Remote Instruction in Focused Assessment With Sonography in Trauma (FAST) Exams for Surgery Residents: A Pilot Study.

BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) exam is an important component to the evaluation of trauma patients. With advances in technology and meeting limitations due to COVID-19, remote instruction and learning have gained popularity. We sought to determine whether remote instruction of FAST exams was feasible as sustainable surgical education and a possible alternative to traditional in-person teaching. METHODS: General surgery residents completed a baseline survey and skills assessment on FAST exams and were then randomized to remote or in-person instruction. The remote group participated in an instructional session with a content expert through video conference and then practiced on a simulated mannequin while the expert remotely provided feedback. The in-person group received the experience with the content expert in the room. Both groups completed a post-course survey immediately after the session and a follow-up survey and objective assessment at six-months. Results were compared with two-way analysis of variance (ANOVA). RESULTS: 14 residents underwent the curriculum, seven in each group. There was a significant increase in self-reported confidence when comparing pre- and immediate post-course results for both the remote and in-person groups. At six months, confidence scores remained elevated and skill assessment scores improved, although the latter did not reach significance. There was no significant difference in post-course results between the groups. CONCLUSIONS: Remote instruction of FAST exams was feasible. Pilot data demonstrated an increase in confidence and suggest outcomes that are similar to in-person instruction, which has positive implications for future remote educational and potentially clinical initiatives.

Development of a critical care ultrasound curriculum using a mixed-methods needs assessment and engagement of frontline healthcare professionals.

PURPOSE: Experts recommend that critical care medicine (CCM) practitioners should be adept at critical care ultrasound (CCUS). Published surveys highlight that many institutions have no deliberate strategy, no formalized curriculum, and insufficient engagement of CCM faculty and trainees. Consequently, proficiency is non-uniform. Accordingly, we performed a needs assessment to develop an inter-professional standardized CCUS curriculum as a foundation towards universal basic fluency. METHODS: Mixed-methods study of CCM trainees, attendings, and nurse practitioners working across five academic and community medical-surgical intensive care units in Edmonton, Alberta. We used qualitative focus groups followed by quantitative surveys to explore, refine, and integrate results into a curriculum framework. RESULTS: Focus groups with 19 inter-professional practitioners identified major themes including perceived benefits, learning limitations, priorities, perceived risks, characteristics of effective instruction, ensuring long-term success, and achieving competency. Sub-themes highlighted rapid attrition of skill following one- to two-day workshops, lack of skilled faculty, lack of longitudinal training, and the need for site-based mentorship. Thirty-five practitioners (35/70: 50%) completed the survey. Prior training included workshops (16/35; 46%) and self-teaching (11/35; 31%). Eleven percent (4/35) described concerns about potential errors in CCUS performance. The survey helped to refine resources, content, delivery, and assessment. Integration of qualitative and quantitative findings produced a comprehensive curriculum framework. CONCLUSION: Building on published recommendations, our needs assessment identified additional priorities for a CCUS curriculum framework. Specifically, there is a perceived loss of skills following short workshops and insufficient strategies to sustain learning. Addressing these deficits could narrow the gap between national recommendations and frontline needs.

RéSUMé: OBJECTIF: Les experts recommandent que les intensivistes soient habiles en échographie aux soins intensifs. Les sondages publiés révèlent que de nombreux établissements ne possèdent pas de stratégie réfléchie ni de curriculum formalisé en échographie, tout en souffrant d'un manque d'implication du corps professoral et des résidents. Les aptitudes ne sont donc pas uniformes. C'est pourquoi nous avons réalisé une évaluation des besoins afin de mettre au point un curriculum interprofessionnel standardisé en échographie aux soins intensifs qui servira de fondation vers une maîtrise des aptitudes de bases universelles. MéTHODE: Nous avons réalisé une étude en méthodes mixtes auprès de résidents, de patrons et d'infirmiers et infirmières praticiens en soins intensifs travaillant dans cinq unités de soins intensifs médico-chirurgicaux universitaires et communautaires à Edmonton, en Alberta. Nous avons formé des groupes de réflexion qualitatifs puis avons réalisé des sondages quantitatifs afin d'explorer, d'approfondir et d'intégrer nos résultats dans un cadre de curriculum. RéSULTATS: Des groupes de réflexion composés de 19 praticiens interprofessionnels ont identifié des thèmes majeurs, notamment les avantages perçus, les obstacles à l'apprentissage, les priorités, les risques perçus, les caractéristiques d'un enseignement efficace, l'assurance d'un succès à long terme et l'acquisition des compétences. Les sous-thèmes ont mis en lumière une attrition rapide des compétences après des ateliers d'un ou deux jours, le manque d'enseignants compétents, le manque de formation longitudinale, et le besoin de mentorat sur le lieu de travail. Trente-cinq praticiens (35/70; 50 %) ont répondu au sondage. Les formations antérieures incluaient des ateliers (16/35; 46 %) et de l'auto-apprentissage (11/35; 31 %). Onze pourcent (4/35) des répondants ont fait part d'inquiétudes concernant les erreurs potentielles dans la performance de l'échographie aux soins intensifs. Le sondage a permis de raffiner les ressources, le contenu, la livraison et l'évaluation. L'intégration des résultats qualitatifs et quantitatifs a permis de réaliser un cadre exhaustif de curriculum. CONCLUSION: En nous appuyant sur les recommandations publiées, notre évaluation des besoins a identifié des priorités supplémentaires pour encadrer une formation d'échographie destinée aux soins intensifs. Plus spécifiquement, il existe une perte perçue des compétences à la suite d'ateliers courts et il manque de stratégies pour soutenir l'apprentissage. En palliant ces manques, il pourrait être possible de réduire le fossé entre les recommandations nationales et les besoins en première ligne.

Canadian Internal Medicine Ultrasound (CIMUS) Expert Consensus Statement on the Use of Lung Ultrasound for the Assessment of Medical Inpatients With Known or Suspected Coronavirus Disease 2019.

OBJECTIVES: To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 (COVID-19). METHODS: Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered. RESULTS: Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus. CONCLUSIONS: In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.

Predicting flood insurance claims with hydrologic and socioeconomic demographics via machine learning: Exploring the roles of topography, minority populations, and political dissimilarity.

Current research on flooding risk often focuses on understanding hazards, de-emphasizing the complex pathways of exposure and vulnerability. We investigated the use of both hydrologic and social demographic data for flood exposure mapping with Random Forest (RF) regression and classification algorithms trained to predict both parcel- and tract-level flood insurance claims within New York State, US. Topographic characteristics best described flood claim frequency, but RF prediction skill was improved at both spatial scales when socioeconomic data was incorporated. Substantial improvements occurred at the tract-level when the percentage of minority residents, housing stock value and age, and the political dissimilarity index of voting precincts were used to predict insurance claims. Census tracts with higher numbers of claims and greater densities of low-lying tax parcels tended to have low proportions of minority residents, newer houses, and less political similarity to state level government. We compared this data-driven approach and a physically-based pluvial flood routing model for prediction of the spatial extents of flooding claims in two nearby catchments of differing land use. The floodplain we defined with physically based modeling agreed well with existing federal flood insurance rate maps, but underestimated the spatial extents of historical claim generating areas. In contrast, RF classification incorporating hydrologic and socioeconomic demographic data likely overestimated the flood-exposed areas. Our research indicates that quantitative incorporation of social data can improve flooding exposure estimates.