This was a prospective cohort study with 33 interns serving as their own historical controls. A 1-day bedside ultrasound workshop was developed as one component of a comprehensive 5-day intern “boot-camp” designed to improve interns’ cognitive, affective and psychomotor skills using active learning techniques including simulation, standardized patients and communication workshops. The “boot-camp” was purposefully placed 3 months into the academic year so that these key concepts did not get lost during the intern’s busy orientation time.
The bedside ultrasound training day consisted of alternating didactics with small group hands-on sessions. Six topics pertinent to Internal Medicine patient management were covered including ultrasound basics (physics, knobology, artifacts), cardiac limited ultrasound exam (CLUE) [5], basic pulmonary exam, abdominal exam, basic vascular anatomy of the aorta, and neck anatomy. The abdominal exam was a modified FAST exam adapted for internal medicine, assessing for free intraperitoneal fluid, inferior vena cava collapse as an assessment of intravascular volume status [11], and ruling out hydronephrosis. Each topic was introduced with a 15- to 20-min didactic. Following the brief didactic session, interns worked within 12 pre-assigned groups of 2–3 learners for 40-min hands-on sessions. Each session was divided into 20 min for completing modules demonstrating pathology on SonoSim® machines and 20 min for facilitator-led hands-on practice with a SonoSite Edge® machine and volunteer models. Volunteers were solicited from the pre-health student list serve of a local university. Facilitators included two clinical trainers from SonoSite® in addition to emergency medicine residents, fellows and faculty, cardiology fellows, and Internal Medicine faculty. All facilitators had experience and training in bedside ultrasound. The teaching during the intensive intervention was re-enforced by two additional 1-h ultrasound training sessions within the first 6 months. However, these were held during noon conference sessions with untracked attendance.
To assess image acquisition, optimization, interpretation and application within the clinical context, study investigators designed a 30-question assessment covering ultrasound basics, neck anatomy, abdomen, limited cardiac, volume assessment, and basic vascular ultrasound. Subject areas were determined by group consensus and based on existing literature supporting the use of bedside ultrasound in the practice of internal medicine. Questions were vetted by the four co-investigators with final edits by the PI. Seventeen questions tested image interpretation, 7 tested concepts of image acquisition/optimization and 6 tested clinical application. A copy of the assessment can be obtained by emailing the corresponding author. See Fig. 1 for an example, test question.
Interns completed the ultrasound knowledge assessment in a proctored room directly before and after the bedside ultrasound training day. They subsequently completed the ultrasound knowledge assessment approximately 6 months after the bedside ultrasound training day on their own time in an unproctored setting. Each individual testing session randomized the question order and did not provide feedback regarding test performance to minimize subjects’ ability to “learn the test”.
Qualitative feedback on the entire training week and each session was collected from learners at the completion of the week via survey.
This study was approved by the Oregon Health & Science University Institutional Review Board. All participants in the intern intensive week gave informed consent to be studied as part of this educational initiative; however, the IRB did waive documentation of consent and interns were notified that the research portion was optional. Each intern selected a unique identifier that test results could be traced to at the onset of the study. Intern identifiers were not known to the data assessors, and all participants were assured that their scores were used only for research purposes rather than summative feedback.
Statistical analysis was calculated using Stata v. 11 using Student’s t test for mean comparison.