The application of a medical tool that is inexpensive and versatile is being held back by a lack of training, but now researchers at the Universidad del Valle (Univalle) are using a statistical tool to optimise that training.
Point-of-care ultrasound (POCUS) refers to the use of ultrasound to diagnose complications where the patient is, for example, in an emergency room, but in Colombia, there are clinics that have the equipment, but few staff with the necessary training to use it.
The desire for POCUS training exceeded current usage, but lack of trained providers (78%), ultrasound equipment (66%) and funding for training (41%) were common obstacles, according to a recent survey of physicians in the United States.
Professor Sandra Patricia Usaquén Perilla, a PhD student in engineering with an emphasis in industrial engineering at the Universidad del Valle (Univalle) and a lecturer in biomedical engineering at the Universidad Militar Nueva Granada explained that the researchers' goal was to compare the use of POCUS by doctors in training with the practice of an expert; and to measure their "learning curve".
"Establishing when a trainee has achieved a competency depends on many factors such as the procedure, the instructor, the type of patient, etc. This is an individual process that with the application of control charts allows monitoring this process and identifying improvements," Professor Usaquén said.
Figure: Cumulative sum test for learning curve (LC-CUSUM) and standard cumulative sum (CUSUM) for learner-reported plasma leakage control tests, by scenario. Credit: Usaquén et al (https://doi.org/10.11144/Javeriana.iued27.ccem)
The Research
POCUS is a tool for diagnosis from medical images of different parts of the body, including the identification of pulmonary oedema (an abnormal accumulation of fluid) and making a clinical decision based on this information.
In the scientific article entitled "Control charts to establish and monitor proficiency in the detection of pulmonary B-lines with Point of Care Ultrasound" published in the Colombian journal Ingeniería y Universidad: Engineering for Development, Usaquén and his collaborators focused on evaluating the ability of physicians to identify pulmonary oedema.
"The result showed that obtaining quality images at the base of the lung is more difficult than at the top of the organ, and therefore requires strengthening the technique for this type of learning," said Usaquén, who was also the lead author of the scientific paper.
Professor Jaime Mosquera Restrepo, the director of the School of Statistics and the Applied Statistics Research Group (INFERIR), as well as a co-author of the scientific paper, used his long experience in applying statistical tools to collaborate on this project.
"These control charts started in industry to measure quality but we can also apply them in the training of doctors," said Professor Mosquera, adding that the advantage of this application is that it decreases subjectivity in assessing the progress of the doctor in training.
"Statistics can help in any situation where you have to make decisions and there is so much uncertainty," Professor Mosquera said.
Dr. Jonathan Kirsch, Dr Jonathan Kirsch, assistant professor in the Department of Internal Medicine at the University of Minnesota; he was a Fulbright Scholar from 2017-2018 in Cali, Colombia, and co-author of the scientific paper explained the benefits to physicians and health educators of a tool that can measure the learning curve of physicians are immense.
"We all have learning curves for our skills, from walking and talking as babies to performing complex professional skills," Professor Kirsch said.
Professor Usaquén said the research group is also working on using POCUS to classify severe Dengue.
"Now that we have tested this methodology in simple techniques, we are working on applying it to the training of personnel in the early detection of severe Dengue," said Professor Usaquén.
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Photo: Professor Jaime Mosquera Restrepo. Credit: Andrew James/NCC-FI/Univalle
International Collaborations
Professors Usaquén and Kirsch explained that collaboration with researchers and those from abroad has several advantages.
"This helps to foster international connections and knowledge sharing, which is crucial for advancing medical research and improving health care outcomes worldwide," Professor Kirsch said , adding that this collaboration has led to several grant applications and bilateral exchanges, for example, a student collaborating with Dr Lyda Osorio and myself will present her work at the Annual International Conference of the American Society of Tropical Medicine and Hygiene.
"I am very grateful to have such wonderful colleagues at Univalle," Professor Kirsch said.
If you are interested in contacting the researcher or learning more about the project, please write to the Communications Office, Faculty of Engineering: comunicaingenieria(at)correounivalle.edu.co. Cover photo: Sandra Patricia Usaquén Perilla. Credit: School of Industrial Engineering
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