The Key Literature in Medical Education podcast this week focuses on the use of mobile ultrasound to improve physical examination. Now before you scroll to another post muttering that you are not interested in ultrasound, there is a meta-message in this KeyLIME episode relevant to all Clinician Educators. For a full debate on the issue, check out the podcast here (and give us a 5-star rating while you’re at it!). Otherwise, check out the abstract below and analyze for yourself the challenges of this approach to learning. While a randomized trial should be applauded in education research, the authors employ a one-time education intervention (i.e. 3 hr workshop), an intervention far too common in residency curricula, to change practice (more than one month later). As the findings of this study suggest, every CE needs to question the impact on learning from a single educational salvo.
– Jonathan (@sherbino)
KeyLIME Session 84 – Article under review:
View/download the abstract here.
Ojeda JC, Colbert JA, Lin X, McMahon GT, Doubilet PM, Benson CB, Wu J, Katz JT, Yialamas MA. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. Journal of General Internal Medicine. 2015 Feb; 30(2):199-206.
Reviewer: Linda Snell
Background
Proficiency and self-confidence in the physical examination (PE) is poor among internal medicine residents and interest in ultrasound (US) technology (especially with miniaturization) has expanded.
Purpose
‘Does use of a pocket sized US improves the PE diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice?’
Type of paper
Research – randomized ‘parallel group’ controlled trial
Key Points on the Methods
Participants: 40 internal medicine residents at a single program at an American academic medical center. Randomized; half underwent 3 hours training in pocket-sized US followed by 1 month of independent practice. Training session was half theory, half practice, on multiple organ systems for multiple abnormalities.
Outcomes measured in an ‘assessment session’, using a checklist, of 10 patient PEs – the majority with cardiac abnormalities. Gold standard was the result of a standard US exam by a specialist. Comparator with a senior physician.
Primary: comparison of diagnostic accuracy of PE alone vs. PE augmented with US.
Secondary: confidence in exam findings; attitudes towards the PE and the role of US, as measured by survey.
Key Conclusions
The authors conclude that the PE diagnostic accuracy of internal medicine residents did not significantly improve with use of a pocket-sized US after a brief training session. US has diagnostic potential to be a valuable aid to enhancing the physical exam, longer or more intensive training may be needed.
Spare Keys – other take home points for clinician educators
Need to ensure training is adequate before doing an education trial!
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