Design and evaluation of an "iBook" on abdominal aortic ultrasound educational activities offered to pre-clerkships students

Brief outline of the project

The goal of this research is to develop an electronic educational tool (iBook) to facilitate the teaching of point-of-care ultrasound (POCUS) to pre-clerkships students. This research is innovative in medical education in order to optimize the training of students and make them more capable of performing an ultrasound scan on the targeted theme. The development and evaluation of iBook is a project that will enhance collaboration between health educators, clinicians and the work of a student researcher. This project will improve students' understanding of the benefits of POCUS and will strengthen their clinical skills by assessing a structure that is difficult to examine. In addition, our research has a long-term goal of meeting the health needs of the remote areas residents’ population by optimizing the early medical knowledge of medical students. Accelerating the development of knowledge and the improvement of clinical skills is well aligned with the strategic directions of the Faculty of Medicine, University of Ottawa. This study will show that the learning approach by this innovative method is more effective in developing the early practice of POCUS in pre-clerkships students, in particular for those who have difficulty performing physical exams.

Ultrasound is a very effective imaging technique for all clinicians. This tool is used safely in a variety of clinical settings by skilled healthcare professionals (Stone-McLean et al., 2017). A wide range of evidence demonstrates that the use of ultrasound improves clinical outcomes, declines rates of failure and complications during procedures, rapidly decreases the list of differential diagnoses, reduces treatment times and the cost of care as well as the use of other types of risky imaging (Khoury et al, 2020).

Moreover, the incidence of abdominal aortic aneurysm (AAA) can reach 5% in men over 50 years and 10% in men smokers over 65%. AAA is one of the leading causes of preventable death in North America (Salyer, 2007). Ultrasound is almost 100% accurate in diagnosing AAA in patients at risk during a routine exam. Ultrasound effectively reduces diagnostic time and improves the death rate of people diagnosed with AAA (Salyer, 2007). In a previous POCUS project, which was carried out with pre-clerkships students at the University of Ottawa, they demonstrated a good ability to obtain images of different organs, in particular the heart (Khoury et al. 2020). In addition, during the Physical Skills Development (PSD) sessions, these same students have difficulty in manually examining the size of the abdominal aorta (AA).

This pilot study aims to:

  1. Design an iBook for use in training during the POCUS Abdominal Aortic Ultrasound program.
  • To evaluate with students the effectiveness of the iBook as a tool to aid in the visualization of ultrasound images of the abdominal aorta.

Methodology:

This research project will take place in two stages. This funding request is for Stage 1 of the project.

  • Step 1: Design the iBook

A literature review will be carried out in scientific databases and in an environmental scan in order to synthesize the information necessary for the design of the iBook. This information will cover knobology, A.A. anatomy, and A.A. ultrasound scan mechanism videos, normal and pathological images.

We will then use the iOS / Apple software to design the iBook before testing it with all members of the research team as well as students.

Step 2: evaluation of the iBook

Design: The assessment will be done as part of a flipped classroom model or we could use the iBook as a teaching tool distributed 1 week before the start of a face-to-face or online workshop (In the form of a "teleconsultation" if the COVID19 pandemic continues). This 2-hour hands-on workshop will focus on the practice of knobology and the practice of abdominal aortic ultrasound.

Population: pre-clerkships students

Data collection: A pre- and post-test 1 questionnaires will be administered to students before and after the practical workshop. During the workshop, students will perform three practice scans to visualize AA, and their fourth scan will be recorded for evaluation by an expert clinician in POCUS. A post-test 2 will be administered six weeks later to the same participants to assess long-term retention. The pre- and post-test 1 & 2 will aim to test the level of knowledge of the students

Expected results:

For stage 1, we expect that the literature review will provide us with enough information to allow us to design the iBook.

For Stage 2, we anticipate that the majority of students will demonstrate a good ability to acquire an adequate image of the abdominal aorta, including interpretable cross-sectional images of the distal abdominal aorta and the bifurcation in longitudinal and transverse views. Furthermore, they will be able to obtain interpretable transverse images of the proximal and middle aorta. In addition, we anticipate an increase in the level of students' knowledge between pre-and posttests. Key Words associated with the project: Aorta; Education; pre-clerkships; pre-clinical; Point-of-care ultrasound; Ultrasound.

Key Words associated with the project:

Aorta; Education; pre-clerkships; pre-clinical; Point-of-care ultrasound; Ultrasound.

Tasks for the upcoming project:

Contribute to the identification of relevant articles in databases
Contribute to the synthesis of information
Contribute to the design of the iBook
Contribute to the design of the questionnaire
Initiate the ethics approval request
Design a scientific poster (for the research day of the faculty of medicine)

Reference:

  1. Khoury, F. (2020). Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability. Journal of Medical Education and Curricular Development, 7, 238212052094361–2382120520943615. https://doi.org/10.1177/2382120520943615
  2. Salyer, S. W. (2007). Essential emergency medicine: for the healthcare practitioner. Elsevier Health Sciences.
  3. Stone-McLean, J., Metcalfe, B., Sheppard, G., Murphy, J., Black, H., McCarthy, H., & Dubrowski, A. (2017). Developing an undergraduate ultrasound curriculum: a needs assessment. Cureus, 9 (9).
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