Kurrikulare Ultraschallausbildung am Bewegungsapparat: Einfluss der anatomischen Vorbildung auf die Weitergabe von Basis-Skills an der Schulter

 

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Zusammenfassung

Ziel: Evaluierung der anatomischen Vorbildung in der muskuloskeletalen Ultraschallausbildung (MSUS) mit der Frage nach dem Ausbildungsbeginn. Dabei wurde der Nutzen von studentischen Dozenten untersucht. Material und Methode: Studenten des 1. (n = 38) und 4. Semesters (n = 49, anatomisch geschult) wurden zufällig in 1 von 2 Gruppen zum Erlernen der Schultersonografie eingeteilt. Die PAL-Gruppe (Peer-Assisted Learning) wurde durch 3 studentische Dozenten, die Ärztegruppe durch 3 ärztliche Dozenten unterrichtet (DEGUM/EULAR, Toshiba Nemio™ XG, 10 MHz). Die quantitativen Daten wurden über eine MC-Prüfung (Theorie) sowie über einen OSCE-Test (Objective Structured Clinical Examination), die qualitativen Daten unter Nutzung der Likert-Skala erhoben. Ergebnisse: Die theoretischen Ergebnisse im Erstsemester waren nach konventionellem Unterricht besser als nach PAL (MC 4,3 vs. 3,1; p = 0,045), jedoch stets schlechter als nach absolvierter anatomischer Ausbildung (p < 0,001). Während der praktischen Evaluation (OSCE) kam es nach konventionellem Unterricht in keinem Schnitt zu Unterschieden zwischen Studenten des 4. oder 1. Semesters (OSCE Score 19,6 vs. 19,7 Punkte; p = 0,978). Studenten ohne anatomisches Vorwissen wiesen nach PAL schlechtere praktische Ergebnisse auf (OSCE Score 16,1, p = 0,042). Schlussfolgerungen: Die Vermittlung von MSUS-Kern-Skills ist früh im Studium möglich. In den ersten Semestern sollten erfahrene Dozenten den Unterricht leiten.

Abstract

Objective: The aim of this study was to evaluate the impact of students preexisting anatomic proficiency to address the fundamental problems related to musculoskeletal ultrasound (MSUS) training by assessing the peer-assisted learning (PAL) system. Methods: Students without anatomic knowledge (first semester, n = 38) and students in their fourth semester of medical school (n = 49) were randomly assigned to two groups: 1) The PAL group – teaching by a group of three minimally trained student-teachers and 2) the Staff group – students were taught by a group of three ultrasound-experienced operators. Sessions included both a theoretical and a praxis component (DEGUM/EULAR, Toshiba Nemio™ XG, 10 MHz). A multiple choice questionnaire (MCQ) and an objective structured clinical examination (OSCE) were performed. Qualitative differences were evaluated by the Likert scale. Results: Exposure included three separate lessons (each 120 minutes, 65 minutes of active scanning). The results of the MCQ were better among the fourth semester students than among those without anatomic knowledge (p < 0.001). Among first semester students, the MCQ results were better for those who had been taught by medical staff than for those who had been instructed by means of PAL (4.3 vs. 3.1; p = 0.045). At no point during the practical evaluation did significant differences arise between students of fourth and first semesters after medical staff tutoring (19.6 vs. 19.7 points; p = 0.978). PAL did result in worse results with regard to practical MSUS competence levels in the students possessing no previous knowledge (OSCE score 16.1; p = 0.042). Conclusions: Although deficits in theoretical knowledge cannot be compensated for, basic MSUS content appears to be adequately transferable to students with limited anatomic knowledge. Thus, an early implementation of MSUS during medical school education would be prudent, provided that the training is performed by an experienced MSUS operator.

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Dr. Matthias Knobe

Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie
RWTH Aachen

Pauwelsstraße 30

52074 Aachen

Phone: 02 41/80-3 51 34

Fax: 02 41/80-3 38 83 60

Email: mknobe@ukaachen.de