Bedside Ultrasound in the Assessment of Deep Venous Thrombosis: Effectiveness of In-Person Versus Online Instruction

This will be a single site prospective pilot study analyzing the agreement between the results of ED student bedside ultrasonography and radiology-performed ultrasonography. Medical students rotating at St Elizabeth Boardman Hospital in the emergency department from any U.S. medical school will be considered for enrollment. Once a rotation has been set up by the medical student and the medical student coordinator, they will be given information on the study being performed and asked if they will be interested. The medical student coordinator will provide them this information. They will be instructed to reply to the co-P.I. if they are interested in participating in the project and given the formal consent to review upon receipt of their affirmative response.

Potential study participants will be provided envelopes by the co-P.I. containing both the formal written consent to participate in the study as well as a short knowledge test of ultrasound technology and the DVT study itself. The student will be required to first sign the consent form, then take the examination and receive a failing score in order to participate in the study. This pre-test will be based heavily on the quizzes from the EMSono learning modules. Permission has been obtained by Dr. Robert Jones to use these questions as the basis for the pre-test examination. A passing score on the pre-test assessment will be considered to be 80% or higher. The assignment list will be computer-generated using the website www.randomizer.org. Students will be given their numeric randomization assignments based on the order in which they finish their exam, after those that pass are excluded. The exact methodology is described in https://www.randomizer.org/tutorial/lesson2.html. Utilizing this methodology, a randomly-generated value of 1 shall be online training, and 2 shall be in-person training.

The study itself shall consist of two arms separated by training. The patient inclusion criteria will not vary between the two arms, only the level of student training. Additional data will be obtained regarding study participants prior to the start of the study, including: training level, approximate number of lower extremity ultrasound studies performed by the participant in the past, overall ultrasound experience, and any formal sonographic education or credentialing.

In the first arm, participating students must have completed the "Practical Scanning" and "Lower Extremity DVT Ultrasound" modules contained within the EMSono online ultrasound instruction. In the second arm, participating student must have attended the in-person training that will be provided by an RDMS-certified ultrasonographer, Kathryn Gentile. The training will last approximately 4 hours in each training method and will include instruction on performing a B-mode compression test of the deep veins of the lower extremities to assess for presence or absence of DVT. There will be no significant difference in the approximate content covered in each training method. Each arm must pass a practical examination in which they must demonstrate basic proficiency in the use of the ultrasound device as well as the ability to obtain all views necessary for their examinations. Failure of the practical exam will result in exclusion from the remainder of the study. They will also be required to repeat the pre-test assessment which will be tracked for improvement from their first pre-test assessment. Both arms will have their pre-test assessment, training, and post-test practical examination monitored by the P.I., co-P.I., ultrasonographer, or another suitable proctor.

Emergency department patients whom the physician has a clinical suspicion for lower extremity DVT or PE and have intention of ordering formal radiology department performed ultrasound will be consented to also have a bedside ultrasound performed by study participant. This consent will be obtained by either the resident or attending physician providing the care of the patient; at which point, the physician will inform whatever student study participant is currently on shift in the department. If there are multiple student study participants present and on shift in the department, the physician must inform a student in an appropriate manner. If a student has already begun to see the patient that is to receive the DVT assessment, then they shall be the study participant selected. If no student has begun to see the patient, then the student with the fewest number of US DVT scans performed in the course of this study will be the study participant selected. If neither of these factors are definitive, then the ED physician shall decide the student to perform the examination via coin toss. If a physical coin is unavailable, then a smartphone coin toss app will be considered an acceptable alternative. The device utilized to obtain these exams shall be a Philips Lumify linear 12-4 MHz probe attached to a Samsung Galaxy View 19" tablet.