Utilization of marketing automation tools for delivery of a faculty development curriculum.

Background: Physician clinical educators play important roles in teaching, providing feedback, and evaluating trainees, but they often have variable preparation and competing demands on their time that make universal participation in workshops, seminars, or short courses designed to foster these skillsets inefficient or impossible. Methods: We designed and implemented a 52-week synchronous curriculum designed to address faculty opportunities to improve teaching skills, feedback for residents and medical students, and evaluation skills, which were delivered using marketing automation tools, including text messaging and email. We evaluated the programmatic impact and feasibility of using the implementation science framework. Results: Over a 104-week evaluation period, there were at least 10,499 total content impressions and 4558 unique recipients, indicating the significant reach of this program to approximately 120 faculty members. Faculty engagement with continuing education materials remained stable or increased over the 2-year evaluation period, indicating that programs like ours can have sustainable impacts. Resident evaluations of faculty across the six key domains also improved after the implementation of the program. Conclusions: Our experience with digital marketing tools reflects that they can be used to deliver impactful curricular content to faculty for continuing educational purposes and that faculty can use these resources in a sustainable way. However, because of the incomplete reach with any single communication, this type of content delivery is not appropriate for isolation as a material of critical importance. More research is needed to identify the best practices and additional education-related uses of this technology.

Physical and biophysical markers of assessment in medical training: A scoping review of the literature.

PURPOSE: Assessment in medical education has changed over time to measure the evolving skills required of current medical practice. Physical and biophysical markers of assessment attempt to use technology to gain insight into medical trainees' knowledge, skills, and attitudes. The authors conducted a scoping review to map the literature on the use of physical and biophysical markers of assessment in medical training. MATERIALS AND METHODS: The authors searched seven databases on 1 August 2022, for publications that utilized physical or biophysical markers in the assessment of medical trainees (medical students, residents, fellows, and synonymous terms used in other countries). Physical or biophysical markers included: heart rate and heart rate variability, visual tracking and attention, pupillometry, hand motion analysis, skin conductivity, salivary cortisol, functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). The authors mapped the relevant literature using Bloom's taxonomy of knowledge, skills, and attitudes and extracted additional data including study design, study environment, and novice vs. expert differentiation from February to June 2023. RESULTS: Of 6,069 unique articles, 443 met inclusion criteria. The majority of studies assessed trainees using heart rate variability (n = 160, 36%) followed by visual attention (n = 143, 32%), hand motion analysis (n = 67, 15%), salivary cortisol (n = 67, 15%), fMRI (n = 29, 7%), skin conductivity (n = 26, 6%), fNIRs (n = 19, 4%), and pupillometry (n = 16, 4%). The majority of studies (n = 167, 38%) analyzed non-technical skills, followed by studies that analyzed technical skills (n = 155, 35%), knowledge (n = 114, 26%), and attitudinal skills (n = 61, 14%). 169 studies (38%) attempted to use physical or biophysical markers to differentiate between novice and expert. CONCLUSION: This review provides a comprehensive description of the current use of physical and biophysical markers in medical education training, including the current technology and skills assessed. Additionally, while physical and biophysical markers have the potential to augment current assessment in medical education, there remains significant gaps in research surrounding reliability, validity, cost, practicality, and educational impact of implementing these markers of assessment.

Do we fix front and back of every APC pelvic injury?

HISTORY-A 47-year-old male was on a cliff when he jumped into the water below. He jumped about 50 feet. Upon landing in the water, he felt his legs separate and abduct violently. He was taken to the Emergency unit of the nearest trauma center and was found to have no injuries except to his pelvis. He could not weight bear because of pelvic pain but had normal distal sensory and motor exam and rectal exam. His-pelvis was painful to examination anteriorly with minor left-sided posterior SI pain, and he had no blood at his meatus. X-rays and CT were done, (Figures 1-5).

Broad fault zones enable deep fluid transport and limit earthquake magnitudes.

