Via Research Recognition Day 2024 VCOM-Carolinas

Educational Reports

An Investigation of Clinical Procedural Skills Educational Strategies for OMS-II Medical Students: A Comparison of In-Person vs. Asynchronous Education and Ultrasound-Guided Central Line Placement Success Andrew W. Hospodor OMS-IV, NRP, Creighton Kellogg OMS-IV, MS, Mackenzie Hale OMS-IV, Nicholas Damiano OMS IV, MA, Lynn Campbell, DO, ACOEP, ACEP Edward Via College of Osteopathic Medicine - Carolinas Campus, Spartanburg, SC. Introduction Results Discussion

The COVID-19 pandemic has changed the landscape of medical education throughout the United States. The paradigm shift from in-person learning and hands-on experiences to online learning and limited in-person opportunities has forever changed the way medical school is conducted. The aim of this study is to explore optimal efficiency of ultrasound based central line education. Ultrasound-guided (US) central venous catheterization was chosen to measure the effectiveness of module-based education due to its complexity, student interest, and duality of skills. The goal of the questionnaires used in this project was to determine not only the student preference of online modules versus in-person teaching, but to also determine if online learning is effective enough to replace in-person learning. Point of care ultrasound (POCUS) is becoming more common in procedures globally within healthcare and medical education alike. Training and broadening the knowledge base is the goal of medical education not only for students domestically, but indeed it is the responsibility of resource rich nations to share globally. Studies conducted at Cooper University Health Care in New Jersey have also examined the effectiveness of ultrasound training with medical residents and have found that in-person training is statistically preferred in terms of retained knowledge. As medical education grows and shifts towards increased use of virtual training, some programs have looked into teaching ultrasound techniques virtually in replacement of in-person learning, which may continue to be necessary due to pandemic related changes in medical education. Fifty-seven participants were selected from a convenience sample of second-year medical student volunteers who were interested in studying POCUS and central venous access (CVC). Participants were grouped based on their scheduling preference without knowledge of which group they would be participating. Prior to each event, students completed a Likert scale survey indicating their confidence in performing US-guided CVC of the internal jugular vein (IJV) as well as their confidence in six domains. A Likert scale survey was developed in order to obtain numerical data to quantify the confidence levels of each student and to be able to compare the averages before and after the assessment. After receiving hands-on training with the manikins, each participant performed the procedure with the number of attempts being recorded along with time to successful aspiration being noted by individual raters. Aspiration from the catheter signified a successful attempt while removal and re-entry of the needle from the manikin signified the start of another attempt. Lecture Based Group An hour-long lecture was given, and then followed by an hour of skills practice culminating in a brief check off. The lecture portion began with the sonographer presenting a basic introduction to ultrasound utilization and then the physician presented specifically on IJV CVC with POCUS. Students were then free to practice in groups of four to six individuals per ultrasound station. Module Based Group Utilizing recordings of the first group’s lectures, an online module was built. This module was submitted to participants of the module-based group one week prior to the hands-on skills event. The students were able to review the information and were required to take a 10-question exam with a passing score of 80% prior to attending the hands-on skill session. Students then had the opportunity to practice the hands-on portion of the training with the physician present for one hour before being asked to preform the task. Methods

There was a small, statistically significant difference in the time of successful completion for ultrasound-guided central line placement between our two subject groups. The number of attempts between the two groups did not differ, but the overall time to successful completion, which was marked by successful aspiration of the central line in place, was faster in the module group. There was no difference between students who had previous central line practice versus those who did not, but data did indicate that students who had experience with ultrasound had a faster procedure time. This study compared two similarly matched groups of second-year medical students. The primary endpoints were number of seconds needed to successfully start a central line on a manikin under ultrasound guidance, number of attempts to success, and participant rated confidence in performing ultrasound-guided central venous catheterization of the IJV. Secondary endpoints were participant confidence ratings across six domains: performing ultrasound in the setting of the major vasculature of the neck, interpreting ultrasound images in the setting of major vasculature of the neck, placement of a central venous catheter in the internal jugular vein, ability to explain indications and contraindications, ability to explain the potential complications of central venous catheterization of the IJV, and knowledge of the internal jugular vein and surrounding anatomy. A statistically significant difference in time required to complete the procedure in the module group compared to the lecture group represents and validates a potential superiority of module-based training over lecture-based training. Despite lacking power, this study was able to detect this significant difference. Conclusions Module-based education showed a statistically significant effect on decreased time of procedure compared to traditional lecture-based education. Students in both groups had statistically significant improvement in all confidence domains regardless of education style. Prior ultrasound training was associated with faster procedure time as well as fewer attempts in training. However, this study lacked power to detect other differences between module and lecture-based education methods. Module based education is similar to and potentially better than, lecture-based training in performing ultrasound guided central venous catheterization of the internal jugular vein on a mannikin amongst second-year medical students. The study validates the utility of module-based education supplemented by hands-on learning, and provides a starting point for future, more powerful studies to explore narrower differences between the approaches.

