Teaching whole body point-of-care ultrasound: advancing the skills of tomorrow's anesthesiologists.
Teaching whole body point-of-care ultrasound: advancing the skills of tomorrow's anesthesiologists.
复制标题
教授全身床旁超声：提高未来麻醉师的技能。
DOI：
10.1097/aln.0000000000000777
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发表时间：
2015
期刊：
影响因子：
8.8
通讯作者：
N. Skubas
中科院分区：
文献类型：
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作者：
N. Skubas
麻醉学，V 123 · No 3 2015年9月499日P OINT-Of-care（POc）超声是超声在各种解剖部位或身体器官上的实时应用，用于诊断或手术目的。它是用独立的，通常是便携式的超声设备进行的，这些设备很容易带到病人身边，甚至可以用手携带或放在口袋里。在本期aNesThesIOlOgy中，来自加州大学欧文分校的ramsingh等人1评估了麻醉科住院医师的POC超声培训课程，发现它是一种有效的教育工具，对围手术期外科家庭具有潜在的临床益处。作者开发了一个教学课程（符合研究生医学教育核心能力要求的认证理事会），以评价心脏功能和血流动力学、肺和腹部、气管插管的位置和视神经鞘的直径。教育活动包括教学讲座、人体模型或模拟设备的实践课程、简短的临床情景以及培训前和培训后的测试。研究的目的是探讨这种课程是否会改善住院医师的培训和临床护理。居民总体满意，提高了他们的知识，并发现活动与他们未来的实践。在手术室、麻醉前或麻醉后区域、重症监护室或其他地点，根据要求进行POc超声检查的住院医师中，对临床管理的可转移性进行了测试。他们的发现，当由主治医生验证时，帮助主要麻醉团队进行新的，主要是心血管和肺部诊断，促使他们在76%的病例中改变管理。目前研究的主要优势是精心设计和执行的教育模块，其中涉及超声初治麻醉住院医师。但是，与基于模拟的课程一样，实践和测试是在健康的人体模型或模拟器上进行的，而不是在不同体质或病理的实际患者身上进行的。然而，作者能够通过在真实的病人身上测试住院医生的新认知和灵活技能的临床应用来弥补这一点。应该指出的是，这种补偿是部分的，因为住院医生发现的任何新发现都必须与监督主治教师的评估一致。因此，目前还不清楚有多少诊断或决策错误的居民。模拟程序对于超声初学者的知识获取和技术技能教学是有用的。2 -8 Ramsingh等人提出的全面的POC超声课程显然是创新的和有远见的。这项研究可能会提供另一套工具，麻醉师谁将在未来的围手术期手术室执业，并作为真正的围手术期医生。如果在单一环境下由单一提供者对患者进行评估，则可以加快速度，如果能够发现或验证最关键的临床诊断，主要是心血管和肺部系统的诊断，则将非常宝贵。这种实践具有增加麻醉实践/组/部门的医院吸引力的潜力，并且甚至可能具有POC超声实践麻醉护理团队的收入潜力。然而，缺乏关于这种超声模拟程序的长期影响的信息。首先，各种超声课程在美国麻醉学委员会的内容大纲中没有找到它们作为一个独特主题的位置。尽管超声既不是唯一的，也不是专门用于心脏麻醉或重症监护的，但现在非心脏麻醉的实践并不常规地包括超声的使用。在许多麻醉学教学中心，麻醉科住院医师第一次接触临床超声可能是在心脏手术室或局部麻醉/阻滞室，而不是在普通手术室、入院前诊所、教学全身床旁超声。
Anesthesiology, V 123 • No 3 499 September 2015 P OINT-Of-care (POc) ultrasound is the real-time application of ultrasound on various anatomic parts or body organs for diagnostic or procedural purposes. It is performed with standalone, usually portable, ultrasound devices that are easy to bring to the patient’s side or even carry by hand or inside one’s pocket. In this issue of aNesThesIOlOgy, ramsingh et al.1 from the University of californiaIrvine assessed a POc ultrasound training curriculum for anesthesiology residents and found it an effective educational tool and of potential clinical benefit for the perioperative surgical home. The authors developed a didactic curriculum (which complied with the accreditation council for graduate Medical education core competencies requirements) to evaluate the cardiac function and hemodynamics, the lungs and abdomen, the position of the endotracheal tube, and the diameter of the optic nerve sheath. The education activities included didactic lectures, practice sessions on human models or simulation devices, short clinical scenarios, and preand posttraining testing. The aims of the study were to explore whether such a curriculum would improve residents’ training and clinical care. The residents were overall satisfied, improved their knowledge, and found the activity relevant to their future practice. The transferability to clinical management was tested with residents who performed POc ultrasound examinations upon request in the operating rooms, preor postanesthesia areas, intensive care units, or other locations. Their findings, when verified by an attending, assisted the primary anesthesia team with new, primarily cardiovascular and pulmonary diagnoses that prompted them to change management in 76% of the cases. The primary strength of the current study is the carefully designed and executed education module, which involved ultrasound-naive anesthesiology residents. But, as is the case for simulation-based curricula, the hands-on practice and testing were on healthy human models or simulators, not on actual patients of varying body habitus or pathology. however, the authors were able to compensate for this by testing the clinical application of the residents’ new cognitive and dexterity skills on real patients. It should be pointed out that this compensation was partial because any new findings detected by the resident had to be in agreement with the evaluation of the supervising attending faculty. Therefore, it remains unclear how many diagnostic or decision errors were made by the residents. simulation programs are useful for the acquisition of knowledge and the teaching of technical skills in ultrasound-naive learners.2–8 The comprehensive POc ultrasound curriculum presented by ramsingh et al. is clearly innovative and with foresight. The study may provide another set of tools for anesthesiologists who will be practicing in a future perioperative surgical home and functioning as true perioperative physicians. The evaluation of patients may be expedited if performed in a single setting and by a single provider, and will be quite invaluable, if it uncovers or verifies the most critical clinical diagnoses, mainly within the cardiovascular and pulmonary systems. such practice has the potential to increase the hospital appeal of the anesthesiology practice/group/department and may even have revenue potential for the POc ultrasound practicing anesthesia care team. however, the information on the long-lasting impact of such ultrasound simulation programs is lacking. first of all, the various ultrasound curricula have not found their place in the american Board of anesthesiology content outline as a distinct topic. although ultrasound is neither unique nor reserved for use in cardiac anesthesia or intensive care, nowadays the practice of noncardiac anesthesia does not routinely incorporate the use of ultrasound. In many anesthesiology teaching centers, an anesthesiology resident’s first encounter with clinical ultrasound is probably in the cardiac operating room or the regional anesthesia/block suite, but not in the general operating room, the preadmission clinic, Teaching Whole Body Point-of-Care Ultrasound