Constraining the controlling factors of fault rupture is fundamentally important. Fluids influence earthquake locations and magnitudes, although the exact pathways through the lithosphere are not well-known. Ocean transform faults are ideal for studying faults and fluid pathways given their relative simplicity. We analyse seismicity recorded by the Passive Imaging of the Lithosphere-Asthenosphere Boundary (PI-LAB) experiment, centred around the Chain Fracture Zone. We find earthquakes beneath morphological transpressional features occur deeper than the brittle-ductile transition predicted by simple thermal models, but elsewhere occur shallower. These features are characterised by multiple parallel fault segments and step overs, higher proportions of smaller events, gaps in large historical earthquakes, and seismic velocity structures consistent with hydrothermal alteration. Therefore, broader fault damage zones preferentially facilitate fluid transport. This cools the mantle and reduces the potential for large earthquakes at localized barriers that divide the transform into shorter asperity regions, limiting earthquake magnitudes on the transform.

The 2023 Core Content of advanced emergency medicine ultrasonography.

In February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.

Slab to back-arc to arc: Fluid and melt pathways through the mantle wedge beneath the Lesser Antilles.

Volatiles expelled from subducted plates promote melting of the overlying warm mantle, feeding arc volcanism. However, debates continue over the factors controlling melt generation and transport, and how these determine the placement of volcanoes. To broaden our synoptic view of these fundamental mantle wedge processes, we image seismic attenuation beneath the Lesser Antilles arc, an end-member system that slowly subducts old, tectonized lithosphere. Punctuated anomalies with high ratios of bulk-to-shear attenuation (Qκ-1/Qµ-1 > 0.6) and VP/VS (>1.83) lie 40 km above the slab, representing expelled fluids that are retained in a cold boundary layer, transporting fluids toward the back-arc. The strongest attenuation (1000/QS ~ 20), characterizing melt in warm mantle, lies beneath the back-arc, revealing how back-arc mantle feeds arc volcanoes. Melt ponds under the upper plate and percolates toward the arc along structures from earlier back-arc spreading, demonstrating how slab dehydration, upper-plate properties, past tectonics, and resulting melt pathways collectively condition volcanism.

Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents.

OBJECTIVE: The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents. METHODS: The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores. RESULTS: Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images. CONCLUSIONS: Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.

Use of Hand-motion Analysis to Assess Competence and Skill Decay for Cardiac and Lung Point-of-care Ultrasound.

OBJECTIVES: Assessment of competence in technical skills, including point-of-care ultrasound (POCUS), is required before a novice can safely perform the skill independently. Ongoing assessment of competence is also required because technical skills degrade over time, especially when they are infrequently performed or complex. Hand-motion analysis (HMA) is an objective assessment tool that has been used to evaluate competency in many technical skills. The purpose of this study was to demonstrate the feasibility and validity of HMA as an assessment tool for competence in both simple and complex technical skills as well as skill degradation over time. METHODS: This prospective cohort study included 36 paramedics with no POCUS experience and six physicians who were fellowship trained in POCUS. The novices completed a 4-hour didactic and hands-on training program for cardiac and lung POCUS. HMA measurements, objective structured clinical examinations (OSCE), and written examinations were collected for novices immediately before and after training as well as 2 and 4 months after training. Expert HMA metrics were also recorded. RESULTS: Expert HMA metrics for cardiac and lung POCUS were significantly better than those of novices. After completion of the training program, the novices improved significantly in all HMA metrics, knowledge test scores, and OSCE scores. Novices showed skill degradation in cardiac POCUS based on HMA metrics and OSCE scores while lung POCUS image acquisition skills were preserved. Novices deemed competent by OSCE score performed significantly better in HMA metrics than those not deemed competent. CONCLUSION: We have demonstrated that HMA is a feasible and valid tool for assessment of competence in technical skills and can also evaluate skill degradation over time. Skill degradation appears more apparent in complex skills, such as cardiac POCUS. HMA may provide a more efficient and reliable assessment of technical skills, including POCUS, when compared to traditional assessment tools.

Ultrasound Hypotension Protocol Time-motion Study Using the Multifrequency Single Transducer Versus a Multiple Transducer Ultrasound Device.

