Simulation based Training in Acquiring Images of Diagnostic Quality at the Bedside to Improve Patient Safety

 描述（由申请人提供）：越来越多的医生在没有接受过心脏病学或放射学培训的情况下采用床旁超声（POCUS）。为了避免诊断错误，有必要确保他们不仅在图像采集和解释方面具有必要的技能，而且还在理解诊断图像质量（DIQ）的构成方面具有必要的技能，以便他们能够识别他们采集的图像是否“足够好”，以针对给定患者的临床表现进行诊断。本提案的目的是开发1）用于量化活体患者采集图像诊断质量的量规，以及2）在技能评估系统（SAS）上实现量规的安全POCUS工具，SAS是华盛顿大学开发的用于培训和评估超声技能的模拟器。我们将开始与心脏超声，但这项技术将适用于其他器官的超声。DIQ的评估弥补了仅教授图像采集和图像解释的程序中的差距。拟议的规则和安全POCUS工具将使DIQ的有效培训成为可能，DIQ是医生很难从简短的POCUS培训计划中学习的一项基本技能。标题和安全POCUS工具将包含加权标准，不仅用于标准视图的DIQ，而且更重要的是，用于关键诊断所需的DIQ。我们还将开发动态指导，一种新的教学工具，以直观地向医生演示如何操纵换能器和调整设备设置有助于实现DIQ。我们将开发一个关于SAS的课程，以教授和评估DIQ的技能。然后，我们将通过比较接受过与未接受DIQ培训的医生正确区分诊断质量适当与不适当的图像的能力，评估DIQ课程对患者安全性的影响。医疗保健福利：这项研究对患者安全具有重要意义，因为获取诊断质量图像的能力可以减少POCUS的假阴性和假阳性诊断，并帮助医生在有限的患者数量上保持技能，从而提高超声在实践中的安全有效利用。

 DESCRIPTION (provided by applicant): Growing numbers of physicians are adopting point of care ultrasound (POCUS) without having trained in cardiology or radiology. To avoid diagnostic error it is necessary to ensure that they have the requisite skills not only in image acquisition and interpretation, but also in understanding what constitutes diagnostic image quality (DIQ) so that they can identify whether their acquired images are "good enough" to make a diagnosis for a given patient's clinical presentation. The objective of the present proposal is to develop 1) a rubric for quantifying the diagnostic quality of images acquired on live patients, and 2) a safe-POCUS tool that implements the rubric on the Skills Assessment System (SAS), a simulator developed at the University of Washington for training and assessment of ultrasound skill. We will begin with cardiac ultrasound but this technology will be applicable to ultrasound of other organs. The assessment of DIQ bridges the gap in programs that only teach image acquisition and image interpretation. The proposed rubric and safe-POCUS tool will enable efficient training in DIQ, an essential skill that is difficult for physicians to learn from abbreviated POCUS trainin programs. The rubric and safe-POCUS tool will contain weighted criteria not only for DIQ of standard views, but also and more importantly, DIQ required for key diagnoses. We will also develop Dynamic Guidance, a novel instructional tool, to visually demonstrate to physicians how manipulating the transducer and adjusting equipment settings helps achieve DIQ. We will develop a curriculum on the SAS to teach and assess skill in DIQ. We will then assess the impact of the DIQ curriculum on patient safety by comparing the ability of physicians with vs. without DIQ training to correctly distinguish images of adequate vs. inadequate quality for diagnosis. HEALTH CARE BENEFIT: This research is significant for patient safety because competence in acquiring images of diagnostic quality may reduce false negative and false positive diagnoses from POCUS, and help physicians maintain skills over time and on limited patient volumes and thereby enhance the safe and effective utilization of ultrasound in their practices.