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Published in: European Journal of Trauma and Emergency Surgery 2/2016

01-04-2016 | Original Article

Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project

Authors: M. Zago, I. Martinez Casas, J. Pereira, D. Mariani, A. R. Silva, A. Casamassima, E. Barbosa, F. Ferreira, M. Ruesseler, G. A. Bass, L. Ponchietti, F. Butti, M. Marconi, L. F. Pinheiro

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2016

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Abstract

Purpose

The European Society for Trauma and Emergency Surgery (ESTES) identified the need for general and trauma surgeons involved in the management of critically ill surgical patients to embrace and learn both basic and advanced US skills. A steering group was created to address this deficit.

Methods

Modular UltraSound ESTES Course (MUSEC) is a modular blended-learning course. It incorporates pre-test/post-test examinations, pre-course online materials, didactic and interactive lectures, interactive case scenarios discussion with pathological US clips, hands-on practice on healthy volunteer models, and on original phantoms for simulating both pathological US findings and practicing US-guided interventional maneuvers. Four independent modules were provided. Surgical decision-making didactics were also included in the course curriculum. Learning gain (Δ of the rating of pre-test and post-test) was calculated for each module. An anonymous post-course satisfaction survey was also administered (16 questions with a Likert’s 5-point scale of evaluation).

Results

Twenty-three MUSEC Courses were run in a 30 months period, training 416 doctors from 29 countries. A total of 52 modules were delivered. The mean pre-test and post-test grades were 8.3/12 and 10.7/12, respectively, yielding a significant mean learning gain of 28.9 % (p = 0.001). Post-course satisfaction survey got an overall ranking of 4.5/5.

