Charlotte Ringsted

International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey.

Objectives To achieve international consensus across multiple specialties on a generic ultrasound rating scale using a Delphi technique. Methods Ultrasound experts from Obstetrics-Gynaecology, Surgery, Urology, Radiology, Rheumatology, Emergency Medicine, and Gastro-Enterology representing North America, Australia, and Europe were identified. A multi-round survey was conducted to obtain consensus between these experts. Of 60 invited experts, 44 experts agreed to participate in the first Delphi round, 41 remained in the second round, and 37 completed the third Delphi round. Seven key elements of the ultrasound examination were identified from existing literature and recommendations from international ultrasound societies. All experts rated the importance of these seven elements on a five-point Likert scale in the first round and suggested potential new elements for the assessment of ultrasound skills. In the second round, the experts re-rated all elements and a third round was conducted to allow final comments. Agreement on which elements to include in the final rating scale was pre-defined as more than 80% of the experts rating an element four or five, on importance to the ultrasound examination. Results Two additional elements were suggested by more than 10% of the experts in the first Delphi round. Consensus was obtained to include these two new elements along with five of the original elements in the final assessment instrument: 1) Indication for the examination 2) Applied knowledge of ultrasound equipment 3) Image optimization 4) Systematic examination 5) Interpretation of images 6) Documentation of examination and 7) Medical decision making. Conclusion International multispecialty consensus was achieved on the content of a generic ultrasound rating scale. This is the first step to ensure valid assessment of clinicians in different medical specialties using ultrasound.

Assessment of performance measures and learning curves for use of a virtual‐reality ultrasound simulator in transvaginal ultrasound examination

To assess the validity and reliability of performance measures, develop credible performance standards and explore learning curves for a virtual‐reality simulator designed for transvaginal gynecological ultrasound examination.

Reliable and valid assessment of ultrasound operator competence in obstetrics and gynecology

To explore the reliability and validity of a recently developed instrument for assessment of ultrasound operator competence, the Objective Structured Assessment of Ultrasound Skills (OSAUS).

Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial

BackgroundVideo-assisted thoracic surgery is gradually replacing conventional open thoracotomy as the method of choice for the treatment of early-stage non-small cell lung cancers, and thoracic surgical trainees must learn and master this technique. Simulation-based training could help trainees overcome the first part of the learning curve, but no virtual-reality simulators for thoracoscopy are commercially available. This study aimed to investigate whether training on a laparoscopic simulator enables trainees to perform a thoracoscopic lobectomy.MethodsTwenty-eight surgical residents were randomized to either virtual-reality training on a nephrectomy module or traditional black-box simulator training. After a retention period they performed a thoracoscopic lobectomy on a porcine model and their performance was scored using a previously validated assessment tool.ResultsThe groups did not differ in age or gender. All participants were able to complete the lobectomy. The performance of the black-box group was significantly faster during the test scenario than the virtual-reality group: 26.6xa0min (SD 6.7xa0min) versus 32.7xa0min (SD 7.5xa0min). No difference existed between the two groups when comparing bleeding and anatomical and non-anatomical errors.ConclusionSimulation-based training and targeted instructions enabled the trainees to perform a simulated thoracoscopic lobectomy. Traditional black-box training was more effective than virtual-reality laparoscopy training. Thus, a dedicated simulator for thoracoscopy should be available before establishing systematic virtual-reality training programs for trainees in thoracic surgery.

Transesophageal Ultrasonography for Lung Cancer Staging: Learning Curves of Pulmonologists

Introduction: Accurate mediastinal nodal staging is essential for patients with resectable non–small-cell lung cancer and is achieved by combined endobronchial ultrasound and transesophageal endoscopic ultrasound (EUS). Training requirements for EUS-guided fine-needle aspiration (FNA) for lung cancer staging are unknown. Methods: Pulmonologists from Denmark and The Netherlands were enrolled in a dedicated, supervised training program. They performed standardized EUS-FNA procedures for mediastinal nodal analysis and their performances were assessed by EUS experts using a validated EUS assessment tool. Data were collected prospectively and used to plot learning curves and relate these to procedures performed by experienced investigators. Results: Four participants performed 91 EUS-FNA procedures (range, 19–24). The performances of the participants improved significantly and became more consistent, but were still highly variable even in the latter part of the learning curves. Only two of the participants reached the mean score of experienced operators—after 17 and 23 procedures, respectively. Conclusions: Pulmonologists with knowledge of lung cancer staging and experience in bronchoscopy quickly improved their performance of EUS-FNA. However, acquisition of skills varies between individuals, and certification should be based on assessment of performance of multiple cases. Twenty procedures were not enough to secure consistent and competent performance of all trainees.

Improving efficiency of clinical skills training: a randomized trial.

