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A Prospective Analysis of Motor and Cognitive Skill Retention in Novice Learners of Point of Care Ultrasound

Rappaport, Charles A. MD1; McConomy, Bryan C. MD2; Arnold, Nicholas R. MD2; Vose, Aaron T. MD2; Schmidt, Gregory A. MD1; Nassar, Boulos MD1

doi: 10.1097/CCM.0000000000004002
Online Clinical Investigations

Objectives: To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners.

Setting: The University of Iowa Hospitals and Clinics.

Subjects: Twenty-four subjects (23 first-year medical students and one first-year physician assistant student).

Design: The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills.

Interventions: Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session.

Measurements and Main Results: For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008).

Conclusions: Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.

1Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.

2Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA.

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Supported, in part, departmental funds from the Department of Internal Medicine.

Dr. Schmidt received funding from McGraw-Hill, UpToDate, and Springer Science. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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