Conclusions

MUSEC is an effective and original educational format, enjoyed by candidates, that fills an educational gap for tailored US education as a procedural skill to acute care surgeons. Ongoing revisions should reduce the current limitations and increase the educational value, in terms of number of modules and post-course credentialing.
Literature
2.
go back to reference Tsao GJ, Orloff LA. Clinician-performed thyroid ultrasound-guided fine-needle aspiration. Otolaryngol Clin North Am. 2014;47(4):509–18.CrossRefPubMed Tsao GJ, Orloff LA. Clinician-performed thyroid ultrasound-guided fine-needle aspiration. Otolaryngol Clin North Am. 2014;47(4):509–18.CrossRefPubMed
3.
go back to reference Torzilli G, editor. US-guided liver surgery. Berlin: Springer; 2014. Torzilli G, editor. US-guided liver surgery. Berlin: Springer; 2014.
4.
go back to reference Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma. 1993;34(4):516–26.CrossRefPubMed Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma. 1993;34(4):516–26.CrossRefPubMed
5.
go back to reference Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment With Sonography For Trauma (EFAST). J Trauma. 2004;57(2):288–95.CrossRefPubMed Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, Hameed SM, Brown R, Simons R, Dulchavsky SA, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the Extended Focused Assessment With Sonography For Trauma (EFAST). J Trauma. 2004;57(2):288–95.CrossRefPubMed
6.
go back to reference Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.CrossRefPubMed Scalea TM, Rodriguez A, Chiu WC, Brenneman FD, Fallon WF Jr, Kato K, McKenney MG, Nerlich ML, Ochsner MG, Yoshii H. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma. 1999;46(3):466–72.CrossRefPubMed
7.
go back to reference Martínez Casas I, Casamassima A, Mariani D, Pereira J, Silva R, Pinheiro LF, Zago M. US ESTES Survey. Resultados de una encuesta europea sobre la utilización de la ecografía “point of care” en cirugía de urgencias y trauma. Cir Esp. 2014;92:231–2. Martínez Casas I, Casamassima A, Mariani D, Pereira J, Silva R, Pinheiro LF, Zago M. US ESTES Survey. Resultados de una encuesta europea sobre la utilización de la ecografía “point of care” en cirugía de urgencias y trauma. Cir Esp. 2014;92:231–2.
8.
go back to reference Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–35.CrossRefPubMed Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–35.CrossRefPubMed
9.
go back to reference Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Crit Care Med. 2007;35(5 Suppl):S290–304.CrossRefPubMed Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Crit Care Med. 2007;35(5 Suppl):S290–304.CrossRefPubMed
10.
go back to reference Zago M. Time for a comprehensive ultrasound-enhanced trauma management. Eur J Trauma Emerg Surg. 2009;35:339–40.CrossRefPubMed Zago M. Time for a comprehensive ultrasound-enhanced trauma management. Eur J Trauma Emerg Surg. 2009;35:339–40.CrossRefPubMed
11.
go back to reference Stawicki SP, Bahner DP. Modern sonology and the bedside practitioner: evolution of ultrasound from curious novelty to essential clinical tool. Eur J Trauma Emerg Surg. 2015;41:457–60.CrossRefPubMed Stawicki SP, Bahner DP. Modern sonology and the bedside practitioner: evolution of ultrasound from curious novelty to essential clinical tool. Eur J Trauma Emerg Surg. 2015;41:457–60.CrossRefPubMed
12.
go back to reference Padalino P, Bomben F, Chiara O, Montagnolo G, Marini A, Zago M, Rebora P. Healing of blunt liver injuries after non-operative management: role of ultrasonography follow-up. Eur J Trauma Emerg Surg. 2009;35:364–70.CrossRefPubMed Padalino P, Bomben F, Chiara O, Montagnolo G, Marini A, Zago M, Rebora P. Healing of blunt liver injuries after non-operative management: role of ultrasonography follow-up. Eur J Trauma Emerg Surg. 2009;35:364–70.CrossRefPubMed
13.
go back to reference Zago M, Mariani D, Casamassima A, Turconi MG, Kurihara H, Luzzana F. Chest XRay can be safely skipped if thoracic US (EFAST) is included in trauma protocol. A prospective study. Eur J Trauma Emerg Surg. 2008;34:55.CrossRef Zago M, Mariani D, Casamassima A, Turconi MG, Kurihara H, Luzzana F. Chest XRay can be safely skipped if thoracic US (EFAST) is included in trauma protocol. A prospective study. Eur J Trauma Emerg Surg. 2008;34:55.CrossRef
