Tobias Todsen

Short- and long-term transfer of urethral catheterization skills from simulation training to performance on patients

BackgroundInexperienced interns are responsible for most iatrogenic complications after urethral catheterization (UC). Although training on simulators is common, little is known about the transfer of learned skills to real clinical practice. This study aimed to evaluate the short- and long-term effects of UC simulated skills training on performance on real patients and to examine whether watching a video of the procedure immediately before assessment enhanced clinical performance.MethodsThis was an experimental study of the effect of a UC simulation-based skills course on medical students’ short-term (after one week) and long-term (after six weeks) performance. The additional effect of video instruction before performance testing on real patients was studied in a randomized trial. Sixty-four students participated in the study, which was preceded by a pilot study investigating the validity aspects of a UC assessment form.ResultsThe pilot study demonstrated sufficient inter-rater reliability, intra-class correlation coefficient 0.86, and a significant ability to discriminate between trainee performances when using the assessment form, p= 0.001. In the main study, more than 90% of students demonstrated an acceptable performance or better when tested on real patients. There was no significant difference in the total score between the one-week and the six-week groups when tested on real patients and no significant difference between the video and the control groups.ConclusionsMedical students demonstrated good transfer of UC skills learned in the skills lab to real clinical situations up to six weeks after training. Simulated UC training should be the standard for all medical school curricula to reduce avoidable complications. However, this study did not demonstrate that an instructional video, as a supplement to simulated skills training, improved clinical UC performance.Trial registrationCurrent Controlled Trials ISRCTN:ISRCTN90745002

An integrable, web-based solution for easy assessment of video-recorded performances

Assessment of clinical competencies by direct observation is problematic for two main reasons the identity of the examinee influences the assessment scores, and direct observation demands experts at the exact location and the exact time. Recording the performance can overcome these problems; however, managing video recordings and assessment sheets is troublesome and may lead to missing or incorrect data. Currently, no existing software solution can provide a local solution for the management of videos and assessments but this is necessary as assessment scores are confidential information, and access to this information should be restricted to select personnel. A local software solution may also ease the need for customization to local needs and integration into existing user databases or project management software. We developed an integrable web-based solution for easy assessment of video-recorded performances (ISEA).

Designing web-apps for smartphones can be easy as making slideshow presentations.

BackgroundLimited clinician involvement in smartphone application development poses problems considering the extensive use of smartphones among medical professionals and patients.FindingsWe present a simple method for the clinician to develop simple web-apps using only an Internet browser and a text editor.ConclusionsThis method may help clinicians develop simple web-apps and increase clinician involvement in smartphone content.

Preparing for Emergency A Valid, Reliable Assessment Tool for Emergency Cricothyroidotomy Skills

Objective Emergency cricothyrodotomy (EC) is a lifesaving procedure. Evidence-based assessment of training effects and competency levels is relevant to all departments involved in emergency airway management. As most training uses low-fidelity models, the predictive value of good performance on such a model becomes relevant with regard to performance on a high-fidelity model (cadaver). This requires a valid assessment tool for EC performance. Study Design Psychometric study on low-fidelity models and human cadavers. Setting University hospital. Subjects and Methods An assessment tool was created. Sixteen physicians (7 experienced surgeons and 9 novice physicians) performed an EC on a low-fidelity model and a cadaver. Two blinded raters assessed video recordings of performances using the assessment tool. Results We found a high interrater reliability, based on a Pearson’s r (0.81), and good evidence for validity, based on successfully distinguishing the 2 groups, using an independent samples t test (P < .001). We found a good correlation between performance on a low-fidelity model and the cadaver with an R2 = 0.78. Conclusion The tool for assessing EC competence proved reliable and valid. Performance on a low-fidelity model measured this way is a good predictor of performance in a more lifelike situation.

Transfer from point-of-care Ultrasonography training to diagnostic performance on patients—a randomized controlled trial

BACKGROUND Clinicians are increasingly using point-of-care ultrasonography for bedside examinations of patients. However, proper training is needed in this technique, and it is unknown whether the skills learned from focused Ultrasonography courses are being transferred to diagnostic performance on patients. METHODS Thirty-one physicians were randomized to participate in a focused Ultrasonography course or control circumstances before they examined 4 patients with different abdominal conditions by ultrasonography. Performance scores and diagnostic accuracy were compared using independent samples t test and binary logistic regression, respectively. RESULTS There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014). CONCLUSIONS Clinicians could successfully transfer learning from an Ultrasonography course to improve diagnostic performance on patients. However, our results also indicate a need for more training when new technologies such as point-of-care ultrasonography are introduced.