INTRODUCTION: Ultrasound hypotension protocols (UHP) involve imaging multiple body areas, each with different transducers and imaging presets. The time for task switching between presets and transducers to perform an UHP has not been previously studied. A novel hand-carried ultrasound (HCU) has been developed that uses a multifrequency single transducer to image areas of the body (lung, heart, abdomen, superficial) that would typically require three transducers using a traditional cart-based ultrasound (CBU) system. Our primary aim was to compare the time to complete UHPs with a single transducer HCU to a multiple transducer CBU. METHODS: We performed a randomized, crossover feasibility trial in the emergency department of an urban, safety-net hospital. This was a convenience sample of non-hypotensive emergency department patients presenting during a two-month period of time. Ultrasound hypotension protocols were performed by emergency physicians (EP) on patients using the HCU and the CBU. The EPs collected UHP views in sequential order using the most appropriate transducer and preset for the area/organ to be imaged. Time to complete each view, time for task switching, total time to complete the examination, and image diagnostic quality were recorded. RESULTS: A total of 29 patients were scanned by one of eight EPs. When comparing the HCU to the CBU, the median time to complete the UHP was 4.3 vs 8.5 minutes (P <0.0001), respectively. When the transport and plugin times were excluded, the median times were 4.1 vs 5.8 minutes (P <0.0001), respectively. There was no difference in the diagnostic quality of images obtained by the two devices. CONCLUSION: Ultrasound hypotension protocols were performed significantly faster using the single transducer HCU compared to a multiple transducer CBU with no difference in the number of images deemed to be diagnostic quality.

Megarectum: systematic histopathological evaluation of 35 patients and new common pathways in chronic rectal dilatation.

AIMS: Megarectum is well described in the surgical literature but few contemporary pathological studies have been undertaken. There is uncertainty whether 'idiopathic' megarectum is a primary neuromuscular disorder or whether chronic dilatation leads to previously reported and unreported pathological changes. We sought to answer this question. METHODS: Systematic histopathological evaluation (in accord with international guidance) of 35 consecutive patients undergoing rectal excision surgery for megarectum (primary: n=24) or megarectum following surgical correction of anorectal malformation (secondary: n=11) in a UK university hospital with adult/paediatric surgical and gastrointestinal neuropathology expertise. RESULTS: We confirmed some previously reported observations, notably hypertrophy of the muscularis propria (27 of 35, 77.1% of patients) and extensive fibrosis (30 of 35, 85.7% of patients). We also observed unique and previously unreported features including elastosis (19 of 33, 57.6%) and the presence of polyglucosan bodies (15 of 32, 46.9% of patients). In contrast to previous literature, few patients had any strong evidence of specific forms of visceral neuropathy (5 of 35, including 3 plexus duplications) or myopathy (6 of 35, including 3 muscle duplications). All major pathological findings were common to both primary and secondary forms of the disease, implying that these may be a response to chronic rectal distension rather than of primary aetiology. CONCLUSIONS: In the largest case series reported to date, we challenge the current perception of idiopathic megarectum as a primary neuromuscular disease and propose a cellular pathway model for the features present. The severe morphological changes account for some of the irreversibility of the condition and reinforce the need to prevent ongoing rectal distension when first identified.

Differences in Gaze Fixation Location and Duration Between Resident and Fellowship Sonographers Interpreting a Focused Assessment With Sonography in Trauma.

