{"title":"基于网络的培训干预在急诊医生早期超声图像解读教学中的有效性。","authors":"Lori Stolz MD , Gillian Sheppard MD , Jeremy Boyd MD , Jessica Baez MD , Patrick Minges MD , Martin Pusic MD, PhD , Mathew Swarm MD , Megan Hilbert MD , Marisa O’Brien MD , Katie Harris MD , Catherine Varner MD , Constance LeBlanc MD , Kathy Boutis MD, BSc","doi":"10.1016/j.annemergmed.2025.01.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><div>To examine the effectiveness of an education intervention on emergency physician accuracy in identifying pregnancy-related findings from first-trimester point-of-care ultrasound. Case features associated with the odds of a correct response were also determined.</div></div><div><h3>Methods</h3><div>This was a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The unsupervised web-based education intervention included first-trimester point-of-care ultrasound cases acquired through the transabdominal (n=200 cases) or transvaginal (n=200 cases) approach. Physicians deliberately practiced identifying pregnancy-related imaging findings until they achieved a mastery standard.</div></div><div><h3>Results</h3><div>In 204 participants, there were learning gains in accuracy (15.2%; 95% confidence interval [CI] 14.6 to 15.8), sensitivity (15.1%; 95% CI 14.3 to 15.9), and specificity (14.3%; 95% CI 13.7 to 15.0). Of these, 132 (64.7%) achieved the mastery standard in a median of 60 cases (interquartile range 58 to 83). Case features associated with an increased odds of a correct intrauterine pregnancy “present” diagnosis were transvaginal versus transabdominal-acquired images (odds ratio [OR]=1.5; 95% CI 1.3 to 1.8) and fetal heartbeat (OR=4.3; 95% CI 3.4 to 5.5). A decreased odds was associated with an eccentrically located intrauterine pregnancy (OR=0.2; 95% CI 0.1 to 0.2), subchorionic hemorrhage (OR=0.5; 95% CI 0.4 to 0.6), adnexal mass (OR=0.7; 95% CI 0.6 to 0.9), and endometrial collection (OR=0.1; 95% CI 0.09 to 0.2).</div></div><div><h3>Conclusions</h3><div>This study’s intervention was effective in teaching first-trimester point-of-care ultrasound image interpretation and identified the specific variables that posed the greatest diagnostic challenges. The methods and results from this work can serve to expand learning opportunities for this critical skill in emergency medicine.</div></div>","PeriodicalId":8236,"journal":{"name":"Annals of emergency medicine","volume":"85 6","pages":"Pages 541-554"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effectiveness of a Web-Based Training Intervention in Teaching Emergency Physicians First-Trimester Point-of-Care Ultrasound Image Interpretation\",\"authors\":\"Lori Stolz MD , Gillian Sheppard MD , Jeremy Boyd MD , Jessica Baez MD , Patrick Minges MD , Martin Pusic MD, PhD , Mathew Swarm MD , Megan Hilbert MD , Marisa O’Brien MD , Katie Harris MD , Catherine Varner MD , Constance LeBlanc MD , Kathy Boutis MD, BSc\",\"doi\":\"10.1016/j.annemergmed.2025.01.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study objective</h3><div>To examine the effectiveness of an education intervention on emergency physician accuracy in identifying pregnancy-related findings from first-trimester point-of-care ultrasound. Case features associated with the odds of a correct response were also determined.</div></div><div><h3>Methods</h3><div>This was a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The unsupervised web-based education intervention included first-trimester point-of-care ultrasound cases acquired through the transabdominal (n=200 cases) or transvaginal (n=200 cases) approach. Physicians deliberately practiced identifying pregnancy-related imaging findings until they achieved a mastery standard.</div></div><div><h3>Results</h3><div>In 204 participants, there were learning gains in accuracy (15.2%; 95% confidence interval [CI] 14.6 to 15.8), sensitivity (15.1%; 95% CI 14.3 to 15.9), and specificity (14.3%; 95% CI 13.7 to 15.0). Of these, 132 (64.7%) achieved the mastery standard in a median of 60 cases (interquartile range 58 to 83). Case features associated with an increased odds of a correct intrauterine pregnancy “present” diagnosis were transvaginal versus transabdominal-acquired images (odds ratio [OR]=1.5; 95% CI 1.3 to 1.8) and fetal heartbeat (OR=4.3; 95% CI 3.4 to 5.5). A decreased odds was associated with an eccentrically located intrauterine pregnancy (OR=0.2; 95% CI 0.1 to 0.2), subchorionic hemorrhage (OR=0.5; 95% CI 0.4 to 0.6), adnexal mass (OR=0.7; 95% CI 0.6 to 0.9), and endometrial collection (OR=0.1; 95% CI 0.09 to 0.2).