How COVID-19 Improved the Structure and Processes of Simulation Point of Care Ultrasound Classes - VHA SimLEARN
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How COVID-19 Improved the Structure and Processes of Simulation Point of Care Ultrasound Classes

By: Janet Sprehe, DNP, APRN, CVRN, RN-BC
Program Director of Simulations/REdI
Tampa VAMC

Tampa, FL. – Prior to COVID-19, the James A. Haley VA Advanced Simulation Center had been committed to training over 60 University of South Florida (USF) Post Graduate Year Three (PGY3) students twice a year in two four-hour daily sessions learning how to use and skillfully obtain quality ultrasound images. The curriculum had consisted of a 60-minute lecture followed by a question and answer section. Afterward, the 60 students then used the remaining time to split into two groups to complete hands-on skill and technique practice in either the remaining morning or after lunch. Six dissimilar hands-on sections were available demonstrating the FAST exam, musculoskeletal, cardiac, and renal exams. Groups that were awaiting their hands-on session time used their time practicing skills with the SonoSim ultrasound training device with the company sales representatives that helped students master the skill of hand holding the probes and choosing the best probe for each desired procedure. Pre and Post session knowledge was measured on a ten-question evaluation with each participant. Follow up surveys were performed three months after to determine the effectiveness of training. All evaluations immediately following the course shown 96% of participants extremely satisfied with the training. Three-month follow up had shown that the ultrasound course had 92% positively affected their skill practice. Comments noted on both three-month following and immediately following course evaluations stated that more hands-on practice was still wanted.

This Ultrasound course was a major highlight that our simulation center offered our new residents and also some Emergency Department Registered Nurses. Some of the challenges facing the way we offered these large one-day classes were ensuring groups switched stations at appropriate times, that all clinical providers teaching their stations had back up to cover their patients those days, the room availability in the simulation center, finding volunteers to allow students to practice on them, and ensuring the SonoSim sales representative was available to man their training device station. These biannual classes took many months to coordinate and plan but were successful and greatly appreciated by the students.

In March 2020, COVID-19 was greatly changing the way academia and class settings delivered pieces of training for students. Students were now learning via computers with no real instructor close by to demonstrate and observe user performance. Health care professionals, however, need to have hands-on practice to effectively diagnose and treat our veteran patients. In a simulation, class size was downsized to ensure safe social distancing when having skill practice sessions. Staff feedback called for more ability to practice skills in a safe environmental setting. Our already-booked simulation class offerings were now being taught in multiple sessions to maintain social distancing which was devising challenges of what classes had first priority for rooms and instructor use.

In planning our June 2020 Ultrasound Class for our PGY3 students, we changed the format where the lecture was made into a prerecorded powerpoint and disseminated to the students two weeks before attending a new four-hour half-day session that was limited to six to nine students working at only three to four stations. In place of having volunteers who allowed students to use ultrasound on them, the students were then the patient. This provided more insight for the PGY3’s on what it felt to have an ultrasound probe pressed into their abdomen or another body part. It also demonstrated the need for explaining what they were going to do to the patient prior to doing the procedure. “Being the patient getting this procedure made me aware of the dynamic communications we need to focus on when we work with our veterans. Feeling how uncomfortable the ultrasound probe felt, lets me know to advise the patient that it may feel uncomfortable but to have the veteran let me know if I need to alter how hard I am pressing on them.” stated a PGY3 student who wished to remain anonymous. The evaluations from these new structured classes and processed shown a 100% rate of satisfaction after the training and had 100% skills retention after a three month follow up. Evaluations showed that the more time each student had their own hands-on time to practice the ultrasound skills made a significant improvement in how the classes were now taught. Dr. Jorge Lamarche asked the groups if they had any questions prior to the hands-on skills and following the students’ responsibility to preview the prerecorded lecture. Pre and Posttest evaluations were conducted as previously. The ability to cover clinics and provider care was less cumbersome to arrange as now we had four half-day sessions in place of a full day with more stations. Our clinical experts in their areas found it easier to attend one half-day session instead of a full-day session. Before COVID-19, our training focused heavily on the skill application but now having fellow students be the patient, a need for remembering how to communicate with each patient was handled better.

Prior, the physician residents were more focused on the actual skill rather than focusing on their patient-physician communications. Although COVID-19 has seemed to be a negative challenge in some simulation centers, we discovered that some of the changes that it mandated actually improved the way our Point of Care Ultrasound course (POCUS) was structured and improved our processes for better student learning. We realize now that more virtual classes are being developed to bring about knowledge to our learners; however, in healthcare, we still require adequate hands-on skill practice to efficiently treat and diagnose. By now having limited participants at the bedside with physicians as patient volunteers, our new way of teaching POCUS classes has been enhanced for the future way we will offer this type of course.