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>ĞĐƚƵƌĞ

DŽĚƵůĞ

ƉͲǀĂůƵĞ͕ ƉŽǁĞƌсϬ͘ ϯϴ

dŝŵĞ ;^ĞĐŽŶĚƐͿ Ŷ DĞĂŶ͕ ^

WƌŽď хͮ ƚͮ͗ Ϭ͘ ϬϭϰϱΎ WƌŽď хƚ͗ Ϭ͘ ϵϵϮϴ WƌŽď фƚ͗ Ϭ͘ ϬϬϳϮΎ WƌŽďĂďŝůŝƚLJ ŽĨ ƚŝŵĞ ŝŶ ƐĞĐŽŶĚƐ ŝƐ ŚŝŐŚĞƌ ĨŽƌ >ĞĐƚƵƌĞ͘

ŶсϮϳ͕ Ϯϵϭ͘ ϱϵ͕ ϭϯϯ͘ Ϭϲ Ŷсϭϵ͕ Ϯ ϵϭ͘ Ϯϲ͕ ϭϯϴ͘ ϯϱ Ŷсϴ͕ ϮϵϮ͘ ϯϴ͕ ϭϮϴ͘ ϲϭ

ŶсϯϬ͕ ϮϭϬ͘ ϴϯ͕ ϭϬϯ͘ ϴϱ ŶсϮϭ Ϯϭϴ͘ ϰϯ͕ ϭϮϯ͘ Ϯϴ

&ŝƌƐƚ /ƚĞƌĂƚŝŽŶ Ŷ DĞĂŶ͕ ^

Ϭ͘ ϬϭϵϭΎ tŝůĐŽdžŽŶͬ <ƌƵƐŬĂůů tĂůůŝƐ dĞƐƚ

^ĞĐŽŶĚ /ƚĞƌĂƚŝŽŶ Ŷ͕ DĞĂŶ͕ ^

Ŷсϵ ϭϵϯ͘ϭϭ͕ ϳϮ ŶсϯϬ ϭ͘ϯ͕ Ϭ͘ϴϰ ŶсϮϭ ϭ͘ϰϯ͕ Ϭ͘ϵϴ

Ϭ͘ ϬϬϱϯΎ tŝůĐŽdžŽŶͬ <ƌƵƐŬĂůů tĂůůŝƐ dĞƐƚ

ƚƚĞŵƉƚƐ Ŷ DĞĂŶ ;ϵϱй >Ϳ͕ ZĂŶŐĞ͕ ^ &ŝƌƐƚ /ƚĞƌĂƚŝŽŶ Ŷ DĞĂŶ ;ϵϱй >Ϳ͕ ZĂŶŐĞ͕ ^ ^ĞĐŽŶĚ /ƚĞƌĂƚŝŽŶ Ŷ DĞĂŶ ;ϵϱй >Ϳ͕ ZĂŶŐĞ͕ ^

ŶсϮϳ ϭ͘ϯϯ͕ Ϭ͘ϲϴ Ŷсϭϵ ϭ͘ϰϮ͕ Ϭ͘ϳϳ Ŷсϴ ϭ͘ϭϮϱ͕ Ϭ͘ϯϱ

WƌŽď хͮ ƚͮ͗ Ϭ͘ ϴϲϴϵ WƌŽď хƚ͗ Ϭ͘ ϱϲϱϱ WƌŽď фƚ͗ Ϭ͘ ϰϯϰϱ

Ϭ͘ ϴϯϬϰ tŝůĐŽdžŽŶͬ <ƌƵƐŬĂůů tĂůůŝƐ dĞƐƚ

Ŷсϵ ϭ͕ Ϭ

Ϭ͘ Ϯϴϴϴ tŝůĐŽdžŽŶͬ <ƌƵƐŬĂůů tĂůůŝƐ dĞƐƚ

Table 1. Lecture vs. Modules: Number of Attempts and Time it took in seconds.

20

Max 736.0 Q3 330.0 Med 255.0 Q1 205.0 Min 128.0

Mean=291.59 Std Dev=133.06 95% Con fi d Interval for Mean = [238.96,344.23]

N: 27 Std Dev: 133.059

15

Lecture Module

Lecture Module

10

5

Count 0 20

Max 574.0 Q3 220.3 Med 184.5 Q1 154.5 Min 97.0

Mean=210.83 Std Dev=103.85 95% Con fi d Interval for Mean = [172.06,249.61]

N: 30 Std Dev: 103.849

15

10

5

0

0

100

200

300

400

500

600

700

800

0

100

200

300

400

500

600

700

Time (Seconds)

