Can you teach a hands-on skill online? A scoping review of e-learning for point-of-care ultrasound in medical education

Maya Harel-Sterling

doi:10.36834/cmej.75272

Auteurs-es

Maya Harel-Sterling The Hospital for Sick Children

DOI :

https://doi.org/10.36834/cmej.75272

Résumé

Contexte : L'enseignement en ligne de l’échographie ciblée (ÉC) est l’objet d’un intérêt et de besoins croissants. L'objectif de cette étude était de passer systématiquement en revue la littérature sur l'apprentissage en ligne comme méthode d'enseignement de l’ÉC dans la formation médicale, d'évaluer les avantages et les limites des différents styles d'apprentissage en ligne pour l’ÉC et d'identifier les lacunes dans la littérature qui pourraient aider à orienter la recherche future dans ce domaine.

Méthodes : Une recherche a été effectuée dans trois bases de données, soit MEDLINE (Ovid), EMBASE et le Cochrane Central Register of Controlled Clinical Trials, le 12 octobre 2021, ce qui a permis d'extraire un total de 1 630 études. 31 études répondaient aux critères d'inclusion et d'exclusion. Ces études ont été classées selon différents styles d'apprentissage en ligne et les progrès des apprenants ont été analysés en ayant recours au modèle de la hiérarchie de Kirkpatrick.

Résultats : Les études ont été classées en trois styles d'apprentissage en ligne : a) apprentissage mixte b) uniquement en ligne (asynchrone ou synchrone) et c) utilisation d'appareils portatifs ou de la télésonographie. Les connaissances en matière d’ÉC et l'interprétation des images ont été enseignées avec succès en ligne, mais l'apprentissage uniquement en ligne pour l'acquisition des images n'a pas été aussi efficace. L'apprentissage mixte et la télésonographie ont été bénéfiques pour l'acquisition des compétences en matière d'acquisition d'images. En général, ce sont les novices qui ont le plus bénéficié de l'apprentissage en ligne.

Conclusion : L'apprentissage en ligne pour l’ÉC gagne en popularité ces dernières années. L’ÉC est une compétence technique complexe et, en fonction de la tâche précise enseignée, différents styles d'apprentissage en ligne peuvent s'avérer plus efficaces. Ces résultats peuvent éclairer les futurs programmes de formation en ÉC.

Références

Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med 2006;48:227-35 https://doi.org/10.1016/j.annemergmed.2006.01.008. DOI: https://doi.org/10.1016/j.annemergmed.2006.01.008

Stone BS, Muruganandan KM, Tonelli MM, Dugas JN, Verriet IE, Pare JR. Impact of point-of-care ultrasound on treatment time for ectopic pregnancy. Am J Emerg Med 2021;49:226-32 https://doi.org/10.1016/j.ajem.2021.05.071. DOI: https://doi.org/10.1016/j.ajem.2021.05.071

Harel-Sterling M, Diallo M, Santhirakumaran S, Maxim T, Tessaro M. Emergency department resource use in pediatric pneumonia: point-of-care lung ultrasonography versus chest radiography. J Ultrasound Med 2019;38:407-14 https://doi.org/10.1002/jum.14703. DOI: https://doi.org/10.1002/jum.14703

Claiborne MK, Ng C, Breslin KA, Chamberlain J, Thomas-Mohtat R. The effect of point-of-care ultrasound on length of stay in the emergency department in children with neck swelling. Am J Emerg Med 2021;48:295-300 https://doi.org/10.1016/j.ajem.2021.05.009. DOI: https://doi.org/10.1016/j.ajem.2021.05.009

Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest 2013;143:532-8 https://doi.org/10.1378/chest.12-0447. DOI: https://doi.org/10.1378/chest.12-0447

Wilson SP, Assaf S, Lahham S, et al. Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: a prospective study. World J Emerg Med 2017;8:25-8 https://doi.org/10.5847/wjem.j.1920-8642.2017.01.004. DOI: https://doi.org/10.5847/wjem.j.1920-8642.2017.01.004

Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008;134:117-25 https://doi.org/10.1378/chest.07-2800. DOI: https://doi.org/10.1378/chest.07-2800

Atkinson P, Bowra J, Milne J, et al. International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): an international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest. Cjem 2017;19:459-70 https://doi.org/10.1017/cem.2016.394. DOI: https://doi.org/10.1017/cem.2016.394

Narula J, Chandrashekhar Y, Braunwald E. Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation. JAMA Cardiol 2018;3:346-50 https://doi.org/10.1001/jamacardio.2018.0001. DOI: https://doi.org/10.1001/jamacardio.2018.0001

Lewis D, Rang L, Kim D, et al. Recommendations for the use of point-of-care ultrasound (POCUS) by emergency physicians in Canada. Cjem 2019;21:721-6 https://doi.org/10.1017/cem.2019.392. DOI: https://doi.org/10.1017/cem.2019.392

Marin JR, Abo AM, Arroyo AC, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016;8:16 https://doi.org/10.1186/s13089-016-0049-5. DOI: https://doi.org/10.1186/s13089-016-0049-5

Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound curricula in undergraduate medical education: a scoping review. J Ultrasound Med 2018;37:69-82 https://doi.org/10.1002/jum.14333. DOI: https://doi.org/10.1002/jum.14333

Moses A, Weng W, Orchanian-Cheff A, Cavalcanti RB. Teaching point-of-care ultrasound in medicine: a scoping review. Can J Gen Intern Med, 2020;15(2), 13–29. https://doi.org/10.22374/cjgim.v15i2.368 DOI: https://doi.org/10.22374/cjgim.v15i2.368

Naciri A, Radid M, Kharbach A, Chemsi G. E-learning in health professions education during the COVID-19 pandemic: a systematic review. J Educ Eval Health Prof 2021;18:27 https://doi.org/10.3352/jeehp.2021.18.27. DOI: https://doi.org/10.3352/jeehp.2021.18.27

Zavitz J, Sarwal A, Schoeneck J, et al. Virtual multi-specialty point-of-care ultrasound rotation for 4th year medical students during COVID-19: innovative teaching techniques improve ultrasound knowledge and image interpretation. AEM educ train. 2021:e10632 https://dx.doi.org/10.1002/aet2.10632. DOI: https://doi.org/10.1002/aet2.10632

Ienghong K, Bhudhisawasdi V, Apiratwarakul K, Suzuki T, Tiamkao S, Gaysonsiri D. Point of care ultrasound training during the coronavirus disease 2019 pandemic. Open Access Macedonian J Med Sci 2021;9:443-6 http://dx.doi.org/10.3889/oamjms.2021.6197. DOI: https://doi.org/10.3889/oamjms.2021.6197

Nix K, Liu EL, Oh L, et al. A distance-learning approach to point-of-care ultrasound training (ADAPT): a multi-institutional educational response during the COVID-19 pandemic. Acad Med. 2021;96:1711-6 https://dx.doi.org/10.1097/ACM.0000000000004399. DOI: https://doi.org/10.1097/ACM.0000000000004399

Becker DM, Tafoya CA, Becker SL, Kruger GH, Tafoya MJ, Becker TK. The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature. Trop Med Int Health 2016;21:294-311 https://doi.org/10.1111/tmi.12657. DOI: https://doi.org/10.1111/tmi.12657

Sangra A, Vlachopoulos D, Cabrera N. Building an inclusive definition of e-learning: an approach to the conceptual framework. Int Rev Res Open Distrib Learn 2012;13:145-159. https://doi.org/10.19173/irrodl.v13i2.1161 DOI: https://doi.org/10.19173/irrodl.v13i2.1161

Galway LP, Corbett KK, Takaro TK, Tairyan K, Frank E. A novel integration of online and flipped classroom instructional models in public health higher education. BMC Med Educ 2014;14:181 https://doi.org/10.1186/1472-6920-14-181. DOI: https://doi.org/10.1186/1472-6920-14-181

Meinert E, Eerens J, Banks C, et al. Exploring the cost of elearning in health professions education: scoping review. JMIR Med Educ 2021;7:e13681 https://doi.org/10.2196/13681. DOI: https://doi.org/10.2196/13681

Wilkinson JN, Saxhaug LM. Handheld ultrasound in training - the future is getting smaller! J Intensive Care Soc 2021;22:220-9 https://doi.org/10.1177/1751143720914216. DOI: https://doi.org/10.1177/1751143720914216

Marsh-Feiley G, Eadie L, Wilson P. Telesonography in emergency medicine: a systematic review. PLoS One 2018;13:e0194840 https://doi.org/10.1371/journal.pone.0194840. DOI: https://doi.org/10.1371/journal.pone.0194840

Mulvagh SL, Bhagra A, Nelson BP, Narula J. Handheld ultrasound devices and the training conundrum: how to get to "seeing is believing". J Amer Soc Echocardio. 2014;27:310-3 https://dx.doi.org/10.1016/j.echo.2014.01.011. DOI: https://doi.org/10.1016/j.echo.2014.01.011

Kirkpatrick D, Kirkpatrick J. Evaluating training programs: the four levels. Oakland: Berrett-Koehler Publishers, Incorporated; 2006.

Chenkin J, Lee S, Huynh T, Bandiera G. Procedures can be learned on the web: a randomized study of ultrasound-guided vascular access training. Acad emerg med 2008;15:949-54 https://dx.doi.org/10.1111/j.1553-2712.2008.00231.x. DOI: https://doi.org/10.1111/j.1553-2712.2008.00231.x

Heiberg J, Hansen LS, Wemmelund K, et al. Point-of-Care clinical ultrasound for medical students. Ultrasound intern open 2015;1:E58-66 https://dx.doi.org/10.1055/s-0035-1565173. DOI: https://doi.org/10.1055/s-0035-1565173

Drake AE, Hy J, MacDougall GA, et al. Innovations with tele-ultrasound in education sonography: the use of tele-ultrasound to train novice scanners. ultrasound j 2021;13:6 https://dx.doi.org/10.1186/s13089-021-00210-0. DOI: https://doi.org/10.1186/s13089-021-00210-0

Kwan C, Pusic M, Pecaric M, Weerdenburg K, Tessaro M, Boutis K. The variable journey in learning to interpret pediatric point-of-care ultrasound images: a multicenter prospective cohort study. AEM Educ Train 2020;4:111-22 https://doi.org/10.1002/aet2.10375. DOI: https://doi.org/10.1002/aet2.10375

Florescu CC, Mullen JA, Nguyen VM, Sanders BE, Vu PQ-P. Evaluating didactic methods for training medical students in the use of bedside ultrasound for clinical practice at a faculty of medicine in Romania. J ultrasound med.2015;34:1873-82 https://dx.doi.org/10.7863/ultra.14.09028. DOI: https://doi.org/10.7863/ultra.14.09028

Soon AW, Toney AG, Stidham T, Kendall J, Roosevelt G. Teaching point-of-care lung ultrasound to novice pediatric learners: web-based e-learning versus traditional classroom didactic. Ped emerg care 2020;36:317-21 https://dx.doi.org/10.1097/PEC.0000000000001482. DOI: https://doi.org/10.1097/PEC.0000000000001482

Hempel D, Haunhorst S, Sinnathurai S, et al. Social media to supplement point-of-care ultrasound courses: the "sandwich e-learning" approach. A randomized trial. Crit ultrasound j 2016;8:3 https://dx.doi.org/10.1186/s13089-016-0037-9. DOI: https://doi.org/10.1186/s13089-016-0037-9

Cawthorn TR, Nickel C, O'Reilly M, et al. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J. Am. Soc. Echocardiogr. 2014;27:302-9 https://dx.doi.org/10.1016/j.echo.2013.12.006. DOI: https://doi.org/10.1016/j.echo.2013.12.006

Haskins SC, Feldman D, Fields KG, et al. Teaching a point-of-care ultrasound curriculum to anesthesiology trainees with traditional didactic lectures or an online e-learning platform: a pilot study. JEPM 2018;20:E624. https://doi.org/10.46374/volxx-issue3-haskins DOI: https://doi.org/10.46374/volxx-issue3-haskins

Kang TL, Berona K, Elkhunovich MA, et al. Web-based teaching in point-of-care ultrasound: an alternative to the classroom? Adv medical educ pract 2015;6:171-5 https://dx.doi.org/10.2147/AMEP.S72159. DOI: https://doi.org/10.2147/AMEP.S72159

Tainter CR, Wong NL, Cudemus-Deseda GA, Bittner EA. The "flipped classroom" model for teaching in the intensive care unit. J intensive care med. 2017;32:187-96 https://dx.doi.org/10.1177/0885066616632156. DOI: https://doi.org/10.1177/0885066616632156

Chenkin J, McCartney CJL, Jelic T, Romano M, Heslop C, Bandiera G. Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians. Crit ultrasound j. 2015;7:14 https://dx.doi.org/10.1186/s13089-015-0031-7. DOI: https://doi.org/10.1186/s13089-015-0031-7

Krishnan S, Kuhl T, Ahmed W, Togashi K, Ueda K. Efficacy of an online education program for ultrasound diagnosis of pneumothorax. Anesthesiology 2013;118:715-21 https://dx.doi.org/10.1097/ALN.0b013e31827f0979. DOI: https://doi.org/10.1097/ALN.0b013e31827f0979

Ray JJ, Meizoso JP, Hart V, et al. Effectiveness of a perioperative transthoracic ultrasound training program for students and residents. J surgical educ. 2017;74:805-10 https://dx.doi.org/10.1016/j.jsurg.2017.02.005. DOI: https://doi.org/10.1016/j.jsurg.2017.02.005

Situ-LaCasse E, Acuna J, Huynh D, et al. Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules? BMC med educ. 2021;21:175 https://dx.doi.org/10.1186/s12909-021-02612-z. DOI: https://doi.org/10.1186/s12909-021-02612-z

Platz E, Liteplo A, Hurwitz S, Hwang J. Are live instructors replaceable? Computer vs. classroom lectures for EFAST training. J Emerg Med. 2011;40:534-8 https://dx.doi.org/10.1016/j.jemermed.2009.08.030. DOI: https://doi.org/10.1016/j.jemermed.2009.08.030

Soni NJ, Boyd JS, Mints G, et al. Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic. j ultrasound. 2021;13:39 https://dx.doi.org/10.1186/s13089-021-00242-6. DOI: https://doi.org/10.1186/s13089-021-00242-6

Gargani L, Sicari R, Raciti M, et al. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project. Nephrol Dial Transplant 2016;31:1982-8 https://doi.org/10.1093/ndt/gfw329. DOI: https://doi.org/10.1093/ndt/gfw329

Butler LT, Berry DC. Understanding the relationship between repetition priming and mere exposure. Br J Psychol 2004;95:467-87 https://doi.org/10.1348/0007126042369776. DOI: https://doi.org/10.1348/0007126042369776

van Merrienboer JJG, Kirschner PA, Kester L. Taking the load off a learner's mind: instructional design for complex learning. Educ Psychol. 2003;38:5-13 https://doi.org/10.1207/s15326985ep3801_2. DOI: https://doi.org/10.1207/S15326985EP3801_2

Hempel D, Sinnathurai S, Haunhorst S, et al. Influence of case-based e-learning on students' performance in point-of-care ultrasound courses: a randomized trial. Eur J Emerg Med. 2016;23(4):298-304. https://doi.org/10.1097/MEJ.0000000000000270 DOI: https://doi.org/10.1097/MEJ.0000000000000270

Lin-Martore M, Olvera MP, Kornblith AE, et al. Evaluating a web-based point-of-care ultrasound curriculum for the diagnosis of intussusception. AEM Educ Train. 2021;5(3):e10526. https://doi.org/10.1002/aet2.10526 DOI: https://doi.org/10.1002/aet2.10526

Platz E, Goldflam K, Mennicke M, Parisini E, Christ M, Hohenstein C. Comparison of web-versus classroom-based basic ultrasonographic and EFAST training in 2 European hospitals. Ann Emerg Med. 2010;56(6):660-7. https://doi.org/10.1016/j.annemergmed.2010.04.019 DOI: https://doi.org/10.1016/j.annemergmed.2010.04.019

Riera A, Leviter JI, Iqbal A, Soma G, Malik RN, Chen L. Agreement with pediatric suprapatellar bursa effusion assessments by point-of-care ultrasound after remote training. Ped emerg care. 2021. https://doi.org/10.1097/PEC.0000000000002341 DOI: https://doi.org/10.1097/PEC.0000000000002341

Brown KA, Riley AF, Alade KH, et al. A novel tool for teaching cardiac point-of-care ultrasound: an exploratory application of the design-based research approach. Pediatr Crit Care Med. 2020;21(12):e1113-e8. https://doi.org/10.1097/PCC.0000000000002441 DOI: https://doi.org/10.1097/PCC.0000000000002441

Cuca C, Barth M, Scheiermann P, et al. Assessment of a new e-learning system on thorax, trachea, and lung ultrasound. Emerg Med Int. 2013;2013:145361. https://doi.org/10.1155/2013/145361 DOI: https://doi.org/10.1155/2013/145361

Moro F, Mascilini F, Buonsenso D, et al. Validation of the performance of "fast lung ultrasound teaching program" for gynecologists/obstetricians dealing with pregnant women with suspicion of covid-19 infection: an italian prospective multicenter study. Ital J Gynaecol Obstet.2021;33(1):52-6. https://doi.org/10.36129/jog.33.01.06 DOI: https://doi.org/10.36129/jog.33.01.06

Socransky S, Lang E, Bryce R, Betz M. Point-of-care ultrasound for jugular venous pressure assessment: live and online learning compared. Cureus. 2017;9(6):e1324. https://doi.org/10.7759/cureus.1324 DOI: https://doi.org/10.7759/cureus.1324

Edrich T, Stopfkuchen-Evans M, Song P, et al. A comparison of web-based with traditional classroom-based training of lung ultrasound for the exclusion of pneumothorax. Anesth Analg. 2016;123(1):123-8. https://doi.org/10.1213/ANE.0000000000001383 DOI: https://doi.org/10.1213/ANE.0000000000001383

Fuchs L, Gilad D, Mizrakli Y, Sadeh Re, Galante O, Kobal S. Self-learning of point-of-care cardiac ultrasound - Can medical students teach themselves? PloS one. 2018;13(9):e0204087. https://doi.org/10.1371/journal.pone.0204087 DOI: https://doi.org/10.1371/journal.pone.0204087