Modelo de treinamento em ultrassonografia para o protocolo eFAST na formação médica

Abstract

Introduction: Point-of-Care Ultrasound (POCUS) is an effective diagnostic tool for the rapid assessment of critically ill patients. The eFAST (Extended Focused Assessment with Sonography for Trauma) protocol is widely used to diagnose severe injuries in trauma settings. Although POCUS education has advanced since the 1990s, its implementation in Brazilian institutions remains limited. Objectives: To develop and implement a training model to train medical students and residents in performing the eFAST protocol, assess pre- and post-training knowledge, and propose the inclusion of this methodology in the formal curriculum of the Medical School at the Federal University of Rio Grande do Norte (UFRN). Methods: A quasi-experimental, pre-post, analytical, and prospective study was conducted, approved by the Research Ethics Committee of the Onofre Lopes University Hospital (HUOL). A total of 157 participants were divided into three groups: clinical cycle students (GCC, N=51) enrolled in the Emergency Medicine course, internship students (GI, N=78) in Emergency and Trauma Medicine, and Medical Residents (GRM, N=28) affiliated with HUOL. Thirteen students who did not consent to participate, withdrew, or were absent from institutional activities were excluded. The training program consisted of three stages: 1) A 60- minute interactive lecture on the basic principles of ultrasonography and the eFAST protocol. 2) A two-hour practical session with a standardized patient. 3) Supervised practice on adult patients admitted to the intensive care unit at HUOL, with the last stage being exclusive to the residents. All participants underwent cognitive assessment before and after theoretical and practical training. Additionally, retention was evaluated through a new cognitive assessment for the GCC, an Objective Structured Clinical Examination (OSCE) for the GI, and Direct Observation of Procedural Skills (DOPS) for the GRM. Satisfaction questionnaires were also administered at the end. Data were analyzed with a significance level of 5%. Results: All groups showed a significant improvement in knowledge after training, with mean scores of 5.17±1.59 vs. 8.11±1.65, 5.12±1.94 vs. 8.75±1.12, and 5.86±1.63 vs. 8.79±1.12 for the three groups, respectively (p-value < 0.0001). In the GCC group, students who did not participate in practical training performed worse in the cognitive retention assessment (5.05±2.29 vs. 6.91±2.32, p-value = 0.015). In the OSCE, internship students demonstrated satisfactory performance in both stations, with mean scores of 7.34±2.29 in station 1 and 8.25±1.92 in station 2. In the DOPS evaluation, 70% of residents were deemed competent to perform the protocol under supervision, while 30% could perform it independently. Regarding satisfaction, 79.4% of participants reported feeling confident in applying the eFAST protocol, and over 90% rated the training model positively. Conclusion: The proposed training model proved effective, significantly improving the performance of both medical students and residents. Additionally, the methodology was well received by participants, demonstrating its potential as a promising tool for ultrasound training in Brazilian medical education.