TimeSeconds

Figure 2 and Figure 2a. Procedure Time (Seconds): Lecture vs. Module

WƌĞ ǀƐ WŽƐƚ ƉͲǀĂůƵĞ tŝůĐŽdžŽŶ ^ŝŐŶĞĚ ZĂŶŬ dĞƐƚ

∆ >ĞĐƚƵƌĞ ǀƐ ∆ DŽĚƵůĞ ƉͲǀĂůƵĞ

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WŽǁĞƌсϬ͘ ϰϯ

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Ϭ͘ ϬϰϳϯΎ dŚĞ ŵŽĚƵůĞ ŐƌŽƵƉ ŝŶĐƌĞĂƐĞĚ ďLJ ƐŝŐŶŝĨŝĐĂŶƚůLJ ŵŽƌĞ ƚŚĂŶ ƚŚĞ ůĞĐƚƵƌĞ ŐƌŽƵƉ ŽǀĞƌĂůů͘

WĞƌĨŽƌŵŝŶŐ h^ ŽĨ ƚŚĞ DĂũŽƌ ǀĂƐĐƵůĂƚƵƌĞ ŽĨ ƚŚĞ ŶĞĐŬ

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DŽĚƵůĞ

References

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/ŶƚĞƌƉƌĞƚŝŶŐ h^ ŽĨ ŵĂũŽƌ ǀĂƐĐƵůĂƚƵƌĞ ŽĨ ƚŚĞ ŶĞĐŬ

Ϭ͘ ϭϯϱϭ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ

DŽĚƵůĞ

1. Eke, O. F., Henwood, P. C., Wanjiku, G. W., Fasina, A., Kharasch, S. J., & Shokoohi, H. (2021). Global point-of-care ultrasound education and training in the age of COVID-19. International Journal of Emergency Medicine , 14 (1), 1 – 4. https://doi.org/10.1186/s12245-021-00338-9 2. Hoffmann, B., Blaivas, M., Abramowicz, J., Bachmann, M., Badea, R., Braden, B., Cantisani, V., Chammas, M., Cui, X., Dong, Y., Gilja, O., Hari, R., Lamprecht, H., Nisenbaum, H., Nolsøe, C., Nürnberg, D., Prosch, H., Radzina, M., Recker, F., Sachs, A., Saftoiu, A., Serra, A., Vinayak, S., Westerway, S., Chou, Y., & Dietrich, C. (2020). Medical Student Ultrasound Education, a WFUMB Position Paper, Part II. A consensus statement of ultrasound societies. Medical Ultrasonography, 22(2), 220-229. doi:http://dx.doi.org/10.11152/mu-2599

WůĂĐĞŵĞŶƚ ŽĨ s ŝŶ /:s >ĞĐƚƵƌĞ

Ϭ͘ ϯϮϮϴ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ

DŽĚƵůĞ

>ĞĐƚƵƌĞ

/ŶĚŝĐĂƚŝŽŶƐ ĂŶĚ ĐŽŶƚƌĂŝŶĚŝĐĂƚŝŽŶƐ

Ϭ͘ ϮϮϱϯ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ

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>ĞĐƚƵƌĞ

ŽŵƉůŝĐĂƚŝŽŶƐ

Ϭ͘ ϬϭϲϭΎ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ dŚĞ >ĞĐƚƵƌĞ ŐƌŽƵƉ ŝŶĐƌĞĂƐĞĚ ďLJ ƐŝŐŶŝĨŝĐĂŶƚůLJ ŵŽƌĞ ďĞƚǁĞĞŶ ƉƌĞ ĂŶĚ ƉŽƐƚ͘

ƒ ”ȋ –‹α‹ͷ’͹ƒȌ – •

DŽĚƵůĞ

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<ŶŽǁůĞĚŐĞ ŽĨ /:s ĂŶĚ ^ƵƌƌŽƵŶĚŝŶŐ ŶĂƚŽŵLJ

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Ϭ͘ ϮϮϬϬ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ

DŽĚƵůĞ

– ‡ȋ ”ƒα–ͳ‹ ‘ͻȌ ͳ – ‡ȋ”ƒα– ‹ͺ‘Ȍ ʹ – ‡ȋ ”ƒα–ʹ‹ ‘ͳȌ ͳ – ‡ȋ”ƒα– ‹ͻ‘Ȍ ʹ Figure 1. Participants. No participants were excluded from analysis.

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WĞƌĨŽƌŵŝŶŐ h^ 'ƵŝĚĞĚ s ŽĨ ƚŚĞ /:s

The authors wish to thank Edward Via College of Osteopathic Medicine Carolinas Campus Simulation Center as the site of our research gathering and procurement of materials. We also wish to thank Catherine Harrison of Highlands Center for Women in Greenville, SC, for her guidance and support as ultrasound technician during our ultrasound courses and data retrieval, and Skip Garner of Edward Via College of Osteopathic Medicine Research Department for his involvement in our IRB process. IRB exemption granted by Edward Via College of Osteopathic Medicine as the IRB Reviewing Body on 10/28/21.

Ϭ͘ ϭϴϲϴ &ŝƐŚĞƌ ’ Ɛ džĂĐƚ dĞƐƚ

DŽĚƵůĞ

Table 2. Matched pair Likert survey response comparison

92

2024 Research Recognition Day