Focused cardiac ultrasound training in medical students: Using an independent, simulator-based curriculum to objectively measure skill acquisition and learning curve.

BACKGROUND: Using simulators built and validated at the University of Washington (UW), the study sought to test whether medical students can learn the basic skills of focused cardiac ultrasound (FoCUS) from an individually paced, simulator-based curriculum, how skills improve, and the rate at which these skills are acquired. METHODS: The curriculum presented didactic material interspersed with hands-on practice. Psychomotor skill was measured by the angle error of the acquired image view plane relative to the correct image view plane. The rate of learning was assessed at baseline, after 7 practice cases, and after 10 cases. To assess the rate of learning, the same case was repeatedly presented at all three tests. To assess students' ability to apply their learning, a previously unseen post-test was included. RESULTS: A total of 41 students completed the course. Average angle error improved from 43° ± 24 pretraining to 23° ± 16 post-training, with most students falling within one SD of the view angle acquired by sonographers. Regarding learning curve, or the rate of skill acquisition, an angle error of 43 ± 24° (pre) changed to 22 ± 14° (interim test, P < .0001 vs. pretest) and remained at that level for the post-test evaluation on both the repeated case (23 ± 16°) and the new case (26 ± 18°). CONCLUSIONS: This study describes the learning curve and technical skill acquisition in FoCUS. A simulator-based curriculum improved medical student's skills in an objective and quantifiable manner. The individually paced curriculum allowed for independent knowledge and skill attainment, without facilitator oversight.

Formative Assessment of Performance in Diagnostic Ultrasound Using Simulation and Quantitative and Objective Metrics.

BACKGROUND: We developed simulator-based tools for assessing provider competence in transthoracic echocardiography (TTE) and vascular duplex scanning. METHODS: Psychomotor (technical) skill in TTE image acquisition was calculated from the deviation angle of an acquired image from the anatomically correct view. We applied this metric for formative assessment to give feedback to learners and evaluate curricula.Psychomotor skill in vascular ultrasound was measured in terms of dexterity and image plane location; cognitive skill was assessed from measurements of blood flow velocity, parameter settings, and diagnosis. The validity of the vascular simulator was assessed from the accuracy with which experts can measure peak systolic blood flow velocity (PSV). RESULTS: In the TTE simulator, the skill metric enabled immediate feedback, formative assessment of curriculum efficacy, and comparison of curriculum outcomes. The vascular duplex ultrasound simulator also provided feedback, and experts' measurements of PSV deviated from actual PSV in the model by <10%. CONCLUSIONS: Skill in acquiring diagnostic ultrasound images of organs and vessels can be measured using simulation in an objective, quantitative, and standardized manner. Current applications are provision of feedback to learners to enable training without direct faculty oversight and formative assessment of curricula. Simulator-based metrics could also be applied for summative assessment.

Integrating Scaffolding and Deliberate Practice Into Focused Cardiac Ultrasound Training: A Simulator Curriculum.

Introduction: Focused cardiac ultrasound (FoCUS) is widely used for the point-of-care evaluation of basic cardiac pathology, and there is a need for efficient and consistent training in this modality. We designed a simulator-based FoCUS curriculum that integrates instructional scaffolding and deliberate practice to create a directed, self-regulated learning experience for novices. The goal of this strategy was to guide the novice's learning efforts more efficiently and moderate cognitive load while retaining the benefits of independent learning. Methods: The complex task of learning cardiac ultrasound is broken into discrete steps, with focused didactic information immediately followed by targeted simulator practice for each module. The practice complexity increases through successive modules, and learners ultimately apply their skills by completing unassisted simulator cases. Immediate visual and quantitative feedback is provided by the simulator whenever an ultrasound image was captured during practice. The entire curriculum is self-guided. Results: Sixteen nurse practitioners and resident physicians completed this FoCUS curriculum. In comparison to a previously validated, lecture-before-practice-style curriculum, the average time to completion decreased from 8.0 ± 2.5 hours to 4.7 ± 1.9 hours (p < .0001). There was no difference in posttraining cognitive or psychomotor outcomes between the curricula as measured by a simulator posttest. Discussion: A curriculum integrating scaffolding and deliberate practice provides a more efficient, but equally effective, means of teaching psychomotor and cognitive skills in FoCUS. These instructional design principles may translate to other operational learning tasks and allow novices to build skills and reach basic competency more rapidly.

Circadian regulation of insect olfactory learning.

Olfactory learning in insects has been used extensively for studies on the neurobiology, genetics, and molecular biology of learning and memory. We show here that the ability of the cockroach Leucophaea maderae to acquire olfactory memories is regulated by the circadian system. We investigated the effect of training and testing at different circadian phases on performance in an odor-discrimination test administered 30 min after training (short-term memory) or 48 h after training (long-term memory). When odor preference was tested by allowing animals to choose between two odors (peppermint and vanilla), untrained cockroaches showed a clear preference for vanilla at all circadian phases, indicating that there was no circadian modulation of initial odor preference or ability to discriminate between odors. After differential conditioning, in which peppermint odor was associated with a positive unconditioned stimulus of sucrose solution and vanilla odor was associated with a negative unconditioned stimulus of saline solution, cockroaches conditioned in the early subjective night showed a strong preference for peppermint and retained the memory for at least 2 days. Animals trained and tested at other circadian phases showed significant deficits in performance for both short- and long-term memory. Performance depended on the circadian time (CT) of training, not the CT of testing, and results indicate that memory acquisition rather than retention or recall is modulated by the circadian system. The data suggest that the circadian system can have profound effects on olfactory learning in insects.