abscess fluid from dense soft-tissue mass like lipoma or sebaceous cyst?

  1. 1.

    Cut the abscess open

  2. 2.

    Demonstrate the sonographic squish sign

  3. 3.

    Demonstrate the sonographic line sign

  4. 4.

    Use Color Doppler

8. What kind of probe should be used when performing ultrasound-guided nerve blocks or peripheral IV access?

  1. a.

    Low frequency curved array probe

  2. b.

    High frequency curved array probe

  3. c.

    Low frequency Linear array probe

  4. d.

    High frequency Linear array probe

9. Describe the sonographic appearance of peripheral nerves.

  1. a.

    Hyperechoic structure with shadowing artifact

  2. b.

    Hypoechoic circular structures that compress with pressure

  3. c.

    Hyperechoic triangular honeycomb appearing structures

  4. d.

    All of the above

10. How much anesthetic solution (1 % Lidocaine) would be sufficient to anesthetize a femoral nerve with ultrasound guidance?

  1. a.

    5 cc/5 ml

  2. b.

    10–20 cc/10–20 ml

  3. c.

    20–40 cc/20–40 ml

  4. d.

    50 cc/50 ml

11. Lidocaine associated systemic toxicity (LAST) can occur if an excess amount of Lidocaine is administered or if Lidocaine is injected directly into vasculature. What is the antidote and dosage?

  1. a.

    Intralipid: 1.5 ml/kg bolus over 1–2 min

  2. b.

    Propofol: 1 mg/kg bolus over 1–2 min

  3. c.

    Glucagon 2 mg very slowly

  4. d.

    Atropine 1.5 ml/kg bolus over 1–2 min

12. How many ultrasound-guided procedures have you performed?

  1. a.

    0

  2. b.

    1–3

  3. c.

    4–6

  4. d.

    7–10

  5. e.

    11–25

  6. f.

    >25

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Cite this article

Amini, R., Stolz, L.A., Breshears, E. et al. Assessment of ultrasound-guided procedures in preclinical years. Intern Emerg Med 12, 1025–1031 (2017). https://doi.org/10.1007/s11739-016-1525-4

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  • DOI: https://doi.org/10.1007/s11739-016-1525-4

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