Evaluation of Interdisciplinary Emergency Ultrasound Workshop for Primary Care Physicians in Nepal

Abstract

Purpose

Point-of-care ultrasound (POCUS) is a quick bedside tool that has the potential to improve emergency care in resource-limited settings due to its relatively low cost and accessibility. Effort to disseminate the knowledge and skills about POCUS is inadequate in low and middle income countries like Nepal. We conducted a two-day interdisciplinary advanced emergency ultrasound workshop that targeted physicians working in emergency department and primary care, especially in rural Nepal. We explored the effectiveness of this training based on validated Kirkpatrick’s 4 steps of evaluating training outcomes.

Materials and Methods

We conducted a prospective quasi-experimental study with mixed research design. Multidisciplinary physicians working in emergency departments participated in the two-day workshop. We assessed and compared the pre- and post-workshop knowledge. We collected on-site and a follow-up feedback to explore pre- and post-workshop confidence level, perceived usefulness and clinical use of ultrasound using a 5-point Likert scale. The barriers to use POCUS were explored.

Results

A total of 50 physicians from different parts of Nepal participated in the workshop. The academic level of the participants, duration of their clinical experience and the previous use of POCUS did not have a significant difference in their pre- and posttest knowledge scores. The difference between the median (IQR) pre- and posttest scores [14 (12.75–17.75) and 24.5 (22.25–25.5), respectively] was statistically significant (p<0.001). Perceived confidence level and usefulness of the POCUS increased significantly in all of its domains (p<0.001). Self-reported increase in its clinical use was significant (p<0.001) for all fields.

Conclusion

The participation in this emergency ultrasound workshop increased the knowledge of participants in POCUS. Their confidence, perceived usefulness and clinical use of POCUS improved significantly. Objective longitudinal follow-up of participants’ skill and demonstration of increased clinical use of POCUS in emergency department influencing the clinical outcome would be the focus of future research.

Keywords:

• emergency department
• multidisciplinary
• point-of-care ultrasound
• primary care
• ultrasonography

Abbreviations

ACEP, American College of Emergency Physicians; DEGUM, German Society for Ultrasound in Medicine; DH, Dhulikhel Hospital; ED, emergency department; E-FAST, extended Ffocused assessment with sonography for trauma; EFSUMB, European Federation of Societies for Ultrasound in Medicine; EM, emergency medicine; FOCUS, focused cardiac ultrasound; GP, general practitioner; IFEM, International Federation for Emergency Medicine; IQR, interquartile range; IRC-KUSMS, Institutional Review Committee, Kathmandu University School of Medical Sciences; LMIC, low- and medium-income country; LUS, lung ultrasound; MSK, musculoskeletal ultrasound; POCUS, point-of-care ultrasound; RUSH, rapid ultrasound for shock and hypotension; SD, standard deviation; SGUM, Swiss Society for ultrasound in Medicine; SPSS, Statistical Package for the Social Sciences; USG, ultrasonography; WHO, World Health Organization; WINFOCUS, World Interactive Network Focused on Critical Ultrasound.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics and Consent Statement

Ethical approval was obtained from the Institutional Review Committee, Kathmandu University School of Medical Sciences (IRC-KUSMS). As this project was a part of educational activities, informed consent waiver was obtained from the IRC- KUSMS. Knowledge and skill assessment were the part of the workshop and mandatory for all participants. However, the result of the scores was anonymous and confidential. The feedback form mentioned the voluntary participation, assured confidentiality/anonymity, and informed the possible dissemination and publication of the results. Participants and instructors in the images provided written informed consent for the images to be published.

Consent for Publication

The consent has been taken from the participants and the instructors in the picture for publication.

Acknowledgments

Instructors for both the workshops (Ursula Hege, Ram Chandra, Manindra Manandhar, Anjana Dangol, Subindra Karki, Sundar Suwal, Susanne Morf and Rudolf Horn). Mr Biraj Neupane, residents (Arjun Karki, Pratisha Pradhan and Sandip Ojha) and staff of the department of General Practice and Emergency Medicine, Dhulikhel Hospital for assisting in the workshop. All the participants for their enthusiastic participation.

Author Contributions

RS conceptualized the study. RS and APS obtained ethical approval, performed data analysis, and wrote the draft manuscript. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There was no funding for this research study.