Teaching the FAST algorithm with the Reacts (Remote Education, Augmented Communication, Training and Supervision) platform – a pilot study

Objectives: Telemedicine allows remote experienced physicians to provide real-time education of new clinical skills while augmented reality (AR) offers an authentic, real-time, simulated experience for learning new skills.... [ view full abstract ]

Objectives:
Telemedicine allows remote experienced physicians to provide real-time education of new clinical skills while augmented reality (AR) offers an authentic, real-time, simulated experience for learning new skills. These two technologies are combined in the Reacts (Remote Education, Augmented Communication, Training and Supervision) platform. Reacts incorporates traditional telecommunication with AR thus allowing live virtual assistance. It is unknown whether Reacts can improve bedside ultrasound skill acquisition in ultrasound-naive medical students. The aim of this study is to determine if Reacts can be used to teach the focussed assessment with sonography for trauma (FAST) algorithm, a well-established bedside ultrasound skill.

Methods:
Medical students (n=6) were recruited from the preparatory medical program (Med-P) at McGill University and randomly divided into two groups (Control and Reacts). Both groups had similar levels of clinical experience and no ultrasound experience. Both groups were given identical educational material to study one week prior to the teaching workshop. Each group received an identical teaching workshop on how to image Morison’s pouch (MP), the splenorenal space (SS), and the pouch of Douglas (PD).

The Control group was taught to image MP, SS, and PD with the instructor in the same room (Control teaching). The experimental group was taught to image the structures via Reacts (Reacts teaching) i.e. with the instructor in a separate room within the same building. The Reacts group was able to view the instructor’s remote scanning techniques on their own patient via real-time image overlay, and the instructor could see the students scanning techniques as well as the generated ultrasound images. There was audio communication between the instructor and the Reacts group.

To assess the effectiveness of the control and Reacts teaching workshops, both groups completed a theoretical and practical test before the workshop (pre-test) and an identical test after the workshop (post-test). The theoretical test (n=10 questions) was designed to test for knowledge of basic ultrasound physics, probe choice, image generation technique, and the importance of imaging MP, SS and PD. The practical test (n=three criteria) was designed to test for ultrasound skills regarding: 1) choice of probe with correct placement of the orientation marker, 2) ability to generate an image and properly identify the three structures and 3) adequate imaging of the whole structure (sweep). The ability to meet the three criteria was scored ‘able’ or ‘unable’ by an emergency physician with bedside ultrasound credentials and blinded to the teaching method.

Results:
Prior to teaching, the Control and the Reacts group showed similar scores for the theoretical pre-test (Control: 87% ± 6; REACTS 73% ± 11, p=0.3). Both groups performed similarly on the practical pre-test (Control: scored ‘unable’ on 27/27 criteria; Reacts: scored ‘unable’ on 27/27 criteria). After teaching, neither group significantly improved their mean score on the theoretical post-test and the scores were not significantly different from each other (Control: 90% ±10; Reacts 93% ±11, p>0.999 ).

After teaching, both the Control and the Reacts group significantly improved their mean score to the same degree on the practical post-test (both scored ‘able’ on 26/27 criteria).

Conclusion:
The results demonstrate that Reacts, a software platform combining telecommunication and AR technology, can successfully teach ultrasound-naive students the bedside ultrasound skills necessary to identify discrete components of the FAST exam. Reacts teaching was equivalent to in-person teaching for the acquisition of practical skills. Theoretical knowledge did not significantly improve after teaching in either the control or Reacts group due to the high pre-test scores. Remote teaching of these bedside ultrasound skills using Reacts may help in the diagnosis of intra-abdominal bleeding and trauma care in remote health care centers.