14.
15.
go back to reference Pereira J, Afonso AC, Constantino J, Matos A, Henriques C, Zago M, Pinheiro LF. Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg. 2016. doi:10.1007/s00068-015-0619-4.PubMed Pereira J, Afonso AC, Constantino J, Matos A, Henriques C, Zago M, Pinheiro LF. Accuracy of ultrasound in the diagnosis of acute cholecystitis with coexistent acute pancreatitis. Eur J Trauma Emerg Surg. 2016. doi:10.​1007/​s00068-015-0619-4.PubMed
16.
go back to reference El Sayed MJ, Zaghrini E. Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int. 2013;2013:531674.CrossRefPubMedPubMedCentral El Sayed MJ, Zaghrini E. Prehospital emergency ultrasound: a review of current clinical applications, challenges, and future implications. Emerg Med Int. 2013;2013:531674.CrossRefPubMedPubMedCentral
17.
go back to reference Via G, Storti E, Spreafico A, Melniker L, Neri L. Point of care ultrasound for sepsis management in resource-limited settings: time for a new paradigm for global health care. Intensive Care Med. 2012;38(8):1405–7.CrossRefPubMed Via G, Storti E, Spreafico A, Melniker L, Neri L. Point of care ultrasound for sepsis management in resource-limited settings: time for a new paradigm for global health care. Intensive Care Med. 2012;38(8):1405–7.CrossRefPubMed
18.
19.
go back to reference Al-Kadi AS, Gillman LM, Ball CG, Panebianco NL, Kirkpatrick AW. Resuscitative long-bone sonography for the clinician: usefulness and pitfalls of focused clinical ultrasound to detect long-bone fractures during trauma resuscitation. Eur J Trauma Emerg Surg. 2009;35(4):357–63.CrossRefPubMed Al-Kadi AS, Gillman LM, Ball CG, Panebianco NL, Kirkpatrick AW. Resuscitative long-bone sonography for the clinician: usefulness and pitfalls of focused clinical ultrasound to detect long-bone fractures during trauma resuscitation. Eur J Trauma Emerg Surg. 2009;35(4):357–63.CrossRefPubMed
20.
go back to reference Stawicki SP, Adkins EJ, Eiferman DS, Evans DC, Ali NA, Njoku C, Lindsey DE, Cook CH, Balakrishnan JM, Valiaveedan S, Galwankar SC, Boulger CT, Springer AN, Bahner DP. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956–63.CrossRefPubMed Stawicki SP, Adkins EJ, Eiferman DS, Evans DC, Ali NA, Njoku C, Lindsey DE, Cook CH, Balakrishnan JM, Valiaveedan S, Galwankar SC, Boulger CT, Springer AN, Bahner DP. Prospective evaluation of intravascular volume status in critically ill patients: does inferior vena cava collapsibility correlate with central venous pressure? J Trauma Acute Care Surg. 2014;76(4):956–63.CrossRefPubMed
21.
go back to reference Kelly N, Esteve R, Papadimos TJ, Sharpe RP, Keeney SA, DeQuevedo R, Portner M, Bahner DP, Stawicki SP. Clinician-performed ultrasound in hemodynamic and cardiac assessment: a synopsis of current indications and limitations. Eur J Trauma Emerg Surg. 2015;41(5):469–80.CrossRefPubMed Kelly N, Esteve R, Papadimos TJ, Sharpe RP, Keeney SA, DeQuevedo R, Portner M, Bahner DP, Stawicki SP. Clinician-performed ultrasound in hemodynamic and cardiac assessment: a synopsis of current indications and limitations. Eur J Trauma Emerg Surg. 2015;41(5):469–80.CrossRefPubMed
22.
go back to reference Frankel HL, Kirkpatrick AW, Elbarbary M, Blaivas M, Desai H, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, Marik PE, Talmor D, Levitov A. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically Ill patients-part I: general ultrasonography. Crit Care Med. 2015;43(11):2479–502.CrossRefPubMed Frankel HL, Kirkpatrick AW, Elbarbary M, Blaivas M, Desai H, Evans D, Summerfield DT, Slonim A, Breitkreutz R, Price S, Marik PE, Talmor D, Levitov A. Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically Ill patients-part I: general ultrasonography. Crit Care Med. 2015;43(11):2479–502.CrossRefPubMed
23.
