Introduction
In European Countries, abdominal ultrasound (US) is often considered a first-line diagnostic technique and an extension of clinical examination [1]. The interpretation of US and its accuracy is operator dependent and, in the absence of adequate training and continuous medical education, US probes may be a useless tool [2,3]. To fill this gap, The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has developed guidelines to identify minimum training requirements for US examinations [4], with 300 exams needed to be a Level 1 sonographer.
In Italy, gastroenterologists have the possibility to learn abdominal US during medical residency or while attending private dedicated training courses. Nonetheless, there is no standardized training among Italian universities and many gastroenterologists acquire US skills only after their residency. This evidence points out the pitfalls of our educational system.
Aims & Methods
The aim of our survey was to identify the overall education and knowledge of abdominal US among young Italian gastroenterologists (<40 years old). For this purpose, we sent a questionnaire to young Italian gastroenterologists and residents in Gastroenterology (GI).
The Ultrasound Committee of the Italian Young Gastroenterologist and Endoscopist Association (Associazione Giovani Gastroenterologi ed Endoscopisti Italiani- AGGEI) distributed via e-mail to all its members (348) a web-based survey and multiple-choice test with images, based on the EFSUMB recommendations about minimum training requirements for a US examination [4].
The answers were collected anonymously and analyzed for distribution and correlations.
Statistical analysis was performed with STATA 13.0 (College Station, TX: StataCorp LP).
Results
The questionnaire was filled out by 110 participants (60 males, 54.5% aged <30) from all over Italy with a response rate of 31.6% Most of the respondents worked in Academic Hospitals and were GI residents or PhD students.
Among the participants, 58.9% learned US during their GI residency by other skilled residents and only 8.2% attended specific US courses. The great majority (90%) of respondents were currently working in a Unit with a US service. During their training participants performed a median number of 320 (IQR 20-1280) upper abdomen and 240 (IQR 20-640) bowel ultrasound examinations. A total of 39 did not perform any bowel US. More than half (55%) completed independently >300 abdominal US (Level 1 EFSUMB sonographer).
Seventy-four point five percent of respondents believe in the value of US education for their future clinical practice. At the univariate logistic regression, being >30 years old and working in a non-academic hospital were factors associated with a positive result in the questionnaire, with a statistically significant association (OR 2.406; 1.142–5.168, p<0.05). Multivariate analysis showed that the respondents who stated to feel confident in performing abdominal US independently had higher points on the test (OR 0.370; 0.161-0.850, p<0.05 at the multivariate logistic regression) (Table 4).
Table 4. Uni and multivariate logistic regression for the evaluation of factors associated with higher scores in the multiple-choice test with images.
Factors associated with high scores (>14/22) in the test | n of respondents with high scores (%) | Univariate logistic regression (OR 95% CI) | p | Multivariate logistic regression (OR 95% CI) | p |
Age <30 <40 |
29/60 (48%) 36/50 (72%) |
0.970 (0.588-1.600) 2.406 (1.142–5.168) |
0.906 0.021 |
|
|
Workplace Academic Not Academic |
44/82 (54%) 21/28 (75%) |
1.157 (0.750-1.787) 2.590 (0.992-6.761) |
0.508 0.052 |
2.409 (0.902-6.434) |
0.079 |
Clinical role GI Resident Consultant |
43/79 (54%) 22/31 (71%) |
1.194 (0.767-1.859) 2.046 (0.837-4.998) |
0.432 0.116 |
|
|
Do you feel confident in performing GIUS/UAUS independently? Yes |
33/45 (73%) |
0.352 (0.155-0.800) |
0.013 |
0.370 (0.161-0.850) |
0.019 |
US service in the GI unit | 58/99 (59%) | 1.237 (0.339-4.502) | 0.747 |
|
|
Do you believe that it is useful to perform UAUS or GIUS independently for a young GI specialist? Yes |
24/28 (85%) |
6 (1.912-18.82) |
0.002 |
|
|
Conclusion
Most young Italian gastroenterologists believe US training has an important role for their education. However, their competence suffers from heterogeneous teaching.
GI Schools should provide standardized theoretical and practical (hands-on training and learning by doing) education for this essential examination.
References
1. Abu-Zidan FM, Cevik AA. Diagnostic point-of-care ultrasound (POCUS) for gastrointestinal pathology: state of the art from basics to advanced. World J Emerg Surg. 2018 Oct 15;13:47. doi: 10.1186/s13017-018-0209-y. PMID: 30356808; PMCID: PMC6190544.
2. Heinzow HS, Friederichs H, Lenz P, et al. Teaching ultrasound in a curricular course according to certified EFSUMB standards during undergraduate medical education: a prospective study. BMC Med Educ 2013 Jun 11; 13: 84. doi: 10.1186/1472-6920-13-84. PMID: 23758796; PMCID: PMC3686658
3. Nourkami-Tutdibi N, Tutdibi E, Schmidt S, et al. Long-term knowledge retention after peer-assisted abdominal ultrasound teaching: is PAL a successful model for achieving knowledge retention? Langzeit-Lerneffekte nach Peer-Assisted Ultraschall-Kurs: Ist PAL eine erfolgreiche Methode in der Erhaltung von Langzeit-Lerneffekten? Ultraschall in Med 2020; 41(1): 36–43. doi: 10.1055/a-1034-7749
4. Valentin, L. Minimum training recommendations for the practice of medical ultrasound. 27.