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Table 2 Publications in education in lung ultrasound: study statistics and conclusion

From: Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

  Statistical analysis Outcome measures Study conclusion Level of evidence
Noble et al. [13]. Evaluation of thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. 2009 Paired t test compared mean score of pre- and post-test Improvement in pre- and post-test scores With minimal didactic and image recognition skill sessions are needed before physicians can recognize the key artifacts, which lead to the diagnosis of pulmonary edema and pneumothorax. 4
Oveland et al. [14]. Animal laboratory training improves lung ultrasound proficiency and speed. 2013 Sensitivity, specificity, positive and negative predictive value Confidence level, scan time, improvement in theoretical score and sensitivity/specificity Novices can quickly learn how to diagnose PTX using lung US. Training in an animal facility imparts a high level of long-term diagnostic proficiency and speed for diagnosing PTX 4
Breitkreutz et al. [15]. Thorax, trachea and lung ultrasonography in Emergency and Critical care medicine: Assessment of an Objective Structured training concept. 2013 Non-parametric Wilcoxon matched pairs (within groups), Mann–Whitney U test (between groups) Improvement in pre- and post-test scores. Recognition and interpretation skill scores. Practical imaging performance scores 1-day training program like THOLUUSE significantly improves theoretical and practical skills for sonographic diagnosis of including PLE and PTX 4
Cuca et al. [16]. Assessment of a new e-learning system on thorax, trachea and lung ultrasound. 2013 Wilcoxon matched pairs test. Self-assessment survey Improvement in pre- and post-test score and sustainability test, qualitative program evaluation score Results of written tests from the e-learning attendance course are comparable and with same progress as attendance-based courses 4
Hulett et al. [17]. Development and Preliminary Assessment of Critical Care Ultrasound Course in an Adult Pulmonary and Critical Care Fellowship Program. 2014 Paired t-test on pre- and postcourse performances Improvement in pre- and post-test scores, practical pre- and postcourse skill score and self-assessment score A formal curriculum dedicated to critical care ultrasound can be developed and implemented on site in a fellowship training program. After validation studies testing longer term retention of knowledge and bedside skills on trainees at other broadly representative medical centres, the curriculum described here might form the basis of a widely applicable onsite critical care ultrasound course curriculum 4
Bhat et al. [18]. Prehospital Evaluation of Effusion, Pneumothorax and standstill (PEEPS): Point-of-care Ultrasound in emergency medical services. 2015 Two-tailed, paired t test Improvement in pre-, post- and sustainability test. Level of confidence This study showed potential promise for training prehospital EMS providers in accurate US interpretation through a 1-h didactic lecture focused on US technique and anatomy for the assessment of pericardial effusion, pneumothorax, and cardiac standstill 4
Connolly et al. [19]. Ultrafest: a novel Approach to Ultrasound in Medical Education Leads to Improvement in Written and Clinical Examinations, 2014 Paired t test analysis Improvement in pre- and post-test score and practical pre- and postcourse skill score A 1-day, 9-h, small group instruction and practice symposium improved student knowledge on trauma and pulmonary US, and improved image acquisition, but the latter fell short of significant proficiency 4
Dinh et al. [20]. Impact of a 2-day critical care ultrasound course during fellowship training: a pilot study. 2015 Students t test, Chi square or ANOVA Improvement in pre-, post-, and 3 month follow-up test score, comfort level score. Number of self-reported scans Introduction of a 2-day critical care ultrasound course has both a positive short- and long-term impact on fellows’ confidence and proficiency with ultrasound use. Utilizing tools such as written tests to assess basic knowledge, live models to teach practical skills, and ultrasound simulators to teach pathological image identification can help standardize critical care ultrasound training 4
Heiberg et al. [21]. Point-of-care clinical ultrasound for medical students. 2015 Paired Students t test, Wilcoxon rank sum test, Chi squared test, linear regression Improvement in pre- and post-test score and practical pre- and postcourse skill score Medical students with no previous experience of ultrasound techniques demonstrated a significant increase in their ability to acquire and interpret an ultrasound image after completion of interactive e-learning, and this competence was further improved after 4 h of systematic hands-on training 4
Sanchez-de-Toledo et al. [22]. Teaching chest ultrasound in an porcine model. 2016 Sensitivity, specificity, positive and negative predictive values Improvement in sensitivity and specificity after 30 and 60 min Brief training in theory combined with animal models facilitates learning for medical professionals with no previous training in US and enables them to recognize the three most relevant thoracic US patterns. The introduction of advanced simulation with animal models can facilitate training of personnel in the recognition and management of acute lung disease 4
See et al. [23]. Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. 2016 Paired t test. Three patients block (36 images) Overall performance score with linear regression Improvement in pre- and post-test scores and practical skill scores We devised a pragmatic lung ultrasound curriculum, which involved building rapport, stimulating self-directed learning, and avoiding cognitive overload. Our training method allowed RTs to acquire the ability to independently perform lung ultrasound after at least ten directly supervised scans 4
Greenstein et al. [24]. Effectiveness of a Critical Care ultrasonography Course. 2016 Two-tailed student t test Improvement in pre- and post-test score and practical pre- and postcourse skill score This 3-day CHEST CCUS course is an effective method to train large groups of clinicians in the skills requisite for CCUS. The majority of learners demonstrated improved performance in both image interpretation and hands-on ultrasonography skills across all educational domains at the completion of the course 4
Krishnan et al. [25]. Efficacy of an online education program for ultrasound diagnosis of pneumothorax. 2013 Sensitivity and specificity at the time of educational program and after 6 months Improvement in sensitivity/specificity, use of ultrasound from baseline to follow-up After viewing a 5-min online training video, physicians can reliably rule out pneumothorax on an optimal ultrasound image. They are also able to retain this skill for up to 6 months 4
Abbasi et al. [26]. Accuracy of emergency physician-performed ultrasound in detecting traumatic pneumothorax after 2-h training course. 2012 Sensitivity and specificity, positive after 5, 10 and 20 ultrasound examinations, × 2-test for proportions and the Student t test for continuous variables Improvement in sensitivity/specificity after 5, 10 and 20 examinations By a brief learning course, the emergency physicians easily diagnosed PTX in trauma patients with a reasonable accuracy in comparison with CT scan as the gold standard 4
Gargani et al. [27]. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: an LUST trial sub-project. 2016 Mean number of b lines ± SD. Pearsons correlation coefficient (trainer vs. trainee). Intraclass correlation coefficient and confidence interval. Interobserver agreement by Bland–Altman plot Test-score agreement (trainee vs. trainer) In conclusion, this study performed in the framework of the LUST trial shows that nephrologists and cardiologists can be effectively trained to measure lung congestion by an entirely web-based educational program 4
Edrich et al. [28]. A comparison of web-based with traditional classroom-based training of lung ultrasound for the exclusion of pneumothorax. 2016 Agreement of reviewers results assessed with Krippendorff test. Total score in percent. One-sided, 2-sample t test Improvement in pre-, post-, and sustainability test score and practical test When training anaesthesiologists to perform LUS for the exclusion of pneumothorax, we found that web-based training was not inferior to traditional classroom-based training and was effective, leading to test scores that were similar to a group of clinicians experienced in LUS 2