Monitoring Personalized Learning Curves for Emergency Ultrasound With Risk-adjusted Learning-curve Cumulative Summation Method
Abstract
Background:Ultrasound (US) has been a regular practice in emergency departments for several decades. Thus,train our students to US is of prime interest. Because US image acquisition ability can be very different from apatient to another (depending on image quality), it seems relevant to adapt US learning curves (LCs) to patientimage quality using tools based on cumulative summation (CUSUM) as the risk-adjusted LC CUSUM (RLC).
Objectives:The aim of this study was to monitor LC of medical students for the acquisition of abdominalemergency US views and to adapt these curves to patient image quality using RLC.
Methods:We asked medical students to perform abdominal US examinations with the acquisition of 11 viewsof interest on emergency patients after a learning session. Emergency physicians reviewed the studentexaminations for validation. LCs were plotted and the student was said proficient for a specific view if his LCreached a predetermined limitfixed by simulation.
Results:SevenstudentswithnopreviousexperienceinUSwereenrolled.Theyperformed19to50examinations of 11 views each. They achieve proficiency for a median of 9 (6–10) views. Aorta and rightpleura views were validated by seven students; inferior vena cava, right kidney, and bladder by six;gallbladder and left kidney byfive; portal veins and portal hilum by four; and subxyphoid and left pleura bythree. The number of US examinations required to reach proficiency ranged fromfive to 41 depending onthe student and on the type of view. LC showed that students reached proficiency with different learningspeeds.
Conclusions:This study suggests that, when monitoring LCs for abdominal emergency US, there is someheterogeneity in the learning process depending on the student skills and the type of view. Therefore, rules basedon a predetermined number of examinations to reach proficiency are not satisfactory.