Browsing by Author "Ma, Irene W. Y."
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Item Open Access An overview of Internal Medicine Point-of-Care Ultrasound rotations in Canada(2022-09-02) Gaudreau-Simard, Mathilde; Wiskar, Katie; Kilabuk, Elaine; Walsh, Michael H.; Sattin, Michael; Wong, Jonathan; Burhani, Zain; Arishenkoff, Shane; Yu, Jeffrey; Lam, Ada W.; Ma, Irene W. Y.Abstract Background Point-of-care ultrasound (POCUS) is a growing part of internal medicine training programs. Dedicated POCUS rotations are emerging as a particularly effective tool in POCUS training, allowing for longitudinal learning and emphasizing both psychomotor skills and the nuances of clinical integration. In this descriptive paper, we set out to review the state of POCUS rotations in Canadian Internal Medicine training programs. Results We identify five programs currently offering a POCUS rotation. These rotations are offered over two to thirteen blocks each year, run over one to four weeks and support one to four learners. Across all programs, these rotations are set up as a consultative service that offers POCUS consultation to general internal medicine inpatients, with some extension of scope to the hospitalist service or surgical subspecialties. The funding model for the preceptors of these rotations is predominantly fee-for-service using consultation codes, in addition to concomitant clinical work to supplement income. All but one program has access to hospital-based archiving of POCUS exams. Preceptors dedicate ten to fifty hours to the rotation each week and ensure that all trainee exams are reviewed and documented in the patient’s medical records in the form of a consultation note. Two of the five programs also support a POCUS fellowship. Only two out of five programs have established learner policies. All programs rely on In-Training Evaluation Reports to provide trainee feedback on their performance during the rotation. Conclusions We describe the different elements of the POCUS rotations currently offered in Canadian Internal Medicine training programs. We share some lessons learned around the elements necessary for a sustainable rotation that meets high educational standards. We also identify areas for future growth, which include the expansion of learner policies, as well as the evolution of trainee assessment in the era of competency-based medical education. Our results will help educators that are endeavoring setting up POCUS rotations achieve success.Item Open Access Comparing accuracy of bedside ultrasound examination with physical examination for detection of pleural effusion(2021-09-06) Walsh, Michael H.; Zhang, Kang X.; Cox, Emily J.; Chen, Justin M.; Cowley, Nicholas G.; Oleynick, Christopher J.; Smyth, Leo M.; Ma, Irene W. Y.Abstract Background In detecting pleural effusion, bedside ultrasound (US) has been shown to be more accurate than auscultation. However, US has not been previously compared to the comprehensive physical examination. This study seeks to compare the accuracy of physical examination with bedside US in detecting pleural effusion. Methods This study included a convenience sample of 34 medical inpatients from Calgary, Canada and Spokane, USA, with chest imaging performed within 24 h of recruitment. Imaging results served as the reference standard for pleural effusion. All patients underwent a comprehensive lung physical examination and a bedside US examination by two researchers blinded to the imaging results. Results Physical examination was less accurate than US (sensitivity of 44.0% [95% confidence interval (CI) 30.0–58.8%], specificity 88.9% (95% CI 65.3–98.6%), positive likelihood (LR) 3.96 (95% CI 1.03–15.18), negative LR 0.63 (95% CI 0.47–0.85) for physical examination; sensitivity 98% (95% CI 89.4–100%), specificity 94.4% (95% CI 72.7–99.9%), positive LR 17.6 (95% CI 2.6–118.6), negative LR 0.02 (95% CI 0.00–0.15) for US). The percentage of examinations rated with a confidence level of 4 or higher (out of 5) was higher for US (85% of the seated US examination and 94% of the supine US examination, compared to 35% of the PE, P < 0.001), and took less time to perform (P < 0.0001). Conclusions US examination