Motion Augmented eXperience (MAX) Feedback Enhances POCUS Performance as Compared to Traditional Expert Feedback, a Pilot Study

Document Type

Conference Proceeding

Publication Date

11-1-2024

Publication Title

Anesth Analg

Abstract

Introduction: Point of care ultrasound (POCUS) encompasses a wide range of assessment and management techniques utilizing ultrasound (US) imaging to provide real-time information to better diagnose and manage patients in emergency, military, and remote situations. In addition, Simulation Based Mastery Learning (SBML) with Deliberate Practice (DP) has been the cornerstone of teaching complex technical skills.1 Traditionally, feedback was based on direct expert observations of performance and checklist-based evaluations. However, this type of feedback suffers from a ceiling effect and may not completely capture performance and areas for improvement. Motion tracking technologies have been employed to track advancements of technical skills in both physicians and military medics.2-4 As part of a comprehensive one-week POCUS training course for Navy Medics, we have begun providing Motion Augmented eXperience (MAX) Feedback to course participants to enhance their performance. We hypothesize that providing this MAX Feedback data to course participants could enhance performance beyond traditional expert feedback. Methods: The primary outcome of this pilot study was to compare MAX feedback and traditional expert feedback. Our research team tracked motion data for rapid ultrasound for shock and hypotension (RUSH) exams performed by 11 course participants; 8 Navy Combat Medics and 3 Submarine Independent Duty Corpsmen. The participants were randomized to either receive MAX Feedback or traditional expert feedback. Motion tracking was done by attaching a sensor (Polhemus ltd, Colchester, VT) to an ultrasound probe (Butterfly IQ +, Burlington, MA) to track the movements of each participant as they completed their RUSH exam. Each trial was timestamped and segmented by individual view for analysis. Each trial was also rated by an expert, who also verified image adequacy before allowing progression to the next view in sequence. The motion metrics analyzed were path length, rotational sum, translational sum, and time. Expert evaluations included image finding, image fine tuning, final image accuracy, speed, global rating, and best and worst image obtained. Each participant completed 2 exams at the end of each daily training session and these results were averaged to produce daily performance results. Each day, prior to conducting RUSH exams, the participants received either feedback based on both expert rating and their motion performance (MAX Feedback) or based on expert feedback alone (Traditional expert feedback). We compared Initial RUSH exam performance on the first 2 exams of the course to the final 2 exams of the week to assess for differences in skill progression. Results: The average MAX feedback path length was 1,109cm as compared to 2,186 cm in the traditional feedback group, p value = 0.0000059. For average rotation, MAX feedback path rotation sum was 9,618 degrees compared to 18,819 in the traditional feedback group, p value = 0.0000592. For translational motion, number of translational motion was 207 in MAX feedback compared to 316 in the traditional feedback group, p value = 0.00041. As for the time comparison, MAX feedback group had 136 seconds as compared to 165 seconds compared to traditional feedback group, p value 0.057. Therefore, MAX Feedback significantly outperformed Traditional Feedback in all motion parameters measured except time with all p values < 0.0005 except Time (p = 0.057). Conclusions: MAX Feedback has enhanced our ability to quantify continued performance improvements over conventional methods, leading to shortened learning curves and improved immediate procedural performance. The end goal of MAX Feedback training is to allow trainees to use POCUS accurately and efficiently in diagnostic and management decisions in a timely manner thus ensuring retention of training. In this pilot study, MAX Feedback results in significantly improved motion performance over traditional expert feedback at the end of a 1-week POCUS training course. The impact of MAX Feedback versus standard expert feedback in our com rehensive POCUS training program for now requires full scale investigation on larger cohorts of trainees, focus on other skills, and comparison to other performance metrics. Follow up is also planned to assess whether MAX Feedback enhances durability of training and skill retention over conventional expert feedback. (Figure Presented).

Volume

139

Issue

5

First Page

299

Last Page

301

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