Kingsley, Ryan

Background: Point-of-care ultrasonography (POCUS) is becoming an increasingly relevant tool in hospital medicine, but its effective application in inpatient perioperative medicine remains to be determined. Much of the POCUS literature describes its use by anesthesiologists to evaluate cardiac function, volume status, pulmonary findings, and gastric volume. Objective: To identify, evaluate, and synthesize all available literature investigating the use of point-of-care ultrasound and associated clinical outcomes in inpatient perioperative medical management. Patients and Methods: A systematic review was designed using the PRISMA guidelines with sources of literature including Ovid, PubMed, Scopus, and the Web of Science. Literature search was conducted for published works between 1 January 2002 to 8 February 2024. Results: Three hundred sixty-seven abstracts were identified in our search, and, ultimately, 24 studies were included in this review. Most studies were done by anesthesiology evaluating cardiopulmonary and gastric POCUS. Studies supported using POCUS to expedite cardiac examination, promptly diagnose postoperative pulmonary complications, and optimize surgical timing. Conclusions: POCUS is a versatile tool in the perioperative setting; however, few studies were powered to assess clinical outcomes, and even fewer showed conclusive evidence of improved clinical outcomes. Furthermore, only two studies evaluated the use of POCUS specifically by acute care providers; more extensive studies are needed from their perspective as they take on increasing perioperative responsibilities.

Abstract Background: Medical education commonly utilizes the “see one, do one” two-step approach for teaching psychomotor skills; however, recent evidence suggests that Peyton’s four-step method leads to superior learning. The effect of Peyton’s four-step method on long term skill retention is less apparent and has never been assessed for Point-of-Care Ultrasound (POCUS). The purpose of this research project was to evaluate the effectiveness of Peyton’s four-step method on teaching the POCUS psychomotor skills of image acquisition to novice learners. Additionally, this research project assessed the influence of Peyton’s four-step method at three different points in time during the skill acquisition phase, in the setting of ongoing deliberate skill practice. Methods: A single-blinded, repeated measures interventional study based on experimental design was completed. PA students from one large academic medical center were randomized into a control group (using the two-step method) and intervention group (using Peyton’s four-step method). Students were taught POCUS of the aorta, bladder, heart, lungs, and kidneys. Students' POCUS skills were assessed during the immediate, intermediate, and delayed learning phases. At each assessment, an organ-specific score and a total score were obtained. Scores were compared using a Wilcoxon rank sum test. An ordinal logistic regression analysis was performed using a generalized linear mixed model with a multinomial distribution and cumulative logit link function to assess overall effect of Peyton's four-step method. Results: Students who were taught using Peyton’s method were found to have an increased likelihood of higher total scores compared to those taught using usual instruction (OR = 4.2, p = 0.003). Peyton’s method was found to have increased likelihood of higher scores for cardiac (OR = 2.3, p = 0.032), lung (OR = 2.5, p = 0.034), and kidney (OR = 3.0, p = 0.015). Student performance statistically improved with Peyton’s four-step method during the immediate (p = 0.031) and delayed (p = 0.011) skill acquisition phases, but not in the intermediate phase. Conclusion: Peyton’s four-step method improves overall psychomotor skill acquisition for POCUS. Peyton’s four-step method specifically improved psychomotor skills in the immediate skill acquisition phase and the delayed skill acquisition phase. The benefit of Peyton’s four-step method was more prominent in higher complexity POCUS applications.

Abstract Purpose : While it’s commonplace in medical education to train learners using simulated patient encounters, task trainers, or by practicing skills on healthy volunteers, little is known about how well learning and skills transfer to patient care. The purpose of this research is to quantify Point-of-Care Ultrasound (POCUS) skill transfer to patient care through performance assessment. Method : A quantitative analysis of aggregated data consisting of image quality of student-performed POCUS examinations from one midwestern Physician Assistant program was performed. Probabilities for scores of 1-2, 3, 4, and 5 were estimated using a multivariable cumulative logit model. Results : Forty-six PA students were included in the study. A total of 6,218 POCUS examinations were included; 4,506 on non-patients, and 1,712 on patients. When evaluating skill transfer from non-patients to patients, the probability of obtaining a high-quality examination decreases significantly, with a more substantial decrease in performance on more complex skills. The probability of a high-quality examination on the twenty-fifth examination was the highest when learning transfer happened earlier. Conclusion : While training medical providers using non-patient experiences is common, educators must understand the significant loss of quality upon skills transfer to patient care. More complex or higher risk skills likely require close monitoring at the point of skill transfer, to support the learner and ensure patient safety. Based on the findings of this research, earlier skill transfer is associated with worse immediate performance but better long-term re-learning outcomes. Increased deliberate practice prior to skill transfer is associated with better first-time performance on actual patients.

Abstract Background In the context of competency-based medical education, more research is needed to define point-of-care ultrasound (POCUS) competency and validate learner assessment. To address noted gaps in the currently validated assessment instruments, we developed the Observed Structured POCUS Readiness Examination (OSPRE). The purpose of this study is to demonstrate evidence of validity and reliability of the OSPRE in Physician Assistant (PA) students. Methods A prospective cohort study was designed to demonstrate evidence of validity and reliability for the OSPRE instrument at one PA program. Students completed a hands-on skills assessment utilizing a simulated patient scenario involving a traumatic injury. Student performance was assessed in real time by one reviewer and asynchronously by a second reviewer blinded to the scoring of the initial reviewer. Inter-rater reliability was calculated for overall score and for each criterion of the OSPRE. Results Intraclass correlation coefficient for the final percentage score between the independent reviewers utilizing the OSPRE instrument was noted to be 0.86 (95% CI 0.56–0.95, p < 0.001), demonstrating overall good reliability. Level of agreement for inter-rater reliability for the specific individual criterion ranged between fair and substantial. Conclusion The OSPRE instrument provides a valid and reliable assessment of POCUS skills in PA students. When compared to previously validated assessment instruments, scores on the OSPRE had a wider range, suggesting that the OSPRE might have a greater discriminatory value for POCUS skillset.

<b>Background:</b> Inclusion of point-of-care ultrasound (POCUS) within medical education is increasing. A lack of clinical preceptors ready to teach POCUS to physician assistant (PA) students has been discovered. Understanding the barriers to student use of POCUS in clinical education will inform curricular planning.<br /> <b>Methods:</b> Qualitative survey research was completed on 212 previously identified PA student preceptors. Descriptive statistics outlining frequencies of responses were completed.<br /> <b>Results:</b> The most frequently identified barriers included lack of preceptor experience with POCUS (63.7%), lack of access to a device (47.6%), and lack of familiarity with POCUS (45.2%). Time and lack of experience with POCUS were more commonly identified by inpatient providers. Lack of clinical indications and device access were more frequent in outpatient preceptors.<br /> <br /> <b>Discussion:</b> As programs incorporate POCUS, creating intentional opportunities for POCUS education on clinical rotations is needed. The differences in barriers based on practice type allow targeted intervention based on specific rotations.