Page 57 - JSOM Winter 2021

from a curriculum-based approach for ultrasound training as at the Navy Trauma Training Center, Los Angeles County and
demonstrated in recent studies on teaching single ultrasound University of California. He serves as a subject matter expert
applications to military medics. 6–11 Although these trainings for deployment teams, attends field courses at the Naval Expe-
were successful, none taught multiple ultrasound techniques ditionary Medical Training Institute in Camp Pendleton, CA,
in one course. and has multiple years of experience in using ultrasound in
austere environments and trauma management. The course
Our team developed and implemented a comprehensive, mul- was based on a flipped classroom model with the total course
timodal course for Special Operations combat and tactical time of 43 hours, which was divided into an online component
medics in ultrasound-guided assessments that included assess- and live lectures/reviews followed by hands-on training. Live
ments of the heart, lung, and abdomen. It also consisted of the instruction also included instructor-led discussions where mil-
placement of venous catheters and provision of focused re- itary operational case-based scenarios were discussed to teach
gional anesthesia. The program combined online coursework medics how to interpret ultrasound findings and make correct
and live didactic sessions, including instructor-led lectures diagnoses/medical decisions. The different ultrasound appli-
and case-based discussions. It also included hands-on prac- cations taught in the course included abdominal ultrasound,
tice sessions on ultrasound simulators, task trainers, and live lung ultrasound, rapid ultrasound for shock and hypotension
models with integrated feedback. Our hypothesis was that a (RUSH), transthoracic echocardiography (TTE), and ultra-
5-day training course for Special Operations combat and tac- sound-guided regional anesthesia and vascular access. The ef-
tical medics would improve their level of knowledge, manual fectiveness of the course was evaluated utilizing the following
skills, and workflow understanding of various applications of criteria adopted to reinforce the three components of profi-
ultrasound. ciency in ultrasound: knowledge, manual skills, and workflow
understanding. 12
Methods
1. For knowledge assessment, participants completed a pre-
Study Design and post-course exam, which included questions to assess
Our team conducted a feasibility study on ultrasound training learners’ ability to make correct diagnoses based on ultra-
for Special Operations combat medics and Special Operations sound findings.
tactical medics after receiving institutional review board ap- 2. For manual skills, experts evaluated participants’ manual
proval for exempt status, with a waiver of documentation of skills throughout the course via a global rating scale. This
informed consent by the Committee on Clinical Investigations scale asked experts to evaluate skills in terms of image find-
at Beth Israel Deaconess Medical Center (BIDMC). A total of ing, image optimization, image acquisition speed, final im-
nine medics in two groups participated in the study after be- age quality, and global assessment. In addition, participants
ing recruited as a convenience sample by one of the authors reported their perceived comfort with ultrasound applica-
(DNL), who completed an Adult Cardiothoracic Anesthesia tions before and after the course.
fellowship at BIDMC and regularly trains military medics. 3. To evaluate the ability to perform ultrasound techniques
Eight participants provided demographic data on their prior using the appropriate practical steps (workflow under-
experience with ultrasound (Table 1). The goal of this study standing) and identify correct diagnoses based on ultra-
was to design and implement a comprehensive training pro- sound findings, participants completed a 2-hour objective
gram for nonphysician military medics to improve their ultra- structured clinical skills examination (OSCE) at the end of
sound knowledge, manual skills, and workflow understanding the course.
so that they can use ultrasound techniques to diagnose casual-
ties on the battlefield. Course Description
The comprehensive course schedule comprising of an online
The ultrasound training program was comprised of a week- component and live instruction is illustrated in Table 2.
long multimodal course designed by experts with more than
15 years of experience in ultrasound education and certified by Online Component
the National Board of Echocardiography. One author (DNL) Prior to live instruction, participants were expected to com-
who contributed to the design is an attending anesthesiologist plete integrated web-based educational modules and an
TABLE 1 Participants’ Prior Experience with Ultrasound
How Many Which area(s) of ultrasound have you had experience with before (select all that apply)?
Ultrasound How Many
Training Sessions Ultrasound Ultrasound- Ultrasound-
Have You Had Exams Have Guided Guided Other
Prior to This You Conducted Vascular Regional Transthoracic Abdominal Lung RUSH Ultrasound
Participant Course? Independently? Access Anesthesia Echocardiography Ultrasound Ultrasound Protocol Technique(s) None
1 2–5 6–10 Yes No Yes No No No Yes No
2 2–5 0 No No No Yes Yes No Yes No
3 >5 >20 Yes Yes No Yes Yes Yes Yes No
4 2–5 1–5 No No No No No No Yes No
5 2–5 11–15 No No No No Yes Yes No No
6 1 0 No No No Yes Yes Yes No No
7 2–5 1–5 No No Yes Yes Yes No No No
8 1 6–10 Yes No No No Yes No Yes No
RUSH = Rapid Ultrasound for Shock and Hypotension.

Ultrasound for Special Operations Medics | 55