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

Figures & data

Figure 1 Location map of participating health care facilities.

Figure 2 Instructor demonstrating foreign body removal in a model.

Figure 3 Participant orientation about the USG probe use before the hands-on sessions.

Figure 4 Participants practicing RUSH protocol in a volunteer participant.

Figure 5 Participants practicing USG guided intervention in locally made gelatin-based model.

Table 1 The Pre- and Posttest Knowledge Score in Relation to the Academic Level, Clinical Experience and Previous Use of USG (n=25)

Variables	n (%)	Pretest Median (IQR)	p value^a	Posttest Median (IQR)	p value^a
Academic Level
Medical officers	11(44)	15 (12.5–18.5)	0.252	24.5 (20–25.5)	0.291
Residents	4(16)	16 (14–20)		26 (23.5–27.75)
Consultants	10(40)	13.5 (10.8–16.3)		24 (22.4–24.9)
Work Experience (years)
0–2	10(40)	14 (11.8–18.3)	0.696	24.5 (22.3–25.5)	0.896
2–4	7(28)	16 (11–18.5)		24 (24–26.5)
>4	8(32)	14 (13.3–16.8)		24.3 (22.8–25.6)
Previous Use of USG (Self-Reported in 5-point Likert Scale- 1 = Never: 5 =Frequent)
1	1		0.622		0.933
2	10	14 (10.9–16.4)		24.3 (21.5–25)
3	4	15 (8–18)		23.8 (22.8–25.5)
4	7	15 (14–18)		24.5 (21–25.5)
5	3	14 (9.5–14)		27 (18–27)

Note: ^aKruskal–Wallis test.

Abbreviations: USG, ultrasonography; n, number; IQR, interquartile range.

Figure 6 Pre- and post-workshop knowledge scores (n=25, p<0.001, Wilcoxon signed rank test p<0.001).

Table 2 The Pre- and Post-Workshop Confidence Level of the Participants (n=22)

Confidence Level	Pre-Workshop Median (IQR)	Post-Workshop Median (IQR)	p value^a
Basic ultrasound skills	2(1.25–2.75)	4(3–4)	<0.001
Focused cardiac ultrasound	1(1–2)	3(3–4)	<0.001
Lung ultrasound	2(1–2)	4(3–4)	<0.001
RUSH	1(1–2)	3.5(3–4)	<0.001
E-FAST during trauma	2(2–3)	4(3–4)	<0.001
Focused ultrasound of abdomen	2(1–2)	3(2–4)	<0.001
Ultrasound of the scrotum	1(1–2)	3(2–4)	<0.001
OBGYN	2(1–2)	4(3–4)	<0.001
Vascular	1(1–2)	3(3–4)	<0.001
MSK	1(1–2)	3(3–4)	<0.001
USG guided procedures	2(1–2)	3(3–4)	<0.001

Note: ^aWilcoxon signed rank test.

Abbreviations: IQR, interquartile range; RUSH, rapid ultrasound for shock and hypotension; E-FAST, extended focused assessment with sonography for trauma; OBGYN, obstetrics and gynecology; MSK, musculoskeletal; USG, ultrasonography.

Table 3 The Pre- and Post-Workshop Perceived Usefulness of the USG (n=22)

Perceived Usefulness	Pre-Workshop Median (IQR)	Post-Workshop Median (IQR)	p value^a
Trauma	2(1–2)	4(3–4)	<0.001
Dyspnea	2(1–2)	4(3–4)	<0.001
Undifferentiated shock	1(1–2)	4(3–4)	<0.001
Acute chest pain	2(1–2)	3(3–4)	<0.001
Acute abdomen	2(1–2)	4(3–4)	<0.001
Acute scrotal pain	1(1–2)	3(2–4)	<0.001
Gynecological emergencies	1(1–2)	3.5(3–4)	<0.001
Vascular emergencies	1(1–2)	3(3–4)	<0.001
Acute MSK problem	1(1–2)	3(3–4)	<0.001
Procedural interventions	1.5(1–2)	3(3–4)	<0.001

Note: ^aWilcoxon signed rank test.

Abbreviations: USG, ultrasonography; IQR, interquartile range; MSK, musculoskeletal.

Figure 7 Pre- and post-workshop frequency of USG use in routine clinical practice of participants (n=40, Wilcoxon signed rank test p<0.001).

Figure 8 Pre- and post-workshop self-reported USG use in various domains of clinical practice in Likert scale of 5 (1 being never and 5 being frequently) n=40 (Wilcoxon signed rank test p<0.001).

Abbreviations: EFAST, extended focused assessment with sonography for trauma; FOCUS, focused cardiac ultrasonography; LUS, lung ultrasonography; RUSH, rapid ultrasound for shock and hypotension; US, ultrasonography; Vasc, vascular; MSK, musculoskeletal.