scholarly journals MP20: ImageSim - performance-based medical image interpretation learning system

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S47-S47
Author(s):  
K. Boutis ◽  
M. Pecarcic ◽  
M. Pusic
Keyword(s):  
Emergency Medicine ◽  
Clinical Practice ◽  
Medical Image ◽  
Medical Images ◽  
Image Interpretation ◽  
Deliberate Practice ◽  
Learning System ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Emergency Medicine Physician

Introduction: Medical images (e.g. radiographs) are the most commonly ordered tests in emergency medicine. As such, emergency medicine physicians are faced with the task of learning the skill of interpreting these images to an expert performance level by the time they provide opinions that guide patient management decisions. However, discordant interpretations of these images between emergency physicians and expert counterparts (e.g. radiologists) is a common cause of medical error. In pediatrics, this problem is even greater due to the changing physiology with age. Methods: ImageSim (https://imagesim.com/) is an evidence-based on-line learning platform derived and validated over an 11 year period (https://imagesim.com/research-and-efficacy/). This learning system incorporates the concepts of cognitive simulation, gamification, deliberate practice, and performance-based competency in the presentation and interpretation of medical images. Specifically, ImageSim presents images as they are experienced in clinical practice and incorporates a normal to abnormal ratio is representative of that seen in emergency medicine. Further, it forces the participant to commit to the case being normal or abnormal and if abnormal, the participant has to visually locate the specific area of pathology on the image. The participant submits a response and gets text and visual feedback with every case. After each case, the participant gets to play again until they reach a desired competency threshold (80% is bronze resident; 90% silver staff emergency medicine physician; 97% gold radiologist). Importantly, the learning experience also emphasizes deliberate practice such that the learning system provides hundreds of case examples and therefore each participants performance has the opportunity to improve along their individual learning curve. Results: Course selection was made based on known medical image interpretation knowledge gaps for practicing emergency physicians. Currently, ImageSim live courses include pediatric musculoskeletal radiographs (2,100 cases, 7 modules) and pediatric chest radiographs (434 cases). In 2018, we will also release a pediatric point-of-care ultrasound course (400 cases, 4 modules) and the pre-pubertal female genital examination (150 cases). For a demo, go to https://imagesim.com/demo/. Using ImageSim, the deliberate practice of about 120 cases (1 hour time commitment) increases accuracy on average by 15%. Currently integrated into 10 emergency medicine training programs and there are about 300 continuing medical education world-wide participants. Conclusion: While acquiring mastery for these images may take years to acquire via clinical practice alone, this learning system can potentially help achieve this in just a few hours.

Open source software e-learning system to improve medical image interpretation in young thoracic surgeons

2016 ◽  
Vol 2 (8) ◽  
Author(s):  
Kazuhiro Ito ◽  
Junichi Shimada ◽  
Daishiro Kato ◽  
Motohiro Nishimura ◽  
Satoru Okada
Keyword(s):  
Open Source ◽  
Open Source Software ◽  
Medical Image ◽  
Image Interpretation ◽  
Learning System ◽  
Years Of Experience ◽  
Network Computing ◽  
Pulmonary Vessels ◽  
E Learning ◽  
Private Network

<p><strong><em>Background</em></strong> We evaluated the efficacy of the e-learning system for improving young thoracic surgeons’ interpretations of chest computed tomography (CT) images.</p><p><strong><em>Methods</em></strong> We established an e-learning system for medical image interpretation using open source software that can be accessed from multiple sites. We used virtual network computing (VNC), a graphical desktop sharing protocol, to observe the remote server desktop screen. OsiriX, an image-processing package, was installed on the server to share medical images. Five young thoracic surgeons (3-8 years of experience) were instructed to interpret a preoperative chest CT from a remote partner hospital. Chest CTs were extracted from remote hospitals, anonymized, and uploaded to the secure server. The participants accessed the server via high-speed Internet secured with a virtual private network. The young surgeons then created a 3-dimensional configuration of the pulmonary vessels before procedure using the 2-dimensional scans. Next, 5 expert thoracic surgeons ranked the renderings on a 10-point scale. The edited surgical video with the actual pulmonary configuration was uploaded to the web server, and the young thoracic surgeons watched the video as a self-education module. They also commented on their peers’ preoperative images of the pulmonary vessels.</p><p><strong><em>Results</em></strong> The scores of the 5 interpretations and drawings of pulmonary vessel branching patterns of patients with lung cancer undergoing lobectomy increased with years of experience.</p><p><strong><em>Conclusions</em></strong> The young thoracic surgeons virtually learned lobectomy using an e-learning system. We believe this virtual resource will help young thoracic surgeons accumulate greater experience. </p>

scholarly journals International Federation for Emergency Medicine Point of Care Ultrasound Curriculum

CJEM ◽  
2015 ◽  
Vol 17 (2) ◽  
pp. 161-170 ◽  
Author(s):  
Paul Atkinson ◽  
Justin Bowra ◽  
Mike Lambert ◽  
Hein Lamprecht ◽  
Vicki Noble ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Continuing Professional Development ◽  
International Federation ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Educational Structure ◽  
Skill Maintenance ◽  
Wide Variability ◽  
International Experts