OBJECTIVES: We quantified the gaze fixation duration of resident and fellowship sonographers interpreting a prerecorded focused assessment with sonography in trauma (FAST). We hypothesized that all sonographers would fixate on each relevant anatomic relationship but that the duration of fixation would differ. METHODS: We conducted a cross-sectional study collecting and analyzing the gaze fixations of a convenience sample of current resident and fellowship sonographers. All sonographers viewed a standardized FAST video, and their gaze fixations were recorded using a Tobii X3-120 eye-tracking bar. Gaze fixations over nine anatomic regions of interest (ROIs) were identified. These were assessed for normality and analyzed using the Wilcoxon rank sum test at an alpha of 0.05 and Bonferroni correction p value of <0.0034. The chi-square test and Pearson's correlation were performed to assess statistical association. RESULTS: The gaze fixation recordings of 24 resident and eight fellowship sonographers were suitable for analysis. Fourteen of the 24 resident sonographers viewed all ROIs in the FAST, whereas all eight fellowship sonographers viewed each of the nine relevant ROIs. Five ROIs were identified over which at least one resident sonographer did not have a gaze fixation. No statistically significant difference was identified between groups. Resident sonographers gaze fixated over the left upper quadrant (LUQ) splenorenal interface for a median (interquartile range) of 10.64 (9.73-11.60) seconds. The fellowship group viewed the same ROI for 8.43 (6.64-8.95) seconds (p < 0.003). All participants viewed this ROI. No other ROIs had a statistical difference. CONCLUSION: Five ROIs were identified that were not visually interrogated by all resident sonographers. Only 14 of 24 resident sonographers visually interrogated every area in the FAST, whereas all fellowship sonographers interrogated every ROI. A statistically significant difference was found in gaze fixation duration between resident and fellowship sonographers in one ROI. Further study is required for gaze fixation assessment to become a tool for the interpretation component of point-of-care ultrasound.

Predictors of False-Negative Focused Assessment With Sonography for Trauma Examination in Pediatric Blunt Abdominal Trauma.

OBJECTIVES: This study investigated associations between patient and injury characteristics and false-negative (FN) focused assessment with sonography for trauma (FAST) in pediatric blunt abdominal trauma (BAT). We also evaluated the effects of FN FAST on in-hospital mortality and length of stay (LOS) variables. METHODS: This retrospective cohort studied children younger than 18 years between January 1, 2002, and December 31, 2013, with BAT, documented FAST, and pathologic fluid on computed tomography, surgery, or autopsy. Multivariable and bivariate analyses were used to assess associations between FN FAST and patient injury characteristics, mortality, and hospital LOS. RESULTS: A total of 141 pediatric BAT patients with pathologic free fluid were included. There were no patient or injury characteristics, which conferred increased odds of an FN FAST. Splenic and bladder injury were negatively associated with FN FAST odds ratio of 0.4 (95% confidence interval [CI], 0.2-0.8) and 0.1 (95% CI, 0-0.8). Abbreviated Injury Scale score of 4 or greater to the abdomen and extremity was negatively associated with FN FAST odds ratio of 0.1 (95% CI, 0-0.3) and 0.3 (95% CI, 0.1-0.9). There was no association between FN FAST and mortality. Patients with an FN FAST had increased hospital LOS after controlling for sex, age, and Injury Severity Score. CONCLUSIONS: Clinicians need to be cautious applying a single initial FAST to patients with minor abdominal trauma or with suspected injuries to organs other than the spleen or bladder. Formalized studies to develop risk stratification tools could allow clinicians to integrate FAST into the pediatric patient population in the safest manner possible.

Teaching Point-of-Care Lung Ultrasound to Novice Pediatric Learners: Web-Based E-Learning Versus Traditional Classroom Didactic.

OBJECTIVE: To assess whether Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of pediatric novice learners in the image acquisition and interpretation of pneumothorax and pleural effusion using point-of-care ultrasound (POCUS). METHODS: We conducted a randomized controlled noninferiority study comparing the effectiveness of Web-based teaching to traditional classroom didactic. The participants were randomized to either group A (live classroom lecture) or group B (Web-based lecture) and completed a survey and knowledge test. They also received hands-on training and completed an objective structured clinical examination. The participants were invited to return 2 months later to test for retention of knowledge and skills. RESULTS: There were no significant differences in the mean written test scores between the classroom group and Web group for the precourse test (absolute difference, -2.5; 95% confidence interval [CI], -12 to 6.9), postcourse test (absolute difference, 2.0; 95% CI, -1.4, 5.3), and postcourse 2-month retention test (absolute difference, -0.8; 95% CI, -9.6 to 8.1). Similarly, no significant differences were noted in the mean objective structured clinical examination scores for both intervention groups in postcourse (absolute difference, 1.9; 95% CI, -4.7 to 8.5) and 2-month retention (absolute difference, -0.6; 95% CI, -10.7 to 9.5). CONCLUSIONS: Web-based teaching is at least as effective as traditional classroom didactic in improving the proficiency of novice learners in POCUS. The usage of Web-based tutorials allows a more efficient use of time and a wider dissemination of knowledge.

Emergency Ultrasound Literature and Adherence to Standards for Reporting of Diagnostic Accuracy Criteria.

BACKGROUND: Given the wide usage of emergency point-of-care ultrasound (EUS) among emergency physicians (EPs), rigorous study surrounding its accuracy is essential. The Standards for Reporting of Diagnostic Accuracy (STARD) criteria were established to ensure robust reporting methodology for diagnostic studies. Adherence to the STARD criteria among EUS diagnostic studies has yet to be reported. OBJECTIVES: Our objective was to evaluate a body of EUS literature shortly after STARD publication for its baseline adherence to the STARD criteria. METHODS: EUS studies in 5 emergency medicine journals from 2005-2010 were evaluated for their adherence to the STARD criteria. Manuscripts were selected for inclusion if they reported original research and described the use of 1 of 10 diagnostic ultrasound modalities designated as "core emergency ultrasound applications" in the 2008 American College of Emergency Physicians Ultrasound Guidelines. Literature search identified 307 studies; of these, 45 met inclusion criteria for review. RESULTS: The median STARD score was 15 (interquartile range [IQR] 12-17), representing 60% of the 25 total STARD criteria. The median STARD score among articles that reported diagnostic accuracy was significantly higher than those that did not report accuracy (17 [IQR 15-19] vs. 11 [IQR 9-13], respectively; p < 0.0001). Seventy-one percent of articles met ≥50% of the STARD criteria (56-84%) and 4% met >80% of the STARD criteria. CONCLUSIONS: Significant opportunities exist to improve methodological reporting of EUS research. Increased adherence to the STARD criteria among diagnostic EUS studies will improve reporting and improve our ability to compare outcomes.

The Effect of Age on Outcome in Excision of Chronic Osteomyelitis with Free Muscle Flap Reconstruction.

Introduction: Curative surgical treatment of chronic osteomyelitis often requires free tissue transfer if there is significant soft tissue compromise. We investigated whether age influenced outcomes of curative osteomyelitis excision in those patients requiring free muscle flap soft tissue reconstruction. Methods: We assessed ninety-five consecutive patients treated with excision of chronic osteomyelitis, skeletal stabilisation/reconstruction and free muscle transfer between 2006 and 2012. We compared outcomes of those aged ≥60 years (n=23) with those <60 years old (n=72). Results: Groups were similar with regard to Cierny and Mader anatomic type and physiological host classification. Length of procedure and length of hospital stay were similar for both groups. There was a greater proportion of ASA grade III patients in the older cohort. Infection recurrence occurred in one of the older cohort (4.3%) and in seven patients in the younger cohort (9.9%) at a mean follow-up of 42 months (range 11-131 months), this was not statistically significant (p=0.27874). There were five free flap losses (6.9%) in the younger group and none in the older group. A greater proportion of patients from the younger cohort required further unplanned surgery (28%) compared to the older group (4.3%), which was statistically significant (p=0.01174). Seven patients (7.4%) had serious medical complications - five of whom were in the younger cohort, including one mortality. Conclusions: Both the young and old can enjoy satisfactory outcomes from surgical resection of chronic osteomyelitis with simultaneous orthoplastic reconstruction including free tissue transfer. Age alone should not be a barrier to potentially curative surgical treatment.

Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement.

INTRODUCTION: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. METHODS: We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasound-guided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. RESULTS: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. DISCUSSION: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

Effect of Emergency Physician-Performed Point-of-Care Ultrasound and Radiology Department-Performed Ultrasound Examinations on the Emergency Department Length of Stay Among Pregnant Women at Less Than 20 Weeks' Gestation.

