Page 74 - JSOM Spring 2023

and time describe their performance and can inform deliber- Author Contributions
ate practice. Time remains a hallmark indicator of proficiency VB helped with study design, data collection and analysis, in-
for myriad skills today; however, time alone fails to capture terpretation of the data, and manuscript preparation. KRM
the quality of an exam and dexterity of a trainee. 5,23–27 While helped with data collection, interpretation of the data, and
GRS scores have been used to grade quality and dexterity, manuscript revision. AS, DNL, DPW, and DCL helped with
these scores require a rater with relevant expertise to make a data collection and manuscript revision. VTW helped with data
subjective judgment on a learner’s performance. In contrast, collection and analysis, interpretation of the data, and manu-
motion analysis is entirely objective, and has been shown to ef- script preparation. JW, RM, and FM helped with study design
fectively distinguish experts from novices across several proce- and manuscript revision. JDM helped with study design, data
dures and specialties. 12,20,28,29 Furthermore, motion metrics are collection, interpretation of data, and manuscript revision.
not subject to the ceiling effect. Whereas GRS scores generally
utilize an ordinal grading system with minimal and maximal References
scores, motion metrics are continuous variables. Therefore, if 1. Buerger AM, Clark KR. Point-of-care ultrasound: A trend in
a trainee achieves a maximum GRS score but continues to im- health care. Radiol Technol. 2017;89(2):127-138.
prove, the full extent of improvements in their performance 2. Butler F, Burkholder T, Chernenko M, et al. Tactical Combat Ca-
sualty Care maritime scenario. J Spec Oper Med. 2022;22(2):9–28.
may not be captured. While discrete GRS scores depend on 3. Tadlock MD, Gurney J, Tripp MS, et al. Between the devil and
zones or thresholds of performance, even minute changes in the deep blue sea: A review of 25 modern naval mass casualty in-
motion metrics remain detectable, and can be used to inform cidents with implications for future Distributed Maritime Opera-
assessment and feedback. tions. J Trauma Acute Care Surg. 2021;91(2S Suppl 2):S46–S55.
4. Ultrasound Guidelines: Emergency, point-of-care and clinical ultra-
Limitations to this study include its relatively small sample size sound guidelines in medicine. Ann Emerg Med. 2017;69(5):e27–e54.
and varied number of expert raters in cohort 1, due to clinical 5. Kumar A, Kugler J, Jensen T. Evaluation of trainee competency
with point-of-care ultrasonography (POCUS): A conceptual
schedules. Furthermore, we did not randomize study partic- framework and review of existing assessments. J Gen Intern Med.
ipants since individuals were selected based on convenience 2019;34(6):1025–1031.
sampling. This selection bias limits the generalizability of our 6. Driskell DL, Gillum JB, Monti JD, Cronin A. Ultrasound eval-
outcomes. The 5-day duration of the course may preclude its uation of soft-tissue foreign bodies by US Army medics. J Med
widespread adoption by both civilian and military personnel. Ultrasound. 2018;26(3):147–152.
Future iterations should randomize participants, include a 7. Meadows RM, Monti JD, Umar MA, et al. US army combat
medic performance with portable ultrasound to detect sono-
control group, and introduce a blinded approach to scoring graphic findings of pneumothorax in a cadaveric model. J Spec
RUSH exams using anonymized recordings. Expert sonogra- Oper Med. 2020;20(3):71–75.
phers should also be recorded in a similar fashion to establish 8. LaDuke M, Monti J, Cronin A, Gillum B. Ultrasound detection of
standard motion metric values for comparison. Lastly, the re- soft tissue abscesses performed by non-physician U.S. Army med-
tention of POCUS skills should be analyzed through follow-up ical providers naïve to diagnostic sonography. Mil Med. 2017;182
assessments at varying intervals of time. (3):e1825–e1830.
9. Heiner JD, Baker BL, McArthur TJ. The ultrasound detection of
simulated long bone fractures by U.S. Army Special Forces Med-
Conclusion ics. J Spec Oper Med. 2010;10(2):7–10.
10. Monti JD, Perreault MD. Impact of a 4-hour Introductory eFAST
Motion analysis quantified and described the performance of Training Intervention Among Ultrasound-Naïve U.S. Military
medics training in POCUS. Motion metrics correlated with Medics. Mil Med. 2020;185(5-6):e601–e608.
qualitative expert ratings. The integration of motion analy- 11. Fatima H, Kuppalli S, Baribeau V, et al. Comprehensive ultra-
sis into POCUS training for SOF combat and tactical medics sound course for Special Operations combat and tactical medics.
J Spec Oper Med. 2021;21(4):54–61.
could provide objective assessments of proficiency and iden- 12. Matyal R, Mitchell JD, Hess PE, et al. Simulator-based trans-
tify areas for deliberate practice in a more standardized fash- esophageal echocardiographic training with motion analysis: a
ion. The skills acquired in this course may be applied beyond curriculum-based approach. Anesthesiology. 2014;121(2):389–399.
the scope of military medicine, into the civilian sector as well. 13. Chin KJ, Tse C, Chan V, et al. Hand motion analysis using the
imperial college surgical assessment device: validation of a novel
and objective performance measure in ultrasound-guided periph-
Acknowledgements eral nerve blockade. Reg Anesth Pain Med. 2011;36(3):213–219.
The authors thank the medics who participated in this study and 14. Corvetto MA, Fuentes C, Araneda A, et al. Validation of the impe-
the Department of Anesthesia, Critical Care and Pain Medicine rial college surgical assessment device for spinal anesthesia. BMC
at Beth Israel Deaconess Medical Center, Boston, MA for their Anesthesiol. 2017;17(1):131.
support of the study. They also thank Arjun Bose and Omar 15. Corvetto MA, Pedemonte JC, Varas D, et al. Simulation-based
Chaudhary for their assistance in implementing the courses. training program with deliberate practice for ultrasound-guided
jugular central venous catheter placement. Acta Anaesthesiol
Scand. 2017;61(9):1184–1191.
Funding 16. Polhemus Liberty. https://polhemus.com/motion-tracking/all-
None. trackers/liberty. Accessed 22 July 2022.
17. Baribeau V, Weinstein J, Wong VT, et al. Motion-tracking ma-
Disclaimer chines and sensors: Advancing education technology. J Cardio-
The views expressed are those of the author and do not reflect thorac Vasc Anesth. 2022;36(1):303–308.
the official policy or position of the US Navy, Department of 18. Baribeau V, Sharkey A, Murugappan KR, et al. Assessing skill
Defense, or the US Government. acquisition in anesthesiology interns practicing central venous
catheter placement through advancements in motion analysis. J
Cardiothorac Vasc Anesth. 2022;36(8 Pt B):3000–3007.
Disclosure 19. Fatima H, Mahmood F, Mufarrih SH, et al. Preclinical
The authors have indicated they have no financial relation- proficiency-based model of ultrasound training. Anesth Analg.
ships relevant to this article to disclose. 2022;134(1):178–187.

72 | JSOM Volume 23, Edition 1 / Spring 2023