Saturday, February 28, 2015

Adventures in Ultrasound

Ultrasound has always been a bit of a black box for me. Aside from a handful of radiology lectures in preclerkship, our exposure has been limited to periodic opportunities during clerkship rotations. Given the increasing use of ultrasound for various applications at the bedside, these skills will be important to have in the future. 

This past Thursday we had the opportunity to spend and hour with Dr. Cavalcanti in the simulation lab at Toronto Western learning how to use the ultrasound maching, utilize ultrasound guidance for paracentesis, and identify anatomical structures in the abdomen.


We started with how to use the machine itself, a simple place to start, but something that I had not been taught explicitly yet. We learned how to change probes, change the type of exam, and modify the depth and gain. We then moved on to using the machine to detect pockets of fluid in a model of an ascitic abdomen. I have seen ultrasound used to do this on a real patient, and the model offered a better than expected simulation of the abdomen.  We then used a fairly advanced ultrasound simulation model to identify fluid in Morrison’s pouch and in the splenorenal recess.  The simulation was able to render both the ultrasound image and a 3-D animated image of the anatomy in real time, which is a fantastic way to teach trainees about how to visualize the structures they’re seeing on the ultrasound machine.  Clinical teaching about ascites was interspersed throughout the session.

I did a PubMed search about ultrasound teaching and simulation after the session and came across an interesting tidbit in a recent article. Coincidentally, a study was recently published in Medical Education that examined whether training in pairs was non-inferior to training an individual.  In “The effect of dyad versus individual simulation-based ultrasound training on skills transfer” thirty learners were randomized to receive training on transvaginal ultrasound simulators either individually or taking turns in pairs.  Participants were final year medical students completed a pre-test, training, and post-test. They were then evaluated performing an ultrasound examination of the uterus, lateral pelvic wall, and pouch of Douglas.  In the end the results showed that training in pairs was non-inferior to training as an individual, which could make training in the future more time-efficient and cheaper. On an individual level, I didn't feel that taking turns with my colleague during the training session we had on Thursday had any tangible drawback- it was a great session using fantastic technology. 

-SR


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