Developing an emergency ultrasound app - a collaborative project between clinicians from different universities

Focused emergency ultrasound is rapidly evolving as a clinical skill for bedside examination by physicians at all levels of education. Ultrasound is highly operator-dependent and relevant training is essential to ensure appropriate use. When supplementing hands-on focused ultrasound courses, e-learning can increase the learning effect. We developed an emergency ultrasound app to enable onsite e-learning for trainees. In this paper, we share our experiences in the development of this app and present the final product.

Cricothyroidotomy – The emergency surgical airway

The creation of the emergency surgical airway, the emergency cricothyroidotomy, is the final step in “Cannot ventilate – cannot oxygenate” management guidelines and is a dreaded procedure among junior physicians. Studies have shown that initial attempts to create a surgical airway are often made by an anesthesiologist or a head and neck surgeon. The procedure is a high-risk, low-frequency one that, even in trained hands, is too often performed unsuccessfully. The fact that more than half of all initial attempts by anesthetists fail means that the teaching of emergency cricothyroidotomy should be a high priority for ear, nose, and throat departments, in which the risk of an unforeseen compromised airway is highest.

Competency‐based assessment in surgeon‐performed head and neck ultrasonography: A validity study

Head and neck ultrasonography (HNUS) increasingly is used as a point‐of‐care diagnostic tool by otolaryngologists. However, ultrasonography (US) is a very operator‐dependent image modality. Hence, this study aimed to explore the diagnostic accuracy of surgeon‐performed HNUS and to establish validity evidence for an objective structured assessment of ultrasound skills (OSAUS) used for competency‐based assessment.

Assessment of competence in focused assessment with sonography for trauma (FAST) examination.

Parameter developed in collaboration with the American College of Emergency Physicians (ACEP). The American Institute of Ultrasound in Medicine (AIUM) is a multidisciplinary association dedicated to advancing the safe and effective use of ultrasound in medicine through professional and public education, research, development of parameters, and accreditation. To promote this mission, the AIUM is pleased to publish, in conjunction with the American College of Emergency Physicians (ACEP), this AIUM Practice Parameter for the Performance of the Focused Assessment With Sonography for Trauma (FAST) Examination. We are indebted to the many volunteers who contributed their expertise, effort, and enthusiasm to complete this project. The AIUM represents the entire range of clinical and basic science interests in medical diagnostic ultrasound, and with hundreds of volunteers , the AIUM has promoted the safe and effective use of ultrasound in clinical medicine for more than 50 years. This document and others like it will continue to advance this mission. Practice parameters of the AIUM are intended to provide the medical ultrasound community with parameters for the performance and recording of high-quality ultrasound examinations. The parameters reflect what the AIUM considers the minimum criteria for a complete examination in each area and are not intended to establish a legal standard of care. AIUM-accredited practices are expected to generally follow the parameters with the recognition that deviations from the parameters will be needed in some cases depending on patient needs and available equipment. Practices are encouraged to go beyond the parameters to provide additional service and information as needed by their referring physicians and patients.

Board 431 - Research Abstract Assessment of Point-of-Care Ultrasonography Competence: An Explorative Study of Validity and Reliability (Submission #1157)

Introduction/Background Ultrasonography is increasingly used by non-radiologist and is an essential part of the management of surgical emergency conditions. However, performances are highly operator-dependent and reliable and valid assessment of trainees ultrasonography competence is therefore needed to ensure patient safety. The aim of this study was to explore the reliability and validity of the novel Objective Structured Assessment of Ultrasound Skills (OSAUS) used for assessment of physicians’\ competence in abdominal ultrasonography of patients. The research questions were: 1) What is the reliability and validity when using the OSAUS scale to judge physicians’ point-of-care ultrasonography competence in a simulated setting?; 2) What is the number of cases and assessors needed for reliable judgment of physicians point-of-care ultrasonography competence using the OSAUS scale? Methods Twenty four physicians representing novices, intermediates and experts in ultrasonography performed point-of-care ultrasonography in a controlled simulated set-up on four patients representing different acute abdominal cases. Ultrasound examinations were video-recorded and assessed blindly using OSAUS by two consultant radiologists. Reliability was examined using Generalizability Theory. Construct validity was examined comparing performance scores between the groups and concurrent validity was explored by correlating physicians OSAUS scores with diagnostic accuracy. Results The reliability coefficient was high, 0.81 and a D-study demonstrated that one assessor and five cases would result in similar reliability. Construct validity was supported by a significant difference in mean score between the novice group, 17 (SD 8.4) and the intermediate group, 30.0 (SD 10.2), p=0.007 and between the intermediate group and the expert group, 72.9 (SD 4.4), p= 0.04. Concurrent validity was demonstrated by a Spearman’s rho Correlation Coefficient, 0.76 (p<0.001). Conclusion Our findings demonstrated that assessment of abdominal ultrasonography competence using the generic OSAUS scale possess high reliability, as well as sufficient construct and concurrent validity. Hence, the OSAUS assessment instrument holds potentials for in-training, as well as end-of-training assessment of performance. Disclosures None.