Remote Mentoring of Point-of-Care Ultrasound Skills to Inexperienced Operators Using Multiple Telemedicine Platforms: Is a Cell Phone Good Enough?

OBJECTIVES: Telemedicine technology contributes to the teaching of point-of-care ultrasound (US); however, expensive equipment can limit its deployment in resource-challenged settings. We assessed 3 low-cost telemedicine solutions capable of supporting remote US training to determine feasibility, acceptability, and effectiveness. We also explored the value of instructional videos immediately before telementoring. METHODS: Thirty-six participants were randomly assigned to receive US mentoring in 1 of 3 telemedicine conditions: multiple fixed cameras, a smartphone, and traditional audio with a live US stream. Participants were then asked to perform a standardized US examination of the right upper quadrant under remote guidance. We measured observer's global ratings of performance along with the mentor's and student's rating of effort and satisfaction to determine which of the 3 approaches was most feasible, acceptable, and effective. During the second phase, students were randomized to watch an instructional video or not before receiving remote coaching on how to complete a subxiphoid cardiac examination. Effort, satisfaction, and performance from the independent observer's and student's perspective were surveyed. RESULTS: There was no significant difference between the different telemedicine setups from the observer's perspective; however, the mentor rated the smartphone significantly worse (P = .028-.04) than other technologies. Platforms were rated equivalent from the student's perspective. No benefit was detected for watching an instructional video before the mentored task. CONCLUSIONS: Remote US skills can be taught equally effectively by using a variety of telemedicine technologies. Smartphones represent a viable option for US training in resource-challenged settings.

Bilateral Transfer of a Visuomotor Task in Different Workspace Configurations.

Bilateral transfer occurs when a learned behavior transfers from one (group of) effectors(s) to another. Researchers investigating bilateral transfer of a visuomotor adaptation task between limbs used across workspaces have observed divergent results. This study assessed whether bilateral transfer of a visuomotor adaptation task changes with workspace configuration manipulation. Ninety-six right-handed young adults were assigned to one of three workspace locations, i.e., ipsilateral, contralateral, and central. Within each workspace were two retention groups (RRR/LLL) and two bilateral transfer groups (RLR/LRL). Performance before and after training was collected to determine direct and after-effects. We observed an asymmetric transfer of pathlength (left to right) but no ensuing after-effect. However, the transfer of movement time and normalized jerk was symmetric in the contralateral workspace. These findings showed differences in the pattern of bilateral transfer asymmetry in the different workspace configurations, which was parameter specific.

Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario.

Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of undergraduate and postgraduate training. Similarly, effective professional development activities stand to benefit greatly from a more stringent integration of simulation and competency-based approaches. This particularly makes sense when considering the goals of patient safety and achievement of optimal clinical outcomes. The current report describes a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation.