Browsing by Subject "Proficiency"

Now showing 1 - 5 of 5
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    An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number?
    (Wiley, 2023-11-22) Turner, Joseph S.; Stewart, Lauren K.; Hybarger, Andrew C.; Ellender, Timothy J.; Stepsis, Tyler M.; Bartkus, Edward A.; Garverick, Paul, II; Cooper, Dylan D.; Emergency Medicine, School of Medicine
    Objectives: Cricothyrotomy is a high-stakes emergency procedure. Because the procedure is rare, simulation is often used to train residents. The Accreditation Council for Graduate Medical Education (ACGME) requires performance of three cricothyrotomies during residency, but the optimal number of training repetitions is unknown. Additional repetitions beyond three could increase proficiency, though it is unknown whether there is a threshold beyond which there is no benefit to additional repetition. The objective of this study was to establish a minimum number of simulated cricothyrotomy attempts beyond which additional attempts did not increase proficiency. Methods: This was a prospective, observational study conducted over 3 years at the simulation center of an academic emergency medicine residency program. Participants were residents participating in a cricothyrotomy training as part of a longitudinal airway curriculum course. The primary outcome was time to successful completion of the procedure as first-year residents. Secondary outcomes included time to completion as second- and third-year residents. Procedure times were plotted as a function of attempt number. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and correlation analysis. Preprocedure surveys collected further data regarding procedure experience, confidence, and comfort. Results: Sixty-nine first-year residents participated in the study. Steady improvement in time to completion was seen through the first six attempts (from a mean of 75 to 41 sec), after which no further significant improvement was found. Second- and third-year residents initially demonstrated slower performance than first-year residents but rapidly improved to surpass their first-year performance. Resident mean times at five attempts were faster with each year of residency (first-year 48 sec, second-year 30 sec, third-year 24 sec). There was no statistically significant correlation between confidence and time to complete the procedure. Conclusions: Additional repetition beyond the ACGME-endorsed three cricothyrotomy attempts may help increase proficiency. Periodic retraining may be important to maintain skills.
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    Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting
    (Springer, 2021-06-30) House, Darlene R.; Amatya, Yogendra; Nti, Benjamin; Russell, Frances M.; Emergency Medicine, School of Medicine
    Background: Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. Methods: A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. Results: Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. Conclusions: Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.
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    Multi-Institutional Survey of Fourth Year Students’ Self Assessed Milestone Based Skill Proficiency and Faculty Expectation During an Emergency Medicine Clerk-ship: Implications For Curriculum Development
    (Taylor & Francis, 2018-09-13) Pettit, Katie; Turner, Joseph; Hogan, Kathryn; Poznanski, Stacey; Pfennig-Bass, Camiron; Kouyoumjian, Sarkis; Hexom, Braden; Perkins, Anthony; Pitre, Cory; Humbert, Aloysius; Emergency Medicine, School of Medicine
    Introduction: Emergency medicine milestones suggest skill performance expectations for graduating medical students. The objective of this study is to examine differences between student’s perceived proficiency and faculty expectations relative to Level 1 EM milestones, identifying opportunities for curriculum development. Methods: Using ACGME milestone language, the authors developed a survey that measures student perceived skill proficiency with 22 skills, which was administered to fourth year medical students at 6 institutions. Similar surveys were sent to faculty to determine their expectations of students’ skill proficiency. Differences between student and faculty responses were calculated. Results: There were 608 student and 114 faculty responses. There was a statistically significant difference between mean student and faculty responses for 13 of the 22 skills. For 10 of these skills, students rated their own skill proficiency higher than faculty expectations. For 3 of the skills, faculty rated their expectations higher than students’ perceived proficiency. Conclusions: For pharmacology skills, student ratings were low, indicating an area to focus curriculum development. Items where student ratings are higher than faculty may be a result of overconfidence or a lack of understanding by faculty of students’ abilities. Formal assessment of skills in these areas would help clarify the reason and direct faculty and curriculum development.
