Assistant Professor of Pediatrics and Neonatology Baylor College of Medicine Houston, Texas, United States
Background: Point-of-care ultrasonography (POCUS) is an imaging modality with a rapidly expanding array of life, time, and cost-saving applications in the Neonatal Intensive Care Unit (NICU). Nevertheless, POCUS is a user-dependent technology that requires refined integration of multiple components, such as cognitive and psychomotor skills, to achieve its intended quality and safety goals. The introduction of novel modalities or bedside training of inexperienced practitioners may risk patient safety. This is especially critical for NICU patients, who are inherently vulnerable. Objective: Develop a POCUS training program grounded in contemporary instructional design strategies and evaluate its effectiveness in promoting competency in POCUS prior to clinical training on real patients. Design/Methods: We designed a pilot POCUS educational program structured into two phases: Pre-clinical and Clinical. We focused on umbilical venous and arterial catheters, and vascular access, as a blueprint for future POCUS training across diverse clinical applications. The pre-clinical phase emphasizes the development of cognitive and psychomotor skills. This phase involves engaging in electronic learning modules, simulation training, and a 6-hour hands-on workshop. The workshops are guided by experienced sonographers and vascular access facilitators, includes real patient video demonstrations along with practical exercises on specialized task trainers and volunteers. Cognitive and confidence assessments were quantified using a numerical scale, while procedural competence was evaluated using validated checklists. Results: A total of 25 learners were enrolled between September 2022 and May 2023, comprising fellows, NNPs, and Faculty. Test scores exhibited a significant improvement from pre-test (median 52%, IQR: 44% – 56%) to post-test (median 82%, IQR: 78% – 88%) (p < 0.001). Likewise, self-reported POCUS scanning and procedure skills confidence level significantly increased (mean 2.15, 95% CI [1.93, 2.37]) (p < 0.001). All participants exhibited scanning and procedural competence, as evidenced by validated POCUS checklists, prior to the culmination of the pre-clinical phase.
Conclusion(s): A comprehensive cognitive and hands-on pre-clinical training significantly enhanced participants' proficiency and confidence levels prior to real NICU patient training. Though recognizing that true clinical competency is only assessed in real-life settings, demonstrating competence in simulation is imperative for patient safety.
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