Annie Heffernan Rominger, Gerardo Antonio Aguilar Gomez, Patrick Elliott
{"title":"在墨西哥恰帕斯州农村门诊诊所工作的医生实施纵向POCUS课程。","authors":"Annie Heffernan Rominger, Gerardo Antonio Aguilar Gomez, Patrick Elliott","doi":"10.1186/s13089-018-0101-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care.</p><p><strong>Methods: </strong>This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback.</p><p><strong>Results: </strong>Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. In the 194 scans in which POCUS changed the diagnosis, the clinical management was changed, as a direct result of the scan results, in 152 (78.4%) of those patient encounters.</p><p><strong>Conclusion: </strong>A longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients.</p>","PeriodicalId":46598,"journal":{"name":"Critical Ultrasound Journal","volume":"10 1","pages":"19"},"PeriodicalIF":3.6000,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13089-018-0101-8","citationCount":"21","resultStr":"{\"title\":\"The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico.\",\"authors\":\"Annie Heffernan Rominger, Gerardo Antonio Aguilar Gomez, Patrick Elliott\",\"doi\":\"10.1186/s13089-018-0101-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care.</p><p><strong>Methods: </strong>This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback.</p><p><strong>Results: </strong>Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. 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引用次数: 21
摘要
背景:在资源有限的环境中,医疗保健具有挑战性,特别是在获得诊断和影像学研究的机会有限的情况下。在这些领域,最便携和最具成本效益的诊断成像是超声。超声波是一种非常容易教的技能,有一个短的,单一的强化培训课程和实践教学;然而,在资源有限的情况下,关于纵向护理点超声(POCUS)课程的数据有限。该干预措施的目标是为在墨西哥恰帕斯州农村诊所工作的当地医生制定有效的纵向POCUS课程,并评估其对患者护理的有效性。方法:对墨西哥恰帕斯州农村诊所的当地督导医生进行为期12个月的纵向超声教育课程。这10家诊所是墨西哥政府和Compañeros En Salud的合作项目,它们获得诊断成像或实验室研究的机会有限。调查人员协助获得了四台供诊所使用的便携式超声仪。接下来,他们在一年多的时间里组织了四次即时超声(POCUS)教学课程,每次课程都侧重于几个不同的概念。这些课程包括讲座和实践教学,参与者包括健康志愿者和各个社区的患者。在12个月的时间里,记录了POCUS,并保存了大多数图像。对日志进行分析,以确定POCUS是否影响患者的医疗管理。为了质量保证和反馈,主要研究者回顾了35.2%的已完成超声检查,即52.2%的保存图像。结果:在12个月的时间里,记录了584例超声检查。最常见的是经腹产科检查(45.5%),其次是腹部/骨盆检查(26.6%)、肌肉骨骼检查(5.7%)和皮肤软组织检查(5.7%)。POCUS的使用改变了194次(34%)扫描后患者的诊断,改变了171次(30%)扫描后患者遭遇的临床管理。在194次POCUS改变诊断的扫描中,152例(78.4%)患者因扫描结果而改变了临床管理。结论:纵向POCUS教育课程是资源有限国家的医生提高临床患者管理水平的有效途径。
The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico.
Background: Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care.
Methods: This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback.
Results: Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. In the 194 scans in which POCUS changed the diagnosis, the clinical management was changed, as a direct result of the scan results, in 152 (78.4%) of those patient encounters.
Conclusion: A longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients.