Elsevier

Journal of Critical Care

Volume 49, February 2019, Pages 38-44
Journal of Critical Care

Education
Comparison of learning outcomes for teaching focused cardiac ultrasound to physicians: A supervised human model course versus an eLearning guided self- directed simulator course

https://doi.org/10.1016/j.jcrc.2018.10.006Get rights and content

Highlights

  • Providing focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors.

  • Our FCU course is non-reliant on instructors, using an automated internet-guided self-directed practice with simulators.

  • This course was more effective in teaching FCU image acquisition on normal humans than a traditional course model.

Abstract

Purpose

Focused cardiac ultrasound (FCU) training in critical care is restricted by availability of instructors. Supervised training may be substituted by self-directed learning with an ultrasound simulator guided by automated electronic learning, enabling scalability.

Materials and methods

We prospectively compared learning outcomes in novice critical care physicians after completion of a supervised one-and-a-half-day workshop model with a self-guided course utilizing a simulator over four weeks. Both groups had identical pre-workshop on-line learning (20h). Image quality scores were compared using FCU performed on humans without pathology. Interpretive knowledge was compared using 20MCQ tests.

Results

Of 161 eligible, 145 participants consented. Total Image quality scores were higher in the Simulator group (95.2% vs. 66.0%, P < .001) and also higher for each view (all P < .001). Interpretive knowledge was not different before (78.6% vs. 79.0%) and after practical training (74.7% vs. 76.1%) and at 3 months (81.0% vs. 77.0%, all P > .1). Including purchase of the simulator and ultrasound equipment, the simulator course required lower direct costs (AUD$796 vs. $1724 per participant) and instructor time (0.5 vs.1.5 days) but similar participant time (2.8 vs. 3.0 days).

Conclusions

Self-directed learning with ultrasound simulators may be a scalable alternative to conventional supervised teaching with human models.

Introduction

Physician-performed focused cardiac ultrasound (FCU) is established in anesthesiology and critical practice [1,2]. The most important barrier to adoption reported by Conlin et al. [1] was lack of training opportunity, who identified a strong need for a scalable teaching process that provides acceptable learning outcomes.

There are three key components to learning a new skill such as FCU – knowledge, practical learning and practice. The traditional initial training model for FCU is a combination of initial knowledge teaching (lectures or eLearning) followed by a supervised workshop of ultrasound on healthy human volunteers. Unfortunately, the initial practical training is dependent on close supervision by trainers, which significantly limits the upward scalability of FCU teaching programs to cope with the increasing demand.

Ultrasound simulators have evolved to be highly sophisticated and realistic, with a recently developed advantage of showing pathology during the initial learning phase, enabling both learning of image acquisition as well as interpretation and reporting. Simulators have been demonstrated to be effective in substitution of human volunteers in initial learning of acquisition of normal FCU views [3], but expansion in training is still restricted by the use of instructors for supervision and also of teaching interpretation of pathology.

The University of Melbourne has developed a course that uses a simulator (Vimedix™, CAE Healthcare, Montreal, Canada) that displays pathology to be almost entirely self-directed (FCU TTE Course [4]), reducing the restriction of trainers to expand the teaching FCU. The supervised teaching of acquisition of normal views is reduced to 3-h using a simulator, after which training of acquiring normal views and interpretation of pathology is entirely self-directed practice with the simulators. By reducing the dependence of training on instructors, the simulator course is much more efficient, enabling an increased volume of training. The evidence gap is whether the learning outcomes of the simulator course are as good as the supervised human model. The aim of this study was to compare the simulator-based training course to a traditional model of a supervised workshop with human models for image acquisition and interpretive skills.

Section snippets

Materials and methods

This prospective observational non-randomized comparative study was approved by The University of Melbourne Human Research Ethics Committee (144321) prior to the commencement of the study period. Written consent was obtained from all participants.

At the commencement of the study period, participants enrolled in either the traditional human model methods course (iHeartScan™ course [5]) or the self-directed simulator course (FCU TTE course [4]) were invited to participate in the study. It was not

Results

Between March 1st 2015 and 18thth January 2017 a convenience sample of 161 participants were enrolled into the education programs (80 participants in the human model group and 81 participants in the simulator group), who all completed their eLearning. After the eLearning and prior to practical training, 11 participants in simulator group and 6 participants in the traditional group either declined participation in the study or were excluded as they were not able to present for follow up (Table 2

Discussion

This study has demonstrated that the simulator based learning program is non-inferior to the traditional workshop style teaching program utilizing human models for interpretive knowledge and satisfaction, and is superior for image acquisition skills.

The non-inferiority design was used as we were concerned that learning to acquire images on a simulator may not provide equivalent training to acquiring images on humans, as is taught in the traditional course, and as reported in the expert

Conclusion

Interpretive learning outcomes were non-inferior, but image acquisition was superior for self-directed simulator learning of focused cardiac ultrasound compared with supervised human model workshop course. Direct costs, instructor and training time were lower for the simulator course

Acknowledgements

We acknowledge the significant contributions to performing this study from the administrative staff of the Ultrasound Education Group, The University of Melbourne, and statistical advice was given by Dr. Sandy Clarke from The University of Melbourne (Consulting Biostatistician).

Conflict of interest statement

Colin Royse, Alistair Royse and David Canty are employees of the University of Melbourne, and Colin Royse and Alistair Royse are directors of iTeachU limited. Educational content from these entities are available for sale in the United States of America through the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiology. The University of Melbourne has received loan equipment from the simulator company CAE.

Funding

This work was supported by a simulation/grant from Australian and New Zealand College of Anaesthetists (S16/002).

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