Point-of-Care Ultrasound (PoCUS) Teleeducation Curriculum for Hospital-at-home Care
- Conditions
- Educational Problems
- Registration Number
- NCT07182162
- Lead Sponsor
- National Taiwan University Hospital
- Brief Summary
Since July 2024, the National Health Insurance Administration has been implementing a pilot "Hospital-at-Home Acute Care Program" to curb hospital admissions. Point-of-Care Ultrasound (PoCUS) is considered the most promising imaging tool for this model. Replicating the hospital's familiar environment-its staffing patterns, diagnostic workflows, and medication protocols-in a patient's home or nursing facility is almost impossible, posing a major challenge to care teams. Medical-simulation training offers a solution, yet current PoCUS courses remain organ-based and lack scenario-based simulations that prepare physicians for HAH practice.
This two-year study will create a PoCUS curriculum and outcome-assessment tools tailored to HAH, adapting previously validated EPA instruments to three HAH scenarios: pneumonia, urinary-tract infection, and soft-tissue infection. Year 1 will develop scenario-based simulation courses and matching EPA tools, and train peer instructors who receive full PoCUS instruction for the three scenarios. Year 2 will randomly assign learners to compare two teaching models-peer training + remote supervision + scenario simulation versus traditional PoCUS training-evaluated with an Objective Structured Clinical Examination (OSCE) scored by EPA forms across multiple domains.
The project aims to establish normative standards for PoCUS training and assessment in HAH, confirm the feasibility of peer training with remote supervision, and provide a platform to train HAH medical teams nationwide, including those in rural areas.
- Detailed Description
Background Point-of-care ultrasound (PoCUS) has evolved from hospital-based imaging to bedside diagnostic support, enabling rapid, problem-oriented assessments across trauma, shock, dyspnea, and resuscitation scenarios as portable devices matured in image quality and accessibility.
Recent medical education trends emphasize competency-based medical education, milestones, and entrustable professional activities (EPAs), requiring structured assessment of indications, image acquisition, interpretation, and integration into management for skill-heavy technologies like ultrasound.
Near-peer training can scale instruction without loss of effectiveness versus faculty-led teaching, while remote supervision and simulation address logistical limits; however, online environments can attenuate nonverbal cues, underscoring the need for purposeful design and validated evaluation tools.
Taiwan's National Health Insurance launched a Hospital-at-Home (HAH) pilot in July 2024 focusing on acute infections-pneumonia, urinary tract infection, and soft tissue infection-where portable diagnostics and PoCUS can substitute or complement in-hospital imaging for timely home-based decisions.
Clinicians transitioning from hospital workflows to patients' homes and care facilities face new operational constraints, motivating scenario-based, high-fidelity simulation to rehearse dynamic conditions and multi-skill tasks that mirror real HAH care.
Objectives The study aims to compare the effectiveness of a PoCUS curriculum using near-peer training with remote supervision and high-fidelity scenario simulation versus traditional on-site in-person PoCUS teaching in the HAH context. The study also aims to determine whether remote OSCE+EPA assessments are consistent with in-person evaluations and feasible for high-stakes skill appraisal. EPA-based assessment levels across four domains-Indication, Acquisition, Interpretation, and Integration-anchored to OSCE cases aligned to HAH pneumonia, UTI, and soft tissue infection scenarios.
Methods This is a two-year, prospective, randomized educational intervention study. In Year 1, we develop HAH-focused scenario-based curricula, designs OSCE+EPA tools via expert consensus, and trains near-peer instructors who undergo rehearsal teaching with faculty observation and immediate feedback to qualify for Year 2 delivery roles.
In Year 2, we randomize PGY residents to receive either traditional PoCUS (didactics plus on-site faculty-supervised hands-on) or the new model (didactics plus near-peer hands-on with remote supervision and scenario simulation), with outcomes measured by OSCE performance scored via EPA instruments.
Participants The target population comprises PGY, internal medicine, and family medicine residents at National Taiwan University Hospital who volunteer to enroll, with a planned Year 2 sample size of approximately 100 participants.
Inclusion criteria are the above-mentioned residency trainee who are aged 20 years old or older. Exclusion criteria include unwillingness to participate.
Outcomes
* The primary outcomes of this study include learning outcomes between traditional and near-peer plus remote supervision and simulation models. Learning outcomes includes self-assessment questionnaire, and EPA-based OSCE scores.
* The secondary outcomes include :
1. TAM survey: Learners' feedback on the new curriculum, using the Technology Acceptance Model (TAM) will be collected after the PoCUS course and before the OSCE testing.
2. Survey of OSCE test: After the OSCE, a survey on the feedback on OSCE test will also be conducted.
3. Inter-rater variability: Agreement between remote and in-person EPA-based OSCE ratings to establish feasibility and equivalence of this remote tool.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 100
■ PGY, internal medicine, and family medicine residents at National Taiwan University Hospital.
■Unwillingness to participate in the study.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Performance score on OSCE 1 month The effectiveness of the curriculum will be evaluated approximately one month after completing the PoCUS course for both the experimental and control groups, using OSCE assessments incorporating EPA constructs. The OSCE will be evaluated independently by two reviewers(on site and remote), with the final score calculated as the average of their individual assessments. Students' performance will be analyzed based on their total OSCE scores as well as their scores for each construct of the EPA.
- Secondary Outcome Measures
Name Time Method TAM survey 1 month Learners' feedback on the new curriculum, using the Technology Acceptance Model (TAM) will be collected after the PoCUS course and before the OSCE testing.
Survey of OSCE test 1 month After the OSCE, a survey on the feedback on OSCE test will also be conducted.
Inter-rater variability 1 month Agreement between remote and in-person EPA-based OSCE ratings to establish feasibility and equivalence of this remote tool
Trial Locations
- Locations (1)
National Taiwan University Hospital
🇨🇳Taipei, Taiwan
National Taiwan University Hospital🇨🇳Taipei, TaiwanNin-Chieh Hsu, MD, PhDPrincipal InvestigatorYu-Feng Lin, MDContact+886-972653086dr.yufenglin@gmail.com