Focused Cardiac and Lung Ultrasound in Anesthesia/Critical Care - The Role of Self-directed Simulation-assisted Training Compared to a Traditional Supervised Approach

Study Overview
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Brief Summary
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The purpose of this study is to determine whether a self-directed and simulation-based lung ultrasound (LUS) and focused cardiac ultrasound (FCU) curriculum is efficacious on anesthesia trainees' image acquisition skills and diagnostic acumen. The investigators hypothesize that a self-directed and ultrasound-assisted LUS and FCU curriculum that includes video lectures, online teaching modules, an ultrasound simulator, and self-directed hands-on sessions on critically ill mechanically ventilated patients is effective in training novice ultrasonographers to obtain good quality images, to correctly interpret them, and to support clinical decision-making in critically ill patients. Trainees will be randomized to fully supervised FCU hands-on sessions on healthy models and critically ill mechanically ventilated patients (control group - traditional apprenticeship model) or to a completely self-directed and simulation-based approach (intervention group). To assess if this new self-directed and simulation-based ultrasound curriculum leads to adequate acquisition of competences (adequate image acquisition and interpretation) in novice ultrasonographers, trainees will have to perform a focused lung and cardiac assessment on a critically ill mechanically ventilated patient.

Official Title
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Focused Cardiac and Lung Ultrasound in Anesthesia/Critical Care - The Role of Self-directed Simulation-assisted Training Compared to a Traditional Supervised Approach

Conditions
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Education, Medical, Critical Care Ultrasonography

Intervention / Treatment
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* Other: Self-directed and simulation-assisted training
* Other: Traditional apprenticeship training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: PGY1 and PGY2 anesthesia resident at the University of Toronto Exclusion Criteria: Previous training in lung ultrasound or FCU
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Self-directed and simulation-assisted training<br> | Other: Self-directed and simulation-assisted training<br>* All participants will attend an ultrasound introductory course (lectures and illustrative interactive cases). Participants randomized to the intervention group will undergo a completely self-directed lung and focused cardiac ultrasound curriculum. A set of video-lectures on how to perform US on a critically ill patient (video-tutorials on image acquisition, troubleshooting, and pitfalls) will be provided. Participant will have access to an ultrasound simulator. Finally, participants in the intervention group will be asked to perform self-directed lung and focused cardiac ultrasound examinations on critically ill patients. An investigator will supervise the sessions but will not interfere with the self-learning process. - To support their learning, trainees will have access to on-line virtual FCU and LUS modules created by the Toronto General Hospital Department of Anesthesia Perioperative Interactive Education (http://pie.med.utoronto.ca/TTE/index.htm).<br>|
| Active Comparator: Traditional apprenticeship training<br> | Other: Traditional apprenticeship training<br>* All participants will attend an half-day ultrasound introductory course. Participants randomized to the conventional group will initially attend 2-hour hands-on session on healthy volunteers, fully supervised by an expert critical care ultrasonographer (acquisition of basic knowledge with US machine settings and probe positioning and orientation, normal view acquisition, and identification of normal anatomical structures and landmarks). Subsequently, participants will attend a 3-hours hands-on session on critically ill patients, fully supervised by an expert critical care ultrasonographer.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference between pre- and post-intervention image acquisition and interpretation skill (as compared to the benchmark exam). | The quality of the images will be scored from 1 (worst) to 5 (best). The score will be based on the assessment of the quality of the image as well as an assessment of relevant cardiac structures included in each view. Difference between pre- and post-intervention image acquisition skills and knowledge as measured by: Scanning time (total and per view) Anatomy recognition Items completion (%) Image interpretation (Y/N for lung sliding, interstitial syndrome, pleural effusion, consolidation, pericardial fluid, LV global function, RV global function, intravascular volume assessment; total and per objective accuracy) MCQs results (%) (Indication & Image interpretation assessment) Video-interpretation of cases results (%) (Image interpretation & Clinical decision-making assessment) Qualitative and quantitative analysis of survey results (dichotomic questions; graded criteria; e.g.10-point Likert scale) |  4-5 months post-study enrolment, after completion of ultrasound training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Differences between self-directed and simulation-assisted training and traditional apprenticeship training | Difference between groups in image acquisition skills and knowledge as measured by: Quality of images obtained (total and per view score) Scanning time (total and per view) Anatomy recognition (at least 4 structures identified/views for FCU, and 3 structures identified/LUS findings for LUS; max score 20 + 6) Items completion (%) Image interpretation (Y/N for lung sliding, interstitial syndrome, pleural effusion, consolidation, pericardial fluid, LV global function, RV global function, intravascular volume assessment; total and per objective accuracy) MCQs results (%) (Indication & Image interpretation assessment) Video-interpretation of cases results (%) (Image interpretation & Clinical decision-making assessment) Qualitative and quantitative analysis of survey results (dichotomic questions; graded criteria; e.g.10-point Likert scale) |  4-5 months post-study enrolment, after completion of ultrasound training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Focused Cardiac Ultrasound, Lung Ultrasound, Simulation, Education, Web-based learning