AbstractTo meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine.The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.

scholarly journals Dedicated time for deliberate practice: one emergency medicine program’s approach to point-of-care ultrasound (PoCUS) training

CJEM ◽  
2015 ◽  
Vol 17 (5) ◽  
pp. 558-561 ◽  
Author(s):  
Melissa Hayward ◽  
Teresa Chan ◽  
Andrew Healey
Keyword(s):  
Emergency Medicine ◽  
Medical Education ◽  
Skill Acquisition ◽  
Point Of Care ◽  
Deliberate Practice ◽  
Lessons Learned ◽  
Point Of Care Ultrasound ◽  
Residency Programs ◽  
Education Literature ◽  
Scholarly Discussion

AbstractPoint-of-care ultrasound (PoCUS) has become an essential skill in the practice of emergency medicine (EM). Various EM residency programs now require competency in basic PoCUS applications. The education literature suggests that deliberate practice is necessary for skill acquisition and mastery. We used an educational theory, Ericsson’s model of deliberate practice, to create a PoCUS curriculum for our Royal College of Physicians and Surgeons of Canada EM residency.Although international recommendations around curriculum requirements exist, this will be one of the first papers to describe the implementation of a specific PoCUS training program. This paper details the features of the program and lessons learned during its initial 3 years. Sharing this experience may serve as a nidus for scholarly discussion around how to best approach medical education in this area.

scholarly journals Development of Core Contents of Point-of-Care Ultrasound Curriculum for Pediatric Emergency Medicine Physician Training: A Modified Delphi Survey

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 757
Author(s):  
Jae-Hyun Kwon ◽  
Jin-Hee Lee ◽  
Young-Rock Ha ◽  
June-Dong Park ◽  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Modified Delphi ◽  
Experience Teaching ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Point Of Care Ultrasonography

Background: As the frequency of ultrasound use in pediatric emergency departments increases, it is necessary to train pediatric emergency medicine (PEM) physicians on pediatric point-of-care ultrasonography (POCUS). We discussed the core content of POCUS applications and proposed a POCUS training curriculum for PEM physicians in South Korea. Methods: Twenty-three experts were included if had performed over 1500 POCUS scans, had at least three years of experience teaching POCUS to physicians, were POCUS instructors or had completed a certified pediatric POCUS program. Experts rated 61 possible POCUS applications in terms of the importance of their inclusion in a PEM POCUS curriculum using the modified Delphi technique. Results: In round one, twelve (52.2%) out of 23 experts responded to the email. Eleven experts satisfied the inclusion criteria. Eleven experts participated in round one of a survey and agreed on 27 (44.3%) out of a total of 61 items. In round two, all 11 experts participated in the survey; they agreed on two (5.9%) of the remaining 34 items, and no items were excluded. Conclusion: Using the Delphi method, 61 applications were discussed, and a consensus was reached on 29 core applications.

scholarly journals MP17: Education innovation: A tool to teach consultation skills using rapid cycle deliberate practice

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S48
Author(s):  
A. Johnston
Keyword(s):  
Emergency Medicine ◽  
Direct Observation ◽  
Clinical Teaching ◽  
Deliberate Practice ◽  
Frames Of Reference ◽  
Emergency Physicians ◽  
Phase 3 ◽  
Actual Consultation ◽  
Consultation Skills ◽  
Three Phases

Innovation Concept: Consultation skills (the collaborator role) are key for safe and effective Emergency Medicine practice. The tool described uses educational techniques familiar to Emergency Physicians and residents (rapid cycle deliberate practice and focused debriefing) to incorporate teaching of this skill into on-shift clinical teaching of Emergency Medicine residents. Methods: We searched the literature for consultation teaching methods. We developed a tool to teach consultation as part of on-shift clinical teaching using pedagogical concepts familiar to Emergency Medicine residents, rapid cycle deliberate practice and focused debriefing. The developed tool has three phases; 1) Introduction to a framework for good consultation skills, 2) Managing push-back and understanding competing frames of reference and 3) Direct observation and feedback on the actual consultation. The tool is designed to be used during a clinical shift. Over a series of consecutive cycles the resident refines a consultation and is eventually directly observed during the actual interaction with a consultant. Curriculum, Tool or Material: For each of the three phases the tool provides a framework for the preceptor to use to guide the presentation and discussion. During phases 1 and 2 the resident will present the consultation a number of times and the preceptor will provide focused debriefing allowing the presentation to be refined and optimized. During phase 3 the preceptor provides direct observation of the actual consultation followed by focused debriefing. Phase 1: Focuses on understanding the learners current skill level and presents a framework for a high quality consultation. Phase 2: Introduces the concept of competing frames of reference and push-back and patient centred strategies for managing this situation. Phase 3: The actual consultation interaction between resident and consultant is observed and debriefed. Conclusion: Consultation skills are important in the day to day practice of Emergency Medicine but rarely the subject of specific teaching. The tool presented can be used during clinical shifts to teach consultation skills using pedagogy familiar to both Emergency Physicians adEM residents.

