Abigail Brackney
Beaumont Health - Royal Oak
Dr. Abigail Brackney is a 2007 graduate of Wayne State University School of Medicine. She completed an Emergency Medicine residency at Henry Ford Hospital in 2010 and subsequently completed an Ultrasound Fellowship at Henry Ford Hospital in 2011. Dr. Brackney is currently the Associate Ultrasound Director in the Department of Emergency Medicine at Beaumont Health in Royal Oak, Michigan and an Assistant Professor at Oakland University William Beaumont School of Medicine.
Study Objectives:
There have been multiple new high-fidelity ultrasound simulators that have been developed in recent years. Previous studies have shown simulators to be beneficial for teaching procedures and for sensitive studies such as transvaginal exams or transesophageal echocardiography. Our aim was to test if the addition of an ultrasound simulator to an Emergency Medicine (EM) Ultrasound rotation improved trainees’ image interpretation.
Methods:
First and 2nd year EM residents, 1st year Pediatric Emergency Medicine (PEM) Fellows, and 4th year medical students were recruited during their two week ultrasound rotation at a large academic institution with over 125,000 visits per year. Only the second year residents had any previous ultrasound experience. Participants were assigned randomly into control and study groups based on the month of their rotation. Prior to the start and upon completion of the rotation, participants completed a 35 question exam. The exam consisted of multiple choice questions, case scenario and video clips on identification of different views and image interpretation. The study group was asked to use the SonoSim ultrasound simulator during the first week of their ultrasound rotation and required to complete at least 15 pre-designated cases which included pericardial tamponade, free fluid and various other pathologies determined beneficial for an EM physician to know. They could complete more cases if they chose to do so. The study group scanned on patients in the Emergency Department during the remainder of their rotation. The control group only scanned on patients in the Emergency Department during the two week rotation. Both groups participated in weekly image review during their rotation, where all point-of-care ultrasounds performed within the Emergency Department during that week were reviewed with ultrasound faculty.
Results:
Twenty-two participants were enrolled in the study, 14 in the study group and 8 in the control group. Three participants in the control group were excluded because they did not complete the post-test. In the study group there were six 1st year EM residents, six 2nd year EM residents, one 4th year student, and one PEM fellow. The control group had two 1st year EM residents and three 2nd year EM residents. The mean score was 27.2 (+/-0.8) for the control and 24.6 (+/-3.5) for the study group, p-value 0.14. On the post test, all participants improved their scores with an overall mean of 31.4 (+/-1.7) and 28.7 (+/-2.3) in the control and study group, respectively, p-value 0.036. However, the mean change between the pre and post-test was 4.2 (+/-1.3) in the control and 4.1 (+/-2.6) in the study group, which was not significant, p-value 1.0. An implementation of the Fisher-Pitman permutation test (a distribution-free alternative to the t-test) was also used because the control group was small (n = 5) and we could not assume the scores were normally distributed. The control group scored higher, on average, on both the pre-test and the post-test, although only the post-test difference was significant at a 0.05 level. The mean score change from pre to post was essentially the same in both groups.
Conclusion:
The addition of an ultrasound simulator did not improve image interpretation during an EM Ultrasound rotation. However, given both groups had equal improvement on their test scores, there may be some benefit in specific learners. This study took place a large academic tertiary care hospital with a very high volume of patients with a wide variety of pathology for the resident to ultrasound. The participants in the study where therefore able to see many different types of pathology during their rotation and using a simulator to supply additional cases did not improve their test scores further. The addition of an ultrasound simulator to aid in training at smaller institutions, or for use with medical students lacking access to ample pathology, may be of more benefit than at large centers for ultrasound image interpretation training.
