Ultrasound-guided cannulation for medical students.
Journal
The clinical teacher
ISSN: 1743-498X
Titre abrégé: Clin Teach
Pays: England
ID NLM: 101227511
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
revised:
13
11
2020
received:
15
07
2020
accepted:
21
12
2020
pubmed:
11
2
2021
medline:
19
8
2021
entrez:
10
2
2021
Statut:
ppublish
Résumé
There is growing recommendation to integrate ultrasound training into undergraduate medical curricula; with limited evidence of its implementation in the United Kingdom. Peripheral intravenous cannulation (PIVC) often has high failure rates-particularly for patients with difficult vascular access. Ultrasound-guided PIVC (US-PIVC) has been shown to increase the rates of success and may reduce dependence on seniors. Teaching US-PIVC to senior medical students may prove a clinically valuable and feasible means of introducing ultrasound into medical programmes. We initially surveyed 18 doctors to assess their perceptions and experience of ultrasound. Thirty-five final-year medical students took part in a novel US-PIVC course. Students' competence was assessed at the end of the session using an objective assessment. Students' pre- and post-course attitudes and confidence were evaluated using questionnaires. All doctors surveyed reported difficulty performing PIVC since starting work: 66% on a monthly basis. None of the students (0%) and 11% of the doctors had previously received ultrasound training. By the end of the course, all students 'agreed' or 'strongly agreed' that the session was enjoyable and that they felt confident performing US-PIVC. Thirty-four of 35 participants attained the minimum competence standard. Students' confidence performing PIVC, regardless of ultrasound guidance, increased significantly (p = 0.002) following the session. As ultrasound becomes a more readily available point-of-care technology, it should be considered for inclusion in the undergraduate medical curriculum. Our course appears to be an effective model of teaching US-PIVC to final-year medical students. Similar courses could act as a pragmatic and clinically rewarding means of implementing US-PIVC teaching into the latter years of undergraduate curricula.
Sections du résumé
BACKGROUND
BACKGROUND
There is growing recommendation to integrate ultrasound training into undergraduate medical curricula; with limited evidence of its implementation in the United Kingdom. Peripheral intravenous cannulation (PIVC) often has high failure rates-particularly for patients with difficult vascular access. Ultrasound-guided PIVC (US-PIVC) has been shown to increase the rates of success and may reduce dependence on seniors. Teaching US-PIVC to senior medical students may prove a clinically valuable and feasible means of introducing ultrasound into medical programmes.
METHODS
METHODS
We initially surveyed 18 doctors to assess their perceptions and experience of ultrasound. Thirty-five final-year medical students took part in a novel US-PIVC course. Students' competence was assessed at the end of the session using an objective assessment. Students' pre- and post-course attitudes and confidence were evaluated using questionnaires.
RESULTS
RESULTS
All doctors surveyed reported difficulty performing PIVC since starting work: 66% on a monthly basis. None of the students (0%) and 11% of the doctors had previously received ultrasound training. By the end of the course, all students 'agreed' or 'strongly agreed' that the session was enjoyable and that they felt confident performing US-PIVC. Thirty-four of 35 participants attained the minimum competence standard. Students' confidence performing PIVC, regardless of ultrasound guidance, increased significantly (p = 0.002) following the session.
DISCUSSION
CONCLUSIONS
As ultrasound becomes a more readily available point-of-care technology, it should be considered for inclusion in the undergraduate medical curriculum. Our course appears to be an effective model of teaching US-PIVC to final-year medical students. Similar courses could act as a pragmatic and clinically rewarding means of implementing US-PIVC teaching into the latter years of undergraduate curricula.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
295-300Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
Références
General Medical Council. Practical Skills and Procedures 2019 [Available from: https://www.gmc-uk.org/-/media/documents/practical-skills-and-procedures-a4_pdf-78058950.pdf]
Jacobson AF, Winslow EH. Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung 2005;34(5):345-359.
Egan G, Healy D, Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emergency Medicine Journal. 2013;30(7):521.
Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. The journal of vascular access. 2015;16(4):321-326.
Au AK, Rotte MJ, Grzybowski RJ, Ku BS, Fields JM. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am J Emerg Med. 2012;30(9):1950-1954.
Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in US medical schools: results of a national survey. Acad Med 2014;89(12):1681-1686.
Royal College of Radiologists. Undergraduate Radiology Curriculum, Second Edition 2017 [Available from: https://www.rcr.ac.uk/sites/default/files/documents/undergraduate_radiology_curriculum_second_edition_2017.pdf]
Artino Jr AR, La Rochelle JS, Dezee KJ, Gehlbach H. Developing questionnaires for educational research. AMEE Guide No. 87. Med Teach. 2014;36(6):463-474.
Miles MB, Huberman AM, Saldana J. Qualitative Data Analysis: SAGE Publications; 2014.
Kirkpatrick DL, Craig R. Evaluation of training. Evaluation of Short-Term training in Rehabilitation Monograph. 1967;3:35-56.
Osborn SR, Borhart J, Antonis MS. Medical students benefit from the use of ultrasound when learning peripheral IV techniques. Critical ultrasound journal. 2012;4(1):2.
National Institute for Health and Care Excellence. Technology appraisal guidance: Guidance on the use of ultrasound locating devices for placing central venous catheters 2002 [Available from: www.nice.org.uk/guidance/ta49/resources/guidance-on-the-use-of-ultrasound-locating-devices-for-placing-central-venous-catheters-pdf-2294585518021]
Davis JJ, Wessner CE, Potts J, Au AK, Pohl CA, Fields JM. Ultrasonography in undergraduate medical education: a systematic review. J Ultrasound Med 2018;37(11):2667-2679.