The growing worldwide use of clinician-performed ultrasound (CPU) marks a dramatic
change in bedside medicine and patient care. With steadily improving portability, accessibility
and technology, ultrasound use continues to grow amongst many medical specialties. Likewise,
the application of CPU in emergency medicine is increasing. Emergency Medicine (EM) is a
medical specialty “based on the knowledge and skills required for the prevention, diagnosis and
management of acute and urgent aspects of illness and injury…” (International Federation for
Emergency Medicine, 1991). Increasingly, emergency physicians are using emergency
department ultrasound (ED U/S) to enhance their assessment of critically-ill patients (American
College of Emergency Physicians, 2008).
The purpose of this study was to evaluate and describe those aspects of ultrasound
simulation (during HFS) that contribute to the development of critical care ED U/S skills.
Secondly, it was of interest to assess how a novel ultrasound simulator (edus2) compared to
video playback on a laptop in terms of the above-mentioned aspects. The population of interest
included both EM trainees and faculty.
This investigation was a randomized, prospective, crossover study with two intervention
treatments for all participants. In Phase I, EM trainees and faculty from London, UK, were
invited to participate in one of four day-long critical-care HFS sessions during which they
participated in four critical-care scenarios. Faculty were involved in assisting with session
debriefing and feedback. All participants completed two cases with each intervention. In Phase
II, faculty in Saskatoon, SK, Canada, were invited to review video recordings of the sessions
from Phase I and evaluate the educational merits of the two ED U/S simulation interventions.
iii
This study produced both quantitative and qualitative data. As this study looked at two
interventions and how they could contribute to the development of ED U/S skills, pre- and postintervention
changes were analysed for statistically significant differences between them. T-test
analyses were used for comparisons. Effect sizes (Cohen’s d) were calculated where statistically
significant findings were observed. Qualitative data was assessed through emergent thematic
analysis and triangulation.
The findings of the study support the integration of ED U/S simulation into HFS.
Integration was found to be of value to both trainees and faculty by allowing trainees to
demonstrate knowledge of indications as well as correct image interpretation and general
integration of ED U/S into critical care (p<0.05). Trainees described an increased motivation to
develop their ED U/S skills as well as greater desire to use ED U/S in everyday practice.
Furthermore, the edus2 was identified as being the preferred training intervention. The
edus2 met functional fidelity through its real time and hands-on applicability. Faculty preferred
the edus2 as it allowed for better assessment of trainee skills that then influenced session
debriefing and formative feedback. Faculty in Phase II found the edus2 intervention sufficient in
offering basic insights into trainee ED U/S skills and mastery (p<0.05).
Implications of the study include support for the use of ultrasound simulation during HFS
for the development of critical care ED U/S skills amongst EM trainees. Further study on the
effects of such hybrid simulation on clinical performance is warranted.
| Identifer | oai:union.ndltd.org:USASK/oai:ecommons.usask.ca:10388/ETD-2014-04-1501 |
| Date | 2014 April 1900 |
| Contributors | Renihan, Patrick, D'Eon, Marcel, Premkumar, Kalyani |
| Source Sets | University of Saskatchewan Library |
| Language | English |
| Detected Language | English |
| Type | text, thesis |
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