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of intraocular pressure, and additional regional anesthesia Moreover, participants’ proficiency in ultrasound needs to be
techniques. In a previous study, musculoskeletal application reassessed at specific intervals in order to measure the rate of
was a large portion of the military medics’ ultrasound encoun- skill decay over time. This assessment will allow us to create
1
ters. Some additional regional anesthesia procedures that strategies to help retention of ultrasound knowledge, manual
could be added are adductor canal blocks and ankle blocks to skills, and workflow understanding using spaced learning and/
further address this need. or refresher training exercises. We can also utilize more ob-
jective assessment methods, such as metrics from hand mo-
Limitations tion tracking systems. Our course instructors were experts in
Although our initial results are promising, we note the follow- ultrasound with multiple years of teaching medical trainees,
ing limitations: allowing them to provide instruction and assess skills based on
the global rating scale simultaneously. However, as this course
1. Our sample size (a convenience sample of nine medics) was becomes more widely available with instructors of varying de-
small. Given the Coronavirus Disease 2019 (COVID-19) grees of experience, objective data measures will be necessary
restrictions, we were unable to hold courses with larger to standardize the evaluation of skills.
numbers of learners. Despite our small sample size, we de-
tected improvements in proficiency in ultrasound after the Finally, the course should be refined with the input of mili-
course. tary medical personnel to ensure that this course can be imple-
2. Although the knowledge exam and global rating scale mented widely and efficiently in the long term. This may result
were developed and reviewed by experts who designed the in adjustments such as a shorter course, more online self-paced
course for content validity, further validation is needed for learning, remote training, and/or training medics or other mil-
future courses. itary medical personnel to be prospective trainers for other
3. Although our knowledge exam and OSCE assessed par- medics at times and locations that fit the existing constraints
ticipants’ ability to make correct diagnoses, they did not for military medical training. Input from military medical per-
include questions to assess logical decision-making that sonnel should also be used to further tailor this program to
Special Operations medics need to make on the field based fit the clinical needs of military medics. The clinical utility of
on ultrasound findings, such as whether a medical evacu- ultrasound for military medics has the potential to improve
ation (MEDEVAC) or casualty evacuation (CASEVAC) is frontline clinical decision-making, and further analysis is re-
needed. Our focus in this pilot study was to improve pro- quired to refine this course into a reliable, sustainable ultra-
ficiency in ultrasound, but this focus should expand to en- sound course.
suring that medics can make correct management decisions
based on ultrasound findings regarding casualties. Author Contributions
4. We did not have a control subject group, such as novice HF and SK helped design, draft, and revise the manuscript,
physicians (i.e., interns, first-year anesthesiology resident and interpret the data. VB, VTW, OC, and AS helped with
physicians, etc.), that would have allowed us to have a design, acquisition of data, analysis, and revision of the man-
frame of reference for the medics’ learning curve and over- uscript. JWB, AL, KRM, AP, LAR, DPW, LJK, and JKS helped
all proficiency at the end of the course as was done in a with acquisition of data, interpretation of data, and revision
previous study for Extended Focused Assessment With of the manuscript. JW, FM, and RM helped with design, in-
11
Sonography for Trauma (eFAST). The addition of a con- terpretation of data, and revision of the manuscript. DNL and
trol group and further validation of our assessment tools, JDM helped with conception, design, and revision of the man-
which are lacking in many studies on ultrasound training, uscript. All authors approved the final manuscript.
would strengthen the validity of our results. 19,20
5. While our course improved medics’ proficiency in multiple Funding
ultrasound techniques, it was relatively more resource- and No funding was received for this project.
time-intensive than previous successful ultrasound training
for medics that taught single ultrasound applications. 6–11 Conflict of Interest
Rather than teaching ultrasound applications individually, The authors report no conflict of interest.
we aimed to create a comprehensive course in which medics
would learn many ultrasound applications from a consis- References
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