</div></div><div><h3>Conclusions</h3><div>This study’s intervention was effective in teaching first-trimester point-of-care ultrasound image interpretation and identified the specific variables that posed the greatest diagnostic challenges. The methods and results from this work can serve to expand learning opportunities for this critical skill in emergency medicine.</div></div>\",\"PeriodicalId\":8236,\"journal\":{\"name\":\"Annals of emergency medicine\",\"volume\":\"85 6\",\"pages\":\"Pages 541-554\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of emergency medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0196064425000150\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of emergency medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0196064425000150","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/20 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
研究目的：探讨教育干预对急诊医生在妊娠早期超声检查中识别妊娠相关发现的准确性的有效性。还确定了与正确反应几率相关的病例特征。方法：这是一项多中心前瞻性横断面研究，以美国和加拿大的急诊医生为方便样本。无监督的基于网络的教育干预包括通过经腹（n=200例）或经阴道（n=200例）途径获得的妊娠早期即时超声病例。医生故意练习识别与妊娠相关的影像学发现，直到他们达到熟练的标准。结果：204名参与者在准确性方面有学习增益(15.2%；95%置信区间[CI] 14.6 ~ 15.8)，敏感性(15.1%；95% CI 14.3 ~ 15.9)，特异性(14.3%；95% CI 13.7 ~ 15.0)。其中，132例（64.7%）达到了掌握标准，中位数为60例（四分位数范围为58至83）。与正确的宫内妊娠“当前”诊断的几率增加相关的病例特征是经阴道和经腹部获得性图像(优势比[OR]=1.5；95% CI 1.3 ~ 1.8)和胎儿心跳(OR=4.3；95% CI 3.4 - 5.5)。偏位宫内妊娠的发生率降低(OR=0.2；95% CI 0.1 ~ 0.2)，绒毛膜下出血(OR=0.5；95% CI 0.4 ~ 0.6)，附件肿块(OR=0.7；95% CI 0.6 ~ 0.9)，子宫内膜收集(OR=0.1；95% CI 0.09 ~ 0.2)。结论：本研究的干预是有效的教学早期护理点超声图像解释，并确定了具体的变量，构成最大的诊断挑战。这项工作的方法和结果可以为急诊医学中这一关键技能的学习提供机会。
Effectiveness of a Web-Based Training Intervention in Teaching Emergency Physicians First-Trimester Point-of-Care Ultrasound Image Interpretation
Study objective
To examine the effectiveness of an education intervention on emergency physician accuracy in identifying pregnancy-related findings from first-trimester point-of-care ultrasound. Case features associated with the odds of a correct response were also determined.
Methods
This was a multicenter prospective cross-sectional study in a convenience sample of emergency physicians in the United States and Canada. The unsupervised web-based education intervention included first-trimester point-of-care ultrasound cases acquired through the transabdominal (n=200 cases) or transvaginal (n=200 cases) approach. Physicians deliberately practiced identifying pregnancy-related imaging findings until they achieved a mastery standard.
Results
In 204 participants, there were learning gains in accuracy (15.2%; 95% confidence interval [CI] 14.6 to 15.8), sensitivity (15.1%; 95% CI 14.3 to 15.9), and specificity (14.3%; 95% CI 13.7 to 15.0). Of these, 132 (64.7%) achieved the mastery standard in a median of 60 cases (interquartile range 58 to 83). Case features associated with an increased odds of a correct intrauterine pregnancy “present” diagnosis were transvaginal versus transabdominal-acquired images (odds ratio [OR]=1.5; 95% CI 1.3 to 1.8) and fetal heartbeat (OR=4.3; 95% CI 3.4 to 5.5). A decreased odds was associated with an eccentrically located intrauterine pregnancy (OR=0.2; 95% CI 0.1 to 0.2), subchorionic hemorrhage (OR=0.5; 95% CI 0.4 to 0.6), adnexal mass (OR=0.7; 95% CI 0.6 to 0.9), and endometrial collection (OR=0.1; 95% CI 0.09 to 0.2).
Conclusions
This study’s intervention was effective in teaching first-trimester point-of-care ultrasound image interpretation and identified the specific variables that posed the greatest diagnostic challenges. The methods and results from this work can serve to expand learning opportunities for this critical skill in emergency medicine.
期刊介绍：
Annals of Emergency Medicine, the official journal of the American College of Emergency Physicians, is an international, peer-reviewed journal dedicated to improving the quality of care by publishing the highest quality science for emergency medicine and related medical specialties. Annals publishes original research, clinical reports, opinion, and educational information related to the practice, teaching, and research of emergency medicine. In addition to general emergency medicine topics, Annals regularly publishes articles on out-of-hospital emergency medical services, pediatric emergency medicine, injury and disease prevention, health policy and ethics, disaster management, toxicology, and related topics.
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