go back to reference Flament JB, Delattre JF, Palot JP, Avisse C, Burde A. Ultrasound-guided percutaneous drainage of intra- peritoneal fluid collections. An experience of a surgical team with 205 patients. Chirurgie. 1991;117(4):298–310.PubMed Flament JB, Delattre JF, Palot JP, Avisse C, Burde A. Ultrasound-guided percutaneous drainage of intra- peritoneal fluid collections. An experience of a surgical team with 205 patients. Chirurgie. 1991;117(4):298–310.PubMed
24.
go back to reference Dalziel PJ, Noble VE. Bedside ultrasound and the assessment of renal colic: a review. Emerg Med J. 2013;30(1):3–8.CrossRefPubMed Dalziel PJ, Noble VE. Bedside ultrasound and the assessment of renal colic: a review. Emerg Med J. 2013;30(1):3–8.CrossRefPubMed
25.
go back to reference Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37:51–6CrossRefPubMed Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37:51–6CrossRefPubMed
26.
go back to reference Theodoro D, Blaivas M, Duggal S, Snyder G, Lucas M. Real- time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT). Am J Emerg Med. 2004;22:197–200.CrossRefPubMed Theodoro D, Blaivas M, Duggal S, Snyder G, Lucas M. Real- time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT). Am J Emerg Med. 2004;22:197–200.CrossRefPubMed
27.
go back to reference Ünlüer EE, Yavasi Ö, Eroğlu O, Yilmaz C, Akarca FK. Ultra-sonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med. 2010;17:260–4.CrossRefPubMed Ünlüer EE, Yavasi Ö, Eroğlu O, Yilmaz C, Akarca FK. Ultra-sonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med. 2010;17:260–4.CrossRefPubMed
28.
go back to reference Scheiermann P, Seeger FH, Breitkreutz R. Ultrasound-guided central venous access in adults and children: procedure and pathological findings. Anaesthesist. 2010;59(1):53–61.CrossRefPubMed Scheiermann P, Seeger FH, Breitkreutz R. Ultrasound-guided central venous access in adults and children: procedure and pathological findings. Anaesthesist. 2010;59(1):53–61.CrossRefPubMed
29.
go back to reference Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.CrossRefPubMedPubMedCentral Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008;6:16.CrossRefPubMedPubMedCentral
30.
go back to reference Rippey J, Gawthrope I. Creating thoracic phantoms for diagnostic and procedural ultrasound training. AJUM. 2012;15(2):43–54. Rippey J, Gawthrope I. Creating thoracic phantoms for diagnostic and procedural ultrasound training. AJUM. 2012;15(2):43–54.
31.
go back to reference Knowles MS. The modern practice of adult education: from pedagogy to andragogy. 2nd ed. New York: Cambridge Books; 1980. Knowles MS. The modern practice of adult education: from pedagogy to andragogy. 2nd ed. New York: Cambridge Books; 1980.
33.
go back to reference Hadley J, Kulier R, Zamora J, Coppus SF, Weinbrenner S, Meyerrose B, Decsi T, Horvath AR, Nagy E, Emparanza JI, Arvanitis TN, Burls A, Cabello JB, Kaczor M, Zanrei G, Pierer K, Kunz R, Wilkie V, Wall D, Mol BW, Khan KS. Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training. J R Soc Med. 2010;103(7):288–94.CrossRefPubMedPubMedCentral Hadley J, Kulier R, Zamora J, Coppus SF, Weinbrenner S, Meyerrose B, Decsi T, Horvath AR, Nagy E, Emparanza JI, Arvanitis TN, Burls A, Cabello JB, Kaczor M, Zanrei G, Pierer K, Kunz R, Wilkie V, Wall D, Mol BW, Khan KS. Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training. J R Soc Med. 2010;103(7):288–94.CrossRefPubMedPubMedCentral
34.
go back to reference Kulier R, Coppus SF, Zamora J, Hadley J, Malick S, Das K, Weinbrenner S, Meyerrose B, Decsi T, Horvath AR, Nagy E, Emparanza JI, Arvanitis TN, Burls A, Cabello JB, Kaczor M, Zanrei G, Pierer K, Stawiarz K, Kunz R, Mol BW. Khan KS The effectiveness of a clinically integrated e-learning course in evidence-based medicine: a cluster randomised controlled trial. BMC Med Educ. 2009;9:21. doi:10.1186/1472-6920-9-21.CrossRefPubMedPubMedCentral Kulier R, Coppus SF, Zamora J, Hadley J, Malick S, Das K, Weinbrenner S, Meyerrose B, Decsi T, Horvath AR, Nagy E, Emparanza JI, Arvanitis TN, Burls A, Cabello JB, Kaczor M, Zanrei G, Pierer K, Stawiarz K, Kunz R, Mol BW. Khan KS The effectiveness of a clinically integrated e-learning course in evidence-based medicine: a cluster randomised controlled trial. BMC Med Educ. 2009;9:21. doi:10.​1186/​1472-6920-9-21.CrossRefPubMedPubMedCentral