OBJECTIVES: We sought to confirm retrospective studies that measured an approximately 20% reduction in emergency department (ED) length of stay (LOS) in early-gestation pregnant women who receive emergency physician-performed point-of-care ultrasound (US) examinations rather than radiology department-performed US examinations for evaluation of intrauterine pregnancy (IUP). METHODS: A randomized controlled clinical trial was performed at an urban academic safety net hospital and 2 Naval medical centers in the United States. The allocation was concealed before enrollment. Clinically stable adult pregnant women at less than 20 weeks' gestation who presented to the ED with abdominal pain or vaginal bleeding were randomized to receive a point-of-care or radiology US to assess for IUP. The primary outcome measure was the ED LOS. RESULTS: A total of 224 patients (point-of-care US, n = 118; radiology US, n = 106) were included for the analysis. The ED LOS was 20 minutes shorter in the point-of-care US arm (95% confidence interval [CI], -54 to 7 minutes). Adjusting for variability due to the location, the ED LOS was calculated to be 31 minutes shorter (95% CI, -64 to 1 minute) than for patients in the radiology US arm. Excluding patients in the point-of-care US arm who crossed over to radiology US after an inconclusive point-of-care US examination, the ED LOS was 75 minutes shorter than in the radiology US arm (95% CI, -97 to -53 minutes). CONCLUSIONS: Early-gestation pregnant ED patients requiring pelvic US were discharged earlier when point-of-care US was used rather than radiology US; however, this trial did not achieve our target of 30 minutes. Nevertheless, our data support the routine use of ED point-of-care US for IUP, saving the most time if a conclusive IUP is identified.

Establishing an Ultrasound Curriculum in Undergraduate Medical Education: How Much Time Does It Take?

OBJECTIVES: Over the years, the use of ultrasound in the medical profession has become a common occurrence. As a result, many medical schools are considering an ultrasound curriculum for first- and second-year medical students. The question posed by many of these programs is how much time and effort are required to establish such a curriculum. We at the University of Colorado School of Medicine sought to quantify the resources and time required. METHODS: We conducted a cohort study that analyzed the time spent teaching, as well as the types of instructors (eg, faculty, resident, and peer student) that contributed to our ultrasound curriculum. The study population consisted of instructors who participated in the curriculum during the 2014-2015 academic year. We analyzed the amount of time that facilitators spent teaching and tabulated these data using their specialty. RESULTS: Our data revealed that within an academic year, a combined total of 484 hours were spent teaching ultrasound to first- and second-year medical students combined. A total of 6 days were required to teach ultrasound to first-year medical students, and a total of 5 days were required for second-year medical students. It required 1 instructor for every 8 students, and most the faculty who volunteered time were from the field of emergency medicine, followed by family medicine and radiology. CONCLUSIONS: We describe the number of hours and instructors required to implement an ultrasound curriculum for undergraduate medical education.

Improved medical student perception of ultrasound using a paired anatomy teaching assistant and clinician teaching model.

This study describes a new teaching model for ultrasound (US) training, and evaluates its effect on medical student attitudes toward US. First year medical students participated in hands-on US during human gross anatomy (2014 N = 183; 2015 N = 182). The sessions were facilitated by clinicians alone in 2014, and by anatomy teaching assistant (TA)-clinician pairs in 2015. Both cohorts completed course evaluations which included five US-related items on a four-point scale; cohort responses were compared using Mann-Whitney U tests with significance threshold set at 0.05. The 2015 survey also evaluated the TAs (three items, five-point scale). With the adoption of the TA-clinician teaching model, student ratings increased significantly for four out of five US-items: "US advanced my ability to learn anatomy" increased from 2.91 ± 0.77 to 3.35 ± 0.68 (P < 0.0001), "Incorporating US increased my interest in anatomy" from 3.05 ± 0.84 to 3.50 ± 0.71 (P < 0.0001), "US is relevant to my current educational needs" from 3.36 ± 0.63 to 3.54 ± 0.53 (P = 0.015), and "US training should start in Phase I" from 3.36 ± 0.71 to 3.56 ± 0.59 (P = 0.010). Moreover, more than 84% of students reported that TAs enhanced their understanding of anatomy (mean 4.18 ± 0.86), were a valuable part of US training (mean 4.23 ± 0.89), and deemed the TAs proficient in US (mean 4.24 ± 0.86). By using an anatomy TA-clinician teaching team, this study demonstrated significant improvements in student perceptions of the impact of US on anatomy education and the relevancy of US training to the early stages of medical education. Anat Sci Educ 11: 175-184. © 2017 American Association of Anatomists.