for pleural effusion was more accurate than the physical examination, conferred higher confidence, and required less time to complete.Item Open Access Correction: An overview of internal medicine point-of-care ultrasound rotations in Canada(2022-09-14) Gaudreau-Simard, Mathilde; Wiskar, Katie; Kilabuk, Elaine; Walsh, Michael H.; Sattin, Michael; Wong, Jonathan; Burhani, Zain; Arishenkof, Shane; Yu, Jefrey; Lam, Ada W.; Ma, Irene W. Y.Item Open Access Correction: Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health(2023-05-04) Kirkpatrick, Andrew W.; McKee, Jessica L.; Ball, Chad G.; Ma, Irene W. Y.; Melniker, Lawrence A.Item Open Access Critical care ultrasound training: a survey exploring the “education gap” between potential and reality in Canada(2021-12-11) Slemko, Jocelyn M.; Daniels, Vijay J.; Bagshaw, Sean M.; Ma, Irene W. Y.; Brindley, Peter G.; Buchanan, Brian M.Abstract Background Critical care ultrasound (CCUS) is now a core competency for Canadian critical care medicine (CCM) physicians, but little is known about what education is delivered, how competence is assessed, and what challenges exist. We evaluated the Canadian CCUS education landscape and compared it against published recommendations. Methods A 23-item survey was developed and incorporated a literature review, national recommendations, and expert input. It was sent in the spring of 2019 to all 13 Canadian Adult CCM training programs via their respective program directors. Three months were allowed for data collection and descriptive statistics were compiled. Results Eleven of 13 (85%) programs responded, of which only 7/11 (64%) followed national recommendations. Curricula differed, as did how education was delivered: 8/11 (72%) used hands-on training; 7/11 (64%) used educational rounds; 5/11 (45%) used image interpretation sessions, and 5/11 (45%) used scan-based feedback. All 11 employed academic half-days, but only 7/11 (64%) used experience gained during clinical service. Only 2/11 (18%) delivered multiday courses, and 2/11 (18%) had mandatory ultrasound rotations. Most programs had only 1 or 2 local CCUS expert-champions, and only 4/11 (36%) assessed learner competency. Common barriers included educators receiving insufficient time and/or support. Conclusions Our national survey is the first in Canada to explore CCUS education in critical care. It suggests that while CCUS education is rapidly developing, gaps persist. These include variation in curriculum and delivery, insufficient access to experts, and support for educators.Item Open Access Empowering the willing: the feasibility of tele-mentored self-performed pleural ultrasound assessment for the surveillance of lung health(2022-01-03) Kirkpatrick, Andrew W.; McKee, Jessica L.; Ball, Chad G.; Ma, Irene W. Y.; Melniker, Lawrence A.Abstract Background SARS-CoV-2 infection, manifesting as COVID-19 pneumonia, constitutes a global pandemic that is disrupting health-care systems. Most patients who are infected are asymptomatic/pauci-symptomatic can safely self-isolate at home. However, even previously healthy individuals can deteriorate rapidly with life-threatening respiratory failure characterized by disproportionate hypoxemic failure compared to symptoms. Ultrasound findings have been proposed as an early indicator of progression to severe disease. Furthermore, ultrasound is a safe imaging modality that can be performed by novice users remotely guided by experts. We thus examined the feasibility of utilizing common household informatic-technologies to facilitate self-performed lung ultrasound. Methods A lung ultrasound expert remotely mentored and guided participants to image their own chests with a hand-held ultrasound transducer. The results were evaluated in real time by the mentor, and independently scored by three independent experts [planned a priori]. The primary outcomes were feasibility in obtaining good-quality interpretable images from each anatomic location recommended for COVID-19 diagnosis. Results Twenty-seven adults volunteered. All could be guided to obtain images of the pleura of the 8 anterior and lateral lung zones (216/216 attempts). These images were rated as interpretable