35.
go back to reference Cuca C, Scheiermann P, Hempel D, Via G, Seibel A, Barth M, Hirche TO, Walcher F, Breitkreutz R. Assessment of a new e-learning system on thorax, trachea, and lung ultrasound. Emerg Med Int. 2013;2013:145361.CrossRefPubMedPubMedCentral Cuca C, Scheiermann P, Hempel D, Via G, Seibel A, Barth M, Hirche TO, Walcher F, Breitkreutz R. Assessment of a new e-learning system on thorax, trachea, and lung ultrasound. Emerg Med Int. 2013;2013:145361.CrossRefPubMedPubMedCentral
36.
go back to reference Röhrig S, Hempel D, Stenger T, Armbruster W, Seibel A, Walcher F, Breitkreutz R. Which learning methods are expected for ultrasound training? Blend learning on trial. Anaesthesist. 2014;63(10):745–52.CrossRef Röhrig S, Hempel D, Stenger T, Armbruster W, Seibel A, Walcher F, Breitkreutz R. Which learning methods are expected for ultrasound training? Blend learning on trial. Anaesthesist. 2014;63(10):745–52.CrossRef
37.
go back to reference Lane N, Lahham S, Joseph L, Bahner DP, Fox JC. Ultrasound in medical education: listening to the echoes of the past to shape a vision for the future. Eur J Trauma Emerg Surg. 2015;41(5):461–7.CrossRefPubMed Lane N, Lahham S, Joseph L, Bahner DP, Fox JC. Ultrasound in medical education: listening to the echoes of the past to shape a vision for the future. Eur J Trauma Emerg Surg. 2015;41(5):461–7.CrossRefPubMed
38.
go back to reference Villamaria CY, Eliason JL, Napolitano L, Stansfield RB, Spencer JR, Rasmussen TE. Endovascular Skills for Trauma And Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J Trauma Acute Care Surg. 2014;76:929–36.CrossRefPubMed Villamaria CY, Eliason JL, Napolitano L, Stansfield RB, Spencer JR, Rasmussen TE. Endovascular Skills for Trauma And Resuscitative Surgery (ESTARS) course: curriculum development, content validation, and program assessment. J Trauma Acute Care Surg. 2014;76:929–36.CrossRefPubMed
39.
go back to reference Sisley AC, Johnson SB, Ericson W, Fortune JB. Use of an Objective Standardized Clinical Examination (OSCE) for assessment of physician performance in the ultrasound evaluation of trauma. J Trauma. 1999;47(4):627–31.CrossRefPubMed Sisley AC, Johnson SB, Ericson W, Fortune JB. Use of an Objective Standardized Clinical Examination (OSCE) for assessment of physician performance in the ultrasound evaluation of trauma. J Trauma. 1999;47(4):627–31.CrossRefPubMed
40.
go back to reference Ziesmann MT, Park J, Unger BJ, Kirkpatrick AW, Vergis A, Logsetty S, Pham C, Kirschner D, Gillman LM. Validation of the quality of ultrasound imaging and competence (QUICk) score as an objective assessment tool for the FAST examination. J Trauma Acute Care Surg. 2015;78(5):1008–13.CrossRefPubMed Ziesmann MT, Park J, Unger BJ, Kirkpatrick AW, Vergis A, Logsetty S, Pham C, Kirschner D, Gillman LM. Validation of the quality of ultrasound imaging and competence (QUICk) score as an objective assessment tool for the FAST examination. J Trauma Acute Care Surg. 2015;78(5):1008–13.CrossRefPubMed
41.
go back to reference Ziesmann MT, Park J, Unger B, Kirkpatrick AW, Vergis A, Pham C, Kirschner D, Logestty S. Gillman LM. Validation of hand motion analysis as an objective assessment tool for the Focused Assessment with Sonography for Trauma examination. J Trauma Acute Care Surg. 2015;79:631–7. Ziesmann MT, Park J, Unger B, Kirkpatrick AW, Vergis A, Pham C, Kirschner D, Logestty S. Gillman LM. Validation of hand motion analysis as an objective assessment tool for the Focused Assessment with Sonography for Trauma examination. J Trauma Acute Care Surg. 2015;79:631–7.
Metadata
Title
Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project
Authors
M. Zago
I. Martinez Casas
J. Pereira
D. Mariani
A. R. Silva
A. Casamassima
E. Barbosa
F. Ferreira
M. Ruesseler
G. A. Bass
L. Ponchietti
F. Butti
M. Marconi
L. F. Pinheiro
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-016-0651-z

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