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Accuracy and Student Perceived Confidence of Varying Knee Aspiration Methods
Grayson Lindsey, T. [1]
Barron, D. [1]
Deal, A. [1]
German, E. [1]
Hogge, K. [1]
Reese, B. [1]
Stokes, S. [1]
Woodruff, T. [1]

Journal: Journal of Osteopathic Medicine Date: 2023/12, 123(12):Pages: A47-A48. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2023-2000/html)

Keywords:

aspiration [1]
clinical competence [189]
knee [70]
medical students [402]
osteopathic medicine [1540]
randomized controlled trial [710]
USA [1086]

Abstract:

Statement of Significance: Ultrasound is a valuable learning tool for medical students and residents. Using ultrasound in a medical curriculum has shown greater satisfaction and higher confidence in translation of skills into clinical settings. The project aims to assess whether providing first-year medical students with ultrasound-guided education increases the accuracy and confidence when performing a knee aspiration on simulation models compared to the landmark guided arthrocentesis. Students taught knee arthrocentesis on simulation models while using ultrasound will have higher accuracy and perceived confidence of performing the aspiration on a real patient compared to students who completed an arthrocentesis training using only anatomical landmarks. Research Methods: 76 OMS-1 students at VCOM-Carolinas were randomly sorted into control or experimental groups. The students who learned knee arthrocentesis via anatomical landmarks were the control group; whereas the students who learned arthrocentesis via ultrasound guide were the experimental group. The control group attended a 30-minute presentation by VCOM faculty on anatomical landmark guided knee aspirations followed by hands-on practice with the simulation models. The experimental group was provided a powerpoint and video explaining ultrasound guided knee aspirations followed by time to practice with the ultrasound and simulation models. This video and powerpoint were modeled after the faculty led presentation to ensure all the same information was covered. Following the presentations and practice, students were asked to perform a knee aspiration using the technique they were taught. Each student got three attempts to successfully perform the procedure. Each student was graded on accuracy and immediately surveyed on their confidence in performing the procedure in a clinical setting. The survey consisted of a five-point Likert scale to assess student confidence on performing the aspiration. Data Analysis: Sample Mean and Standard Deviation of Outcomes by Group Group No Ultrasound (n = 41) Ultrasound (n = 35) Number of Attempts 2.37 ± 1.11 1.54 ± 0.98 Confidence 2.73 ± 1.12 3.28 ± 1.10 Statistical Analysis: Analyses began by summarizing the outcomes using sample means and standard deviations by group. Due to the ordinal nature of the data, non-parametric methods, specifically the Wilcoxon Rank Sum test, was used to test for differences in outcomes between groups. A Type I error rate of 0.05 was used for each test. All tests were conducted using SAS 9.4 Conclusion: A statistically significant improvement in accuracy was shown in participants using the ultrasound guided technique for knee arthrocentesis. There was also a statistically significant increase in self-reported confidence between the experimental and control groups. Currently, there is no consensus or standardization of teaching or training of ultrasound among different institutions and countries for educational purposes or for assessment of practioners’ skills and accreditation.5 However, the increased use of point-of-care ultrasound imaging in the clinical setting suggests that medical students and medical curriculum should be dynamic and continue to advance forward with technology. Ultrasound has emerged to be a vital point of care testing tool so much that multiple meta-analyses call for more ultrasound in medical education.5 Our study demonstrated significant improvement in the accuracy of performing ultrasound guided knee arthrocentesis among first year medical students with those students reporting a statistically significant increase in confidence when performing the knee aspiration. The results of the study suggest that including ultrasound guided knee arthrocentesis to the current curriculum would be beneficial to OMS-1 students at VCOM-Carolinas.

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