Animal Laboratory Training Improves Lung Ultrasound Proficiency and Speed

Background

Although lung ultrasound (US) is accurate in diagnosing pneumothorax (PTX), the training requirements and methods necessary to perform US examinations must be defined.

Objective

Our aim was to test whether animal laboratory training (ALT) improves the diagnostic competency and speed of PTX detection with US.

Methods

Twenty medical students without lung US experience attended a 1-day course. Didactic, practical, and experimental lectures covered the basics of US physics, US machines, and lung US, followed by hands-on training to demonstrate the signs of normal lung sliding and PTX. Each student's diagnostic skill level was tested with three subsequent examinations (at day 1, day 2, and 6-month follow-up) using experimentally induced PTX in porcine models. The outcome measures were sensitivity and specificity for US detection of PTX, self-reported diagnostic confidence, and scan time.

Results

The students improved their skills between the initial two examinations: sensitivity increased from 81.7% (range 69.1%−90.1%) to 100.0% (range 94.3%−100.0%) and specificity increased from 90.0% (range 82.0%−94.8%) to 98.9% (range 92.3%−100.0%); with no deterioration 6 months later. There was a significant learning curve in choosing the correct answers (p = 0.018), a 1-point increase in the self-reported diagnostic confidence (7.8−8.8 on a 10-point scale; p < 0.05), and a 1-min reduction in the mean scan time per lung (p < 0.05).

Conclusions

Without previous experience and after undergoing training in an animal laboratory, medical students improved their diagnostic proficiency and speed for PTX detection with US. Lung US is a basic technique that can be used by novices to accurately diagnose PTX.     

Does Simulator Training for Medical Students Change Patient Opinions and Attitudes toward Medical Student Procedures in the Emergency Department?

Objectives: To determine how simulator training impacts patients' preferences about medical student procedures in the emergency department. Methods: A questionnaire was administered to a convenience sample of 151 of 185 patients approached (82% participation) seen in the emergency department of a midwestern teaching hospital. The questionnaire asked how many procedures they would prefer a medical student have performed after mastering the procedure on a simulator before allowing the medical student to perform this procedure on them. The procedures included venipuncture, placement of an intravenous line, suturing the face or arm, performing a lumbar puncture, placement of a central line, placement of a nasogastric tube, intubation, and cardioversion. These results were compared with those of a similar study asking about the same procedures without the stipulation that the skill had been mastered on a simulator. Results: A high of 57% (venipuncture) and a low of 11% (placement of a central line) would agree to be a student's first procedure after simulator training. Except for intubating and suturing, participants were more likely (p < 0.05) to allow a medical student to perform a procedure on them after simulator training than without simulator training. Many patients prefer not to have a medical student perform a procedure no matter how many procedures the student has done (low of 21% for venipuncture, high of 55% for placement of a central line). Conclusions: Patients are more accepting of medical students performing procedures if the skill has been mastered on a simulator. However, many patients do not want a medical student to perform a procedure on them regardless of the student's level of training.