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    Predictors of Second-Language Reading Performance
    (Publisher of original article: Multilingual Matters & Channel View Publications [BREAK][LINK]http://www.multilingual-matters.com/[/LINK][BREAK] Access to the original article may require subscription and authorized logon ID/password. IUPUI faculty/staff/students please check University Library resources before purchasing an article. Questions on finding the original article via our databases? Ask a librarian: [LINK]http://www.ulib.iupui.edu/research/askalibrarian[/LINK]., 1983) Connor, Ulla, 1948-
    This study identified individual, instructional and socio-cultural factors that are reliable predictors of limited-English-proficiency (LEP) children's reading performance in English. The reading comprehension section of the Metropolitan Achievement Test was used to assess the reading skills of 91 LEP students (K-12) with different linguistic backgrounds in the U.S. school system. Information about the independent variables was gathered from a special questionnaire. The data were analysed by means of multiple regression analysis. The results of regression analysis showed that in this sample, grade, Vietnamese language background, percentage of English spoken at home, higher level paternal occupation, and a relatively high number of students in the English-as-a-second-language class had positive effects on the reading skills of the subjects. With these data it was impossible to separate the impact of length of U.S. residence from the length of ESL instruction in U.S. Intensity of ESL instruction showed a statistically significant negative effect on the reading scores. There were several predictors which did not have a significant effect on reading performance: gender, number of siblings and sibling position, hours of television watching, number of public library visits, length parents' stay in the U.S., parents' levels of education and social status, and mother's staying at home. A central theme of this study is that single-variate approaches are inadequate to study the causes of reading performance; rather, several predictors should be employed to measure true relationships between L2 reading performance and independent predictors.
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    What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines?
    (Wiley, 2020-07-22) Russell, Frances M.; Ferre, Robinson; Ehrman, Robert R.; Noble, Vicki; Gargani, Luna; Collins, Sean P.; Levy, Phillip D.; Fabre, Katarina L.; Eckert, George J.; Pang, Peter S.; Emergency Medicine, School of Medicine
    Aims The goal of this study was to determine the number of scans needed for novice learners to attain proficiency in B‐line quantification compared with expert interpretation. Methods and results This was a prospective, multicentre observational study of novice learners, physicians and non‐physicians from three academic institutions. Learners received a 2 h lung ultrasound (LUS) training session on B‐line assessment, including lecture, video review to practice counting and hands‐on patient scanning. Learners quantified B‐lines using an eight‐zone scanning protocol in patients with suspected acute heart failure. Ultrasound (US) machine settings were standardized to a depth of 18 cm and clip length of 6 s, and tissue harmonics and multibeam former were deactivated. For quantification, the intercostal space with the greatest number of B‐lines within each zone was used for scoring. Each zone was given a score of 0–20 based on the maximum number of B‐lines counted during one respiratory cycle. The B‐line score was determined by multiplying the percentage of the intercostal space filled with B‐lines by 20. We compared learner B‐line counts with a blinded expert reviewer (five US fellowship‐trained faculty with > 5 years of clinical experience) for each lung zone scanned; proficiency was defined as an intraclass correlation of > 0.7. Learning curves for each learner were constructed using cumulative sum method for statistical analysis. The Wilcoxon rank‐sum test was used to compare the number of scans required to reach proficiency between different learner types. Twenty‐nine learners (21 research associates, 5 residents and 3 non‐US‐trained emergency medicine faculty) scanned 2629 lung zones with acute pulmonary oedema. After a mean of 10.8 (standard deviation 14.0) LUS zones scanned, learners reached the predefined proficiency standard. The number of scanned zones required to reach proficiency was not significantly different between physicians and non‐physicians (P = 0.26), learners with no prior US experience vs. > 25 prior patient scans (P = 0.64) and no prior vs. some prior LUS experience (P = 0.59). The overall intraclass correlation for agreement between learners and experts was 0.74 and 0.80 between experts. Conclusions Our results show that after a short, structured training, novice learners are able to achieve proficiency for quantifying B‐lines on LUS after scanning 11 zones. These findings support the use of LUS for B‐line quantification by non‐physicians in clinical and research applications.