Twelve tips for integrating ultrasound guided peripheral intravenous access clinical skills teaching into undergraduate medical education.

Peripheral Intravenous access (PIV) is a procedure undertaken by Medical Practitioners and Non-Medical Practitioners. Traditional PIV uses a visual and tactile technique to locate blood vessels close to the surface of the skin. Chronic medical conditions, dehydration, obesity and recurrent intravenous access can make PIV challenging. Ultrasound (US) guided PIV is recommended to aid the identification of the arm arteries and veins and improve the success rate of needle placement in difficult cases. Medical and non-medical schools, and hospital organisations, are recognising the importance of US guided PIV education for undergraduate and postgraduate Medical and Non-Medical Practitioners. This to promote independence, efficiency and to improve patient safety. The aim of this 12 tips article is to highlight the considerations and practicalities of integrating and delivering, a practical based skills (PBS) session, on the use of US guided practice as an adjunct in difficult PIV, into the undergraduate medical education curricula.

Can we successfully teach novice junior doctors basic interventional ultrasound in a single focused training session?

BACKGROUND: Ultrasonography is recognised as an invaluable imaging modality for assessing critically unwell patients and obtaining vascular access. Senior emergency medicine and anaesthetic clinicians will regularly use ultrasound-guided imaging to establish vascular access for unwell patients; however, junior doctors, who are routinely the first clinicians to review deteriorating patients, are not encouraged or required to develop basic ultrasound interventional skills and are therefore ill equipped to use ultrasonography. AIM: To demonstrate that teaching basic interventional ultrasound skills to novice junior doctors in a single focused session is an achievable outcome. METHOD: We reviewed the success of the 'Junior doctor Ultrasound Training' (JUST) course in teaching basic interventional ultrasound skills to junior clinicians. We collated information from 237 JUST delegates. We surveyed candidates' prior ultrasound experience and retrospectively analysed their level 2 Kirkpatrick formative assessment outcome following the JUST course. RESULTS: The overwhelming majority of doctors had no prior ultrasound experience (>95%). 99% (235) of candidates performed ultrasound to an acceptable standard to pass the formative assessment. 73% (174) achieved the course outcomes independent of faculty prompting. 1% (2) candidates failed the formative assessment. CONCLUSION: Basic ultrasound competency is an achievable educational outcome for the overwhelming majority of novice junior doctors. Our findings add to growing evidence that early ultrasound tuition can be both valuable and economical for training clinicians. By arming junior doctors with a relevant and versatile skill set, we can provide opportunity for clinicians to develop their expertise and prepare for the future challenges of clinical medicine.

The development of a pragmatic, clinically driven ultrasound curriculum in a UK medical school.

Whether ultrasound (US) should be incorporated into a medical undergraduate curriculum remains a matter of debate within the medical education arena. There are clear potential benefits to its early introduction particularly with respect to the study of living anatomy and physiology in addition to the learning of clinical skills and procedures required for the graduate clinical practice. However, this needs to be balanced against what is perceived as an added value in addition to financial and time constraints which may potentially lead to the sacrifice of other aspects of the curriculum. Several medical schools have already reported their experiences of teaching US either as a standalone course or as a fully integrated vertical curriculum. This article describes and discusses the initial experience of a UK medical school that has taken the steps to develop its own pragmatic vertical US curriculum based on clinical endpoints with the intent of using US to enhance the learning experience of students and equipping them with the skills required for the safe practice as a junior doctor.

Ultrasound probe grip: the afternoon tea technique.

BACKGROUND: Globally, ultrasound is being used to assist in central venous and difficult peripheral intravenous access in a variety of emergency and non-emergency clinical settings. CONTEXT: After reading Flood's paper on safe central venous access and noting the difficulties clinicians find in probe stabilisation whilst performing dynamic intravenous access, we decided to share our teaching technique. INNOVATION: The purpose of this correspondence is to highlight the 'afternoon tea technique' as a potential teaching method for probe stabilisation. IMPLICATIONS: It is hoped that this technique will improve the image quality in dynamic procedures and increase the success rate of ultrasound-guided intravenous access in clinical practice.

How to do it: bedside ultrasound to assist lumbar puncture.

For many neurologists, lumbar puncture is the only practical procedure that they undertake on a regular basis. Although anaesthetists and emergency physicians routinely employ ultrasound to assist lumbar puncture, neurologists do not. In this article, we outline the technique that we use for an ultrasound-assisted lumbar puncture, together with the evidence base that suggests that ultrasound has significant benefits. We aim to raise awareness of a method that can make lumbar puncture more likely to succeed and to be more comfortable for the patient.

Measurement and implications of postural changes in blood pressure.

Postural changes in blood pressure are a commonly elicited vital sign. It is important that the measurements are reproducible in order to be clinically meaningful. This article makes recommendations about how and what to document as part of the technique of recording, on the basis of the literature.