Thorax, trachea, and lung ultrasonography in emergency and critical care medicine: assessment of an objective structured training concept

Abstract

Background and Study objective. Focused lung ultrasound (LUS) examinations are important tools in critical care medicine. There is evidence that LUS can be used for the detection of acute thoracic lesions. However, no validated training method is available. The goal of this study was to develop and assess an objective structured clinical examination (OSCE) curriculum for focused thorax, trachea, and lung ultrasound in emergency and critical care medicine (THOLUUSE). Methods. 39 trainees underwent a one-day training course in a prospective educational study, including lectures in sonoanatomy and -pathology of the thorax, case presentations, and hands-on training. Trainees' pre- and posttest performances were assessed by multiple choice questionnaires, visual perception tests by interpretation video clips, practical performance of LUS, and identification of specific ultrasound findings. Results. Trainees postcourse scores of correct MCQ answers increased from 56 ± 4% to 82 ± 2% (mean± SD; P < 0.001); visual perception skills increased from 54 ± 5% to 78 ± 3% (P < 0.001); practical ultrasound skills improved, and correct LUS was performed in 94%. Subgroup analysis revealed that learning success was independent from the trainees' previous ultrasound experience. Conclusions. THOLUUSE significantly improves theoretical and practical skills for the diagnosis of acute thoracic lesions. We propose to implement THOLUUSE in emergency medicine training.

Figures

Figure 1

(a) Representative training station with ultrasound phantom. (b)–(g) B-mode sonograms of ultrasound dummies filled with various components to mimic characteristic findings and artifacts of ultrasound examination of the chest. (b) Liquid filled dummy simulates pleural line and PLE. Note the presence of a needle artifact (long axis); (c) dummy filled with air to mimic reverberation artifacts typically found in PTX, (d) dummy filled with rice grains and starch to mimic partly consolidated hemothorax or fibrinous structures, (e) olive as substitute for soft but solid tissue, (f) jelly babies, and (g) a wooden tiger duck for identification of target objects.

Figure 2

(a)-(b) Standardized training sequence for ultrasound examination of the right hemithorax. Trainees had to examine four views for pleural effusion (a) or six views for pneumothorax (b) by correct positioning of the ultrasound probe.

Figure 3

(a) Theoretical learning results of individual trainees and test groups assessed with MCQ in a pre-course (Pre) and post-course (Post) testing. Box plots represent the 25th and 75th percentiles with median. Dashed line indicates an arbitrary defined pass level of 60% (b) Number of trainees who correctly answered MCQ. Each symbol represents an independent question sorted by related categories. (c) Test for visual perceptive skills, where trainees had to identify characteristic physiologic or pathologic ultrasound findings, each shown in a 10 sec video clips. Dashed line indicates an arbitrary defined pass level of 60%. (d) Numbers of trainees who obtained a correct answer during visual perceptive skill test. Each symbol represents a video-clip sorted by related categories.

Figure 4

(a)-(b) Practical postcourse examinations after completion of all skill trainings (a) Every circle represents the sum of correct ultrasound examinations of specific sites by individual trainees, as assessed by practical postcourse examination (maximum count: n = 16). (b) Each identical symbol represents a distinct learning objective (1: trachea, thyroid, central vessels, and isthmus, 2: chest wall, 3: pleura, lung, 4: diaphragm, solid organs, and 5: detection sequence of PLE or PTX). Data are arranged to visualize the cumulative scores of trainees per tested objective (maximum count: n = 54). Dashed line indicates an arbitrary defined pass level of 60% correct answers.