In our study we compared the skill gain in obtaining correct still frames as used in focused emergency echocardiographic exam by hands-on trainings supervised by student tutors versus expert echocardiographers. In both groups there was a increase in skill, but the group that was taught by the expert echocardiographers scored significantly better. Thus, hands on-training supervised by student tutors is probably inferior to hands on-training by expert echocardiographers for focused emergency echocardiography skills.
In previously published studies comparing the peer assisted learning concept with faculty teaching there was no difference in knowledge and skill gain, even when using ultrasound techniques
[15, 16, 23, 24]. This finding may be due to the complexity of echocardiography in comparison to the aforementioned skills. The student tutor training was probably too short, or the student tutors needed more time to teach the same skills compared to expert echocardiographers. Another possibility is that the contents of our echocardiography training were too ambitious. In addition to the FATE and FEEL concepts, we also taught the students to recognize overt valve disease (without grading). In a study by Alexander et al. from the Duke University novice echocardiographers with a portable ultrasound device had a good agreement to gold standard echocardiography after a three hour training for major findings (i.e. pericardial effusion, aortic valve immobility), but only a moderate agreement for less overt pathologies (i.e. moderate or severe left ventricular dysfunction, mitral valve regurgitation)
Since it requires a lot of practice to find the correct acoustic window for echocardiography, the student tutors probably took longer to demonstrate the correct position and to correct the students, thus limiting the students’ practice time. It is not clear, whether this can be counterbalanced with a more extensive training for the student tutors.
This raises the question as to which degree of complexity can be sufficiently covered by peer assisted learning involving student tutors who generally lack a broader clinical experience. At our faculty, aside from this course on echocardiography, abdominal sonography and central line catheterization are the most complex procedural skills taught by student tutors on a simulator at the skills lab. We consider peer assisted learning to be sufficient to teach the basics of these advanced skills. However, it has yet to be determined which degree of complexity in procedural skills can or cannot be taught by peer assisted learning. On the other hand, procedural skills lab training only prepares students for their upcoming clinical activities. It cannot be a substitute for expert knowledge arising from years of clinical practice and it is designed to prepare for practice, not to substitute practice. Therefore, it is of doubt whether the rather small difference in knowledge gain between EC and ST in this study is really relevant for future clinical activities of the medical students.
Our study has several limitations: first of all, it is a single centre experience with a small sample size. The OSCE comprised only parts of the whole focused emergency echocardiographic exam and the allotted time was limited in order to standardize the examination conditions. Our aim was to assess the ability to find the correct acoustic window and to recognize the anatomical cardiac structures, so the assessment did not comprise pathological findings. In addition, we assessed the echocardiography skills immediately after the lessons, so there are no data on long term retention.
Future research is needed to determine whether it is feasible to integrate focused emergency echocardiography into medical school curricula.