by the 3 experts in 99.8% (647/648) of reviews. Fully imaging one’s posterior region was harder; only 108/162 (66%) of image acquisitions was possible. Of these, 99.3% of images were interpretable in blinded evaluations. However, 52/54 (96%) of participants could image their lower posterior lung bases, where COVID-19 is most common, with 99.3% rated as interpretable. Conclusions Ultrasound-novice adults at risk for COVID-19 deterioration can be successfully mentored using freely available software and low-cost ultrasound devices to provide meaningful lung ultrasound surveillance of themselves that could potentially stratify asymptomatic/paucisymptomatic patients with early risk factors for serious disease. Further studies examining practical logistics should be conducted. Trial Registration: ID ISRCTN/77929274 on 07/03/2015.Item Open Access International consensus conference recommendations on ultrasound education for undergraduate medical students(2022-07-27) Hoppmann, Richard A.; Mladenovic, Jeanette; Melniker, Lawrence; Badea, Radu; Blaivas, Michael; Montorfano, Miguel; Abuhamad, Alfred; Noble, Vicki; Hussain, Arif; Prosen, Gregor; Villen, Tomás; Via, Gabriele; Nogue, Ramon; Goodmurphy, Craig; Bastos, Marcus; Nace, G. S.; Volpicelli, Giovanni; Wakefield, Richard J.; Wilson, Steve; Bhagra, Anjali; Kim, Jongyeol; Bahner, David; Fox, Chris; Riley, Ruth; Steinmetz, Peter; Nelson, Bret P.; Pellerito, John; Nazarian, Levon N.; Wilson, L. B.; Ma, Irene W. Y.; Amponsah, David; Barron, Keith R.; Dversdal, Renee K.; Wagner, Mike; Dean, Anthony J.; Tierney, David; Tsung, James W.; Nocera, Paula; Pazeli, José; Liu, Rachel; Price, Susanna; Neri, Luca; Piccirillo, Barbara; Osman, Adi; Lee, Vaughan; Naqvi, Nitha; Petrovic, Tomislav; Bornemann, Paul; Valois, Maxime; Lanctot, Jean-Francoise; Haddad, Robert; Govil, Deepak; Hurtado, Laura A.; Dinh, Vi A.; DePhilip, Robert M.; Hoffmann, Beatrice; Lewiss, Resa E.; Parange, Nayana A.; Nishisaki, Akira; Doniger, Stephanie J.; Dallas, Paul; Bergman, Kevin; Barahona, J. O.; Wortsman, Ximena; Smith, R. S.; Sisson, Craig A.; Palma, James; Mallin, Mike; Ahmed, Liju; Mustafa, HassanAbstract Objectives The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students. Methods 64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting. Results A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care. Conclusions The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.Item Open Access The association of attentional foci and image interpretation accuracy in novices interpreting lung ultrasound images: an eye-tracking study(2023-09-11) Lee, Matthew; Desy, Janeve; Tonelli, Ana C.; Walsh, Michael H.; Ma, Irene W. Y.Abstract It is unclear, where learners focus their attention when interpreting point-of-care ultrasound (POCUS) images. This study seeks to determine the relationship between attentional foci metrics with lung ultrasound (LUS) interpretation accuracy in novice medical learners. A convenience sample of 14 medical residents with minimal LUS training viewed 8 LUS cineloops, with their eye-tracking patterns recorded. Areas of interest (AOI) for each cineloop were mapped independently by two experts, and externally validated by a third expert. Primary outcome of interest was image interpretation accuracy, presented as a percentage. Eye tracking captured 10 of 14 participants (71%) who completed the study. Participants spent a mean total of 8 min 44 s ± standard deviation (SD) 3 min 8 s on the cineloops, with 1 min 14 s ± SD 34 s spent fixated in the AOI. Mean accuracy score was 54.0% ± SD 16.8%. In regression analyses, fixation duration within AOI was positively associated with accuracy [beta-coefficients 28.9 standardized error (SE) 6.42, P = 0.002). Total time spent viewing the videos was also significantly associated with accuracy (beta-coefficient 5.08, SE 0.59, P < 0.0001). For each additional minute spent fixating within the AOI, accuracy scores increased by 28.9%. For each additional minute spent viewing the video, accuracy scores increased only by 5.1%. Interpretation accuracy is strongly associated with time spent fixating within the AOI. Image interpretation training should consider targeting AOIs.