Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship

Figures & data

Table 1. Tutor characteristics, continuous variables denoted as median [25th percentile, 75th percentile].

Metric	Composition of near-peer tutors (n = 16), median 25%, 75%]	Composition of faculty tutors (n = 16) median [25%, 75%]	p-value
Age (years)	23 [22, 23.3]	41 [33.8, 53.8]	<0.001
Men (n)	5	12	0.03
Women (5)	11	4
Ultrasound scans per month	4 [2.0, 6.5]	27.5 [19.3, 40.0]	<0.001
Ultrasound experience (years)	2 [1.0, 2.0]	11.5 [5.5, 19.0]	<0.001
Ultrasound teaching frequency (hours per month)	4 [2.5, 5.3]	2 [1.0, 5.0]	0.25
Ultrasound teaching experience (years)	1 [1.0, 2.0]	4.5 [1.0, 10.8]	0.06

Figure 1. Video camera and microphone arrangement.

Table 2. Verbatim examples for methods and other activities from cognitive apprenticeship.

	Method/activity	Verbatim example
Modeling
	- Demonstration	[Tutor holds the probe, silently demonstrates how to find the spleen]
	- Demonstration + explanation	[Tutor holds the probe, demonstrates how to find the ovary] “Up here, where you can see this hypoechogenic structure—that’s probably the right ovary”
	- Theoretical explanation	Tutor: “When examining the liver, we typically start in the so called shoulder- navel-plane”
Coaching
	- Observation	[Student silently scans the heart to depict all 4 chambers, tutor observes]
	- Observation + explanation	[Student tries to distinguish vessels of the neck, tutor observes] Tutor: “Laterally you usually have the internal [carotid artery] that extends into the brain and medially there’s the external. And if you aren’t sure anymore you can check whether you’re seeing any branches from one of them”
	- Feedback	[Student struggles to find the spleen] Tutor: “The depth is correct, but you have to go a bit higher, towards the head.”
	- Set tasks	[Student finished to look through the bladder] Tutor “Now you could look for the maximum diameter and take a measurement there.”
	- Help verbally	Tutor: “The best way to find an organ is in the plane where it is longest, in the kidney in longitudinal section. Turn the transducer a little and then [pause] fan it. Turn the transducer a little.”
	- Help manually	Tutor: [Student is holding the transducer and searches a certain plane of the thyroid gland]. [Tutor grabs the transducer around the hand of the student, who is still holding it] “If you see the thyroid gland like this, then you are too far medial, so you go sidewards” [Tutor moves the transducer until it shows the correct plane].
Articulation
	- Ask open questions	[Student correctly depicts a hepatic vein] Tutor: “How can we distinguish that from the portal vein?” Student: “The Portal vein is echogenic all around.”
	- Ask closed questions	[Student correctly demonstrates the confluence of sinuses] Tutor: “What do you have ventrally of these two structures?” Student: “The pancreas”
	- Stimulate questions	Tutor: “Do you have questions on this?”
	- Think about gaps	Tutor “What did you personally scan during the last course, do you remember?” Student “Only the kidney”
Exploration
	- Set own tasks	[Students rotate to have another student perform the ultrasound] Tutor: "And what do you show us?" Student: "I would try liver and pancreas again."
	- Set own goals	Tutor: "That means you can decide a bit what you want to do. There should be enough time that everyone can do everything”
Safe learning climate		[Student struggles to get a clear image of the pancreas] Tutor: " […] It’s not your fault at all, it’s just not that easy."
Procedural information		Tutor: "Then I would suggest we start with the genital organs now, and then we can always change and look at the kidneys and the efferent urinary tract as well"
Off-Task		[A new student prepares for scanning and a new student lies down on the stretcher]

Figure 2. Illustration of the direct coding of videos within MAXQDA.

Table 3. Summary of time used for cognitive apprenticeship methods and other activities, denoted as median [25th percentile, 75th percentile], n = 32.

Method	Duration (median)	Duration
		[25%, 75%]
Modeling	04:50	[03:04, 08:30]
- Demonstration	00:14	[00:00, 00:56]
- Demonstration + explanation	02:31	[00:59, 05:37]
- Theoretical explanation	01:34	[01:03, 02:18]
Coaching	29:14	[26:50, 34:00]
- Observation	08:25	[06:49, 10:54]
- Observation + explanation	09:46	[07:05, 11:47]
- Feedback	02:36	[01:33, 03:20]
- Set tasks	01:10	[00:48, 01:33]
- Help verbally	03:58	[03:03, 05:10]
- Help manually	01:05	[00:20, 01:49]
Articulation	12:04	[08:18, 15:29]
- Ask open questions	04:41	[02:47, 07:20]
- Ask closed questions	01:57	[01:09, 02:51]
- Stimulate questions	03:34	[02:41, 04:31]
- Think about gaps	00:27	[00:15, 00:42]
Exploration	00:38	[00:14, 00:57]
- Set own goals	00:00	[00:00, 00:07]
- Set own tasks	00:28	[00:09, 00:51]
Safe learning climate	00:45	[00:26, 01:22]
Procedural information	01:28	[01:07, 01:48]
Off-task	04:22	[03:24, 04:58]

Figure 3. Teaching activities within cognitive apprenticeship methods (median values). *Statistically significant differences.