Purpose or Case Report: Midgut volvulus (MV) is a surgical emergency conventionally diagnosed with fluoroscopy. Ultrasonography (US) is an alternate method to expedite diagnosis when a radiologist is not on-site, but can be limited by interpreter and sonographer familiarity with the key findings needed to make the diagnosis. The primary objective of this study was to see if a newly-designed curriculum improved trainee knowledge of US for midgut volvulus.
Methods & Materials: Study was HIPAA compliant and IRB exempt. Curriculum consisted of a self-directed online PowerPoint presentation and an in-person session where midgut volvulus US technique was demonstrated and the self-directed didactic presentation was discussed in small groups. All local radiology residents and pediatric radiology fellows were invited to participate. Participation was optional, but participants were asked to complete pre and post tests. Both on-line tests have 7 questions to assess knowledge, 3 unknown cases (cine clips, one each of MV, normal, and malrotation), and 2 self-graded comfort with US questions. The posttest has 2 added questions of the trainees’ perceived usefulness of the training. The change in test scores was plotted for each trainee, and the Wilcoxon signed-rank test was used to compare test scores pre and post training. Training level of volunteers was summarized using frequency with percentage.
Results: 16 trainees completed all modules: PGY6 or 7 (n=4, 25%), PGY5 (n=2, 13%), PGY4 (n=3, 19%), PGY3 (n=2, 13%), PGY2 (n=5, 31%). 6 trainees completed only pre or post tests, and were not included in the analysis. There was an improvement in knowledge question scores following training (p<0.002): pre vs post median 7.0 vs 10.5, min 2.0 vs 6.0, max 12.0 vs 12.0. For both self-graded ability to interpret MV US (pre vs post median 5.5 vs 9.0, min 1.0 vs 5.0, max 10.0 vs 10.0) and how to troubleshoot MV US with the sonographer (pre vs post median 3.5 vs 8.0, min 1.0 vs 4.0, max 10.0 vs 10.0), there was improvement following training (p<0.001 for both). Trainees indicated the in-person training helped their understanding of MV (mean 9.1/10). Trainees did not agree that the self-directed module was good enough, and the hands-on session was unnecessary (mean 3.9/10).
Conclusions: The tested curriculum improved trainees’ knowledge of US for midgut volvulus. Trainees found the in-person session helpful. Success in future educational efforts may be facilitated with in-person sonographic demonstrations and discussion of any self-directed module.