ABSTRACTBACKGROUNDThe rising number of medical students and the impact this has on students’ learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation.OBJECTIVEThe aim of this study was to evaluate the effect of dyad training on students’ patient encounter skills.DESIGNExperimental, randomized, observer-blinded trial.PARTICIPANTSForty-nine pre-clerkship medical students without prior clinical experience.INTERVENTIONAll students underwent a 4-h course on how to manage patient encounters. Subsequently, the students were randomized into a dyad practice group (nu2009=u200924) or a single practice group (nu2009=u200925). Both groups practiced for 4xa0h on four different case scenarios, using simulated patients. Students in the dyad group practiced together and took turns as the active participant, whereas students in the single group practiced alone.MAIN MEASUREPerformance tests of patient encounter skills were conducted 2xa0weeks after the training by two blinded raters. Students had no clinical training during those weeks. A questionnaire-based evaluation surveyed students’ confidence in their patient management skills.KEY RESULTSThe dyad group scored significantly higher on the performance test, mean 40.7xa0% (SD 6.6), than the single group, mean 36.9xa0% (SD 5.8), Pu2009=u20090.04, effect size 0.61. Inter-rater reliability was 0.69. The dyad group expressed significantly higher confidence in managing future clinical patient encounters than the single group, mean 7.6 (SD 0.9) vs. mean 6.5 (SD 1.1), respectively, Pu2009<u20090.001, effect size 1.16.CONCLUSIONDyad training of pre-clerkship medical students’ patient encounter skills is effective, efficient, and prompts higher confidence in managing future patient encounters compared to training alone. This training format may help maintain high-quality medical training in the face of an increasing number of students in medical schools.

Simulator training for endobronchial ultrasound: a randomised controlled trial

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is very operator dependent and has a long learning curve. Simulation-based training might shorten the learning curve, and an assessment tool with solid validity evidence could ensure basic competency before unsupervised performance. A total of 16 respiratory physicians, without EBUS experience, were randomised to either virtual-reality simulator training or traditional apprenticeship training on patients, and then each physician performed EBUS-TBNA procedures on three patients. Three blinded, independent assessor assessed the video recordings of the procedures using a newly developed EBUS assessment tool (EBUSAT). The internal consistency was high (Cronbachs α=0.95); the generalisability coefficient was good (0.86), and the tool had discriminatory ability (p<0.001). Procedures performed by simulator-trained novices were rated higher than procedures performed by apprenticeship-trained novices: mean±sd are 24.2±7.9u2005points and 20.2±9.4u2005points, respectively; p=0.006. A pass/fail standard of 28.9 points was established using the contrasting groups method, resulting in 16 (67%) and 20 (83%) procedures performed by simulator-trained novices and apprenticeship-trained novices failing the test, respectively; p<0.001. The endobronchial ultrasound assessment tool could be used to provide reliable and valid assessment of competence in EBUS-TBNA, and act as an aid in certification. Virtual-reality simulator training was shown to be more effective than traditional apprenticeship training. Virtual-reality simulation-based training shortens the learning curve for endobronchial ultrasound (EBUS) http://ow.ly/OazC9

Which factors are associated with trainees' confidence in performing obstetric and gynecological ultrasound examinations?

To explore the association between clinical training characteristics and trainees level of confidence in performing ultrasound scans independently.

Virtual-reality simulation to assess performance in hip fracture surgery.

Background and purpose Internal fixation of hip fractures is a common and important procedure that orthopedic surgeons must master early in their career. Virtual-reality training could improve initial skills, and a simulation-based test would make it possible to ensure basic competency of junior surgeons before they proceed to supervised practice on patients. The aim of this study was to develop a reliable and valid test with credible pass/fail standards. Methods 20 physicians (10 untrained novices and 10 experienced orthopedic surgeons) each performed 3 internal fixation procedures of an undisplaced femoral neck fracture: 2 hook-pins, 2 screws, and a sliding hip screw. All procedures were preformed on a trauma simulator. Performance scores for each procedure were obtained from the predefined metrics of the simulator. The inter-case reliability of the simulator metrics was explored by calculation of intra-class correlation coefficient. Validity was explored by comparison between novices’ and experts’ scores using independent-samples t-test. A pass/fail standard was set by the contrasting-groups method and the consequences were explored. Results The percentage of maximum combined score (PM score) showed an inter-case reliability of 0.83 (95% CI: 0.65–0.93) between the 3 procedures. The mean PM score was 30% (CI: 7–53) for the novices and 76% (CI: 68–83) for the experienced surgeons. The pass/fail standard was set at 58%, resulting in none of the novices passing the test and a single experienced surgeon failing the test. Interpretation The simulation-based test was reliable and valid in our setting, and the pass/fail standard could discriminate between novices and experienced surgeons. Potentially, training and testing of future junior surgeons on a virtual-reality simulator could ensure basic competency before proceeding to supervised practice on patients.

What an ambulance nurse needs to know: A content analysis of curricula in the specialist nursing programme in prehospital emergency care

In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution.