VCOM Carolinas Research Day 2023

Simulation and Technology

Accuracy and Student Perceived Confidence of Varying Knee Aspirations Methods Danielle C. Barron, OMS II*, Anna C. Deal, OMS II*, Tom Lindsey, DO, FACOS Edward Via College of Osteopathic Medicine, Center for Simulation and Technology, Spartanburg, SC. * Equal contribution . Statistician - David Redden, PhD. Introduction Results Conclusions

Abstract # SIM-5

References A statistically significant improvement in accuracy was shown in participants using the ultrasound guided technique for knee arthrocentesis. There was also a statistically significant increase in self-reported confidence between the experimental and control groups. Currently, there is no consensus or standardization of teaching or training of ultrasound among different institutions and countries for educational purposes or for assessment of practioners’ skills and accreditation. 5 However, the increased use of point-of-care ultrasound imaging in the clinical setting suggests that medical students and medical curriculum should be dynamic and continue to advance forward with technology. Ultrasound has emerged to be a vital point of care testing tool so much that multiple meta-analyses call for more ultrasound in medical education. 5 Our study demonstrated significant improvement in the accuracy of performing ultrasound guided knee arthrocentesis among first year medical students with those students reporting a statistically significant increase in confidence when performing the knee aspiration. The results of the study suggest that including ultrasound guided knee arthrocentesis to the current curriculum would be beneficial to OMS-1 students at VCOM-Carolinas. 1. Lafleur A, Demchuck G, Tremblay M-L, Simard C, Rivière É. Value of money in self-regulated procedural simulation. Clin Teach 2019; 16:615-22. 2. Jackson, Douglas W. MD; Evans, Nicholas A. MD; Thomas, Bradley M. MD. Accuracy of Needle Placement into the Intra-Articular Space of the Knee. The Journal of Bone & Joint Surgery 84(9):p 1522-1527, September 2002. 3. Berona K, Abdi A, Menchine M, et al. Success of ultrasound-guided versus landmark-guided arthrocentesis of hip, ankle, and wrist in a cadaver model. Am J Emerg Med . 2017;35(2):240-244. doi:10.1016/j.ajem.2016.10.056 4. Kondrashova, T., Coleman, C. Enhancing Learning Experience Using Ultrasound Simulation in Undergraduate Medical Education: Student Perception. Med.Sci.Educ. 27, 489 – 496 (2017). 5. Hani S, Chalouhi G, Lakissian Z, Sharara-Chami R. Introduction of Ultrasound Simulation in Medical Education: Exploratory Study. JMIR Med Educ . 2019;5(2):e13568. Published 2019 Sep 26. doi:10.2196/13568

Mastering the procedural skills of arthrocentesis is essential to ensuring effective treatment, but also prevents complications. Historically, knee arthrocentesis has been taught using the anatomical landmark method in medical education. In 2019, Lalfeur et al noted that 64 residents had a mean confidence level of performing arthrocentesis successfully a 4.8 out of 10, while Jackson et al found that nearly 1 out of every 4 needle placements were extra-articular using the anatomical landmark method. 1,2 However, it has been shown that the use of ultrasound improved success rates in aspiration by greater than 60% compared to anatomical landmark techniques. 3 Ultrasound can be a valuable tool in the education of medical students and residents and has shown deeper satisfaction and higher confidence in ability to replicate these skills in a clinical setting when incorporated into their curriculum. 4 When comparing landmark guided joint arthrocentesis with ultrasound guided joint arthrocentesis by medical residents in cadaver models, the residents felt far more confident in their abilities and their success of treatment with ultrasound guided arthrocentesis. In addition, residents were able to perform the skill in fewer attempts, less time, and slightly more accurately. 3 Goal: This project aims to assess whether providing first year medical students with ultrasound guided education increases the accuracy and confidence when performing a knee aspiration on simulation models compared to the landmark guided arthrocentesis .

Table 1 . Aspiration Accuracy. The table below shows the accuracy of the group who used ultrasound to perform knee aspiration and the group who used anatomical landmarks to perform a knee aspiration. There was a statistically significant increase in the accuracy of students who used ultrasound to perform the joint aspiration. The p-value was 0.0003.


76 OMS-1 students at VCOM-Carolinas were randomized into a control group or experimental group. The control group (non-ultrasound group) learned knee arthrocentesis via anatomical landmarks during a one-hour skills lab with VCOM faculty followed by hands-on practice with simulation models.

The experimental group (ultrasound group) was provided a PowerPoint and demonstration video explaining ultrasound guided knee arthrocentesis followed by practice with the ultrasound simulation models. This demonstrational video and PowerPoint were modeled after the faculty led presentation to ensure the same information was taught.

Table 2 . Confidence in Performing Joint Aspiration . After performing their joint aspiration, students were asked to rate their level of agreement with the following statement, “I feel confident in my ability to perform a joint aspiration using the technique from today on a patient.” There was a statistical significance in the confidence of the group who performed the knee aspiration with ultrasound guidance. The p-value is 0.0304. The group who used ultrasound to perform the joint aspiration had a total of 35 students, and the group who used anatomical landmarks had a total of 41 students. The disproportionate groups is due to students withdrawing from the study.


Upon completing the presentations and practice, students were asked to perform knee arthrocentesis using the technique they were taught. Each student was given a maximum of three attempts to successfully perform the procedure. Each student was graded on accuracy and immediately surveyed on their confidence in performing the procedure in a clinical setting via a five-point Likert scale. The data was analyzed with the Wilcox Rank Sum test.

The authors would like to acknowledge Stacey Stokes, LPN and Tarraz Woodruff, RN for their help with Sim Center, knee aspiration models, and use of Butterfly Ultrasound machines.


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