Pocket-Sized Ultrasound as an Aid to Physical Diagnosis for Internal Medicine Residents: A Randomized Trial

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From: Journal of General Internal Medicine(Vol. 30, Issue 2)
Publisher: Springer
Document Type: Report
Length: 453 words

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Byline: Jason C. Ojeda (1), James A. Colbert (2,4,6), Xinyi Lin (3), Graham T. McMahon (4,6), Peter M. Doubilet (5,6), Carol B. Benson (5,6), Justina Wu (4,6), Joel T. Katz (4,6), Maria A. Yialamas (4,6) Keywords: medical education; assessment/evaluation; medical education clinical skills training; clinical skills assessment; educational technology Abstract: BACKGROUND Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded. OBJECTIVE We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice. DESIGN This was a randomized parallel group controlled trial. PARTICIPANTS Forty internal medicine residents in a single program at an academic medical center participated in the study. INTERVENTION Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice. MAIN MEASURES The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound. KEY RESULTS Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p=0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p=0.023). CONCLUSIONS The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice. Trial Registration: clinicaltrials.gov: number NCT01948076 URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2 Author Affiliation: (1) Department of Medicine, Jefferson University, Philadelphia, PA, USA (2) Department of Medicine, Newton-Wellesley Hospital, Newton, MA, USA (3) Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA (4) Department Of Medicine, Brigham and Women's Hospital, Boston, MA, USA (5) Department of Radiology, Brigham & Women's Hospital, Boston, MA, USA (6) Harvard Medical School, Boston, MA, USA Article History: Registration Date: 22/10/2014 Received Date: 03/02/2014 Accepted Date: 21/10/2014 Online Date: 12/11/2014 Article note: Electronic supplementary material The online version of this article (doi: 10.1007/s11606-014-3086-4) contains supplementary material, which is available to authorized users.

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Gale Document Number: GALE|A399902362