A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound.

OBJECTIVES: To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners. SETTING: The University of Iowa Hospitals and Clinics. SUBJECTS: Twenty-four subjects (23 first-year medical students and one first-year physician assistant student). DESIGN: The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills. INTERVENTIONS: Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session. MEASUREMENTS AND MAIN RESULTS: For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008). CONCLUSIONS: Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.

Looking for light in the din: An examination of the circadian-disrupting properties of a medical intensive care unit.

OBJECTIVE: Critically ill patients exhibit profound disturbances of circadian rhythmicity, most commonly in the form of a phase delay. We investigated the specific zeitgeber properties of a medical intensive care unit to develop a model that explained these abnormalities. RESEARCH METHODOLOGY: Prospective, observational study conducted during 2013-2014. Twenty-four-hour ambient light (lux, 672 hours) and sound pressure levels (dBA, 504 hours) were measured in patient rooms. Patients and families were surveyed regarding their perceptions of the environment. SETTING: University-based adult medical intensive care unit. MAIN OUTCOME MEASURES: The timing and intensity of the ambient light-dark cycle and sound environment and the relationship of these measurements to patient/family perceptions. RESULTS: Twenty-four-hour light-dark cycles were extremely weak and phase delayed relative to the solar cycle. Morning light averaged 12.1 (4.8, 37.2) lux, when only 24.9% ±â€¯10.9% of available light was utilised; yet patients and families did not identify low daytime light levels as problematic. Median noise levels were invariably excessive (nighttime 47.9 [45.0, 51.3] dBA) with minimal variation, consistent with the absence of a defined rest period. CONCLUSION: The intensive care unit functions as a near-constant routine protocol disconnected from solar time. Behavioural interventions to promote entrainment should be supported by objective measurements of light and sound.