scholarly journals Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

2020 ◽  
pp. 102490792092631
Author(s):  
Wei-Chen Chen ◽  
Chung-Hsien Chaou ◽  
Chip-Jin Ng ◽  
Yueh-Ping Liu ◽  
Yu-Che Chang
Keyword(s):  
Emergency Medicine ◽  
Residency Training ◽  
Clinical Supervision ◽  
Pediatric Patients ◽  
Training Programs ◽  
Demographic Data ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Emergency Physicians

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

scholarly journals LO092: The educational impact of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S61-S62
Author(s):  
C. Hrymak ◽  
E. Weldon ◽  
C. Pham
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Image Acquisition ◽  
Image Interpretation ◽  
Comfort Level ◽  
Point Of Care Ultrasound ◽  
Educational Impact ◽  
Hands On ◽  
Before And After ◽  
Junior Residents

Introduction: Point of care ultrasound for assessment of undifferentiated hypotension and shock is part of the clinical scope of Emergency Physicians in Canada. The RUSH Exam outlines a systematic approach to these patients. A RUSH Exam educational model using didactic and hands on practice was developed and implemented for Emergency Medicine (EM) residents. This study evaluated the effectiveness of the module in a simulated setting on the following endpoints: improvement in image acquisition, interpretation, speed, and subjective comfort level, among EM residents with basic ultrasound training. Methods: Approval was received from the institutional health research ethics board for this before and after simulation study. Residents in the -EM Program or CCFP-EM Program from July 2014 to July 2015 were eligible to consent. Participants were excluded if they were unable to complete all portions. All residents were educated to the same level of introductory ultrasound training based on the curriculum in place at our institution. The 8-hour intervention included RUSH didactic and hands on small group sessions. Testing before and after the intervention was performed with the SonoSim Livescan training platform. Two evaluators scored each resident on the accuracy of image acquisition, image interpretation, and time to scan completion. A before and after survey assessed resident comfort level with performing ultrasound on an emergency patient in shock, and basing decisions on ultrasound findings. Statistical analysis was performed using McNemar’s test for image acquisition and interpretation, a paired T test for time, and the Bahpkar test for the questionnaire. Results: 16 EM residents including 11 senior residents and 5 junior residents were enrolled. Improvement was achieved in the categories of IVC image acquisition and interpretation, as well as interpretation for B-lines, lung sliding, cardiac apical and parasternal long axis, and DVT (p<0.05). Subjective comfort level of performing ultrasound in shock and basing decisions on the findings was increased (p<0.0001). Among junior residents, there was an increased speed of image acquisition. Conclusion: With the introduction of the RUSH Exam educational module, EM residents showed improved image acquisition, image interpretation, speed, and comfort level when using ultrasound in critically ill patients.

scholarly journals Point-of-Care Ultrasound Training and Credentialing for mid-late Career Emergency Physicians: Is it worth it?

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 56-57
Author(s):  
Courtney Smalley ◽  
Erin Simon ◽  
McKinsey Muir ◽  
Fernando Delgado ◽  
Baruch Fertel
Keyword(s):  
United States ◽  
Emergency Medicine ◽  
Quality Assurance ◽  
American Medical Association ◽  
Medical Association ◽  
Emergency Physician ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Emergency Physicians ◽  
Residency Programs

Point-of-care ultrasound (POCUS) is becoming more prevalent in community emergency medicine (EM) practice with the current American College of Emergency Physician guidelines recommending POCUS training for all graduates from United States based residency programs as well as support for POCUS privileging by the American Medical Association. However, in a recent survey of nonacademic EDs, it was found that most providers lack US training, credentialing, and quality assurance (QA) assessments of their POCUS studies. In 2017, our healthcare system embarked on a system-wide credentialing process for POCUS to credential community physicians with little to no POCUS training.

Improving Patient Care Through Medical Image Perception Research

2015 ◽  
Vol 2 (1) ◽  
pp. 74-80 ◽  
Author(s):  
Elizabeth A. Krupinski
Keyword(s):  
Patient Care ◽  
Medical Image ◽  
Medical Images ◽  
Image Interpretation ◽  
Automated Image Analysis ◽  
Training Methods ◽  
Cognitive Mechanisms ◽  
Image Perception ◽  
Medical Specialties ◽  
Improving Patient Care

The interpretation of medical images across medical specialties is critical to patient care. As technology changes, so does health care, and clinicians today are increasingly viewing medical images in a variety of environments. Although access to such data is useful, even clinicians with expertise in image interpretation make errors. These errors may become more frequent as clinician workdays become longer and the number of images to be interpreted becomes larger. To prevent errors in medical image interpretation, we need to understand the underlying perceptual and cognitive mechanisms that guide image interpretation. We can then use what is learned to develop better training methods, automated image analysis, and processing tools. We can devise methods to reduce clinician fatigue and stress, and develop practice guidelines thereby improving patient care and outcomes.

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