Behavior Change and Skills Retention With an Action Record After Ultrasonography Training

Abstract Background In simulation training, behavior change (Kirkpatrick’s level 3) is more important than learning improvement (Kirkpatrick’s level 2). However, few studies have evaluated behavior change because it is difficult to assess objectively. Skills retention is another challenge. We evaluated whether keeping a record of the number of ultrasound (US) examinations performed after a simulation course led to positive behavior changes and improved skills retention. Methods A 2-day point-of-care ultrasound (POCUS) course in cardiac US, lung US, lower extremity deep vein thrombosis (DVT) US, and abdominal US was held for Japanese nurse practitioners and trainees in 2018 and 2019. Participants kept a record of the number of US examinations they performed for 3 months before and 3 months after the course. The number of US exams performed was grouped into six categories. All participants underwent pre-course, immediate post-course, and 4-month post-course testing to assess image interpretation skills, image acquisition skills, and confidence. Results Thirty-three participants from 21 facilities completed the program. The median number of US exams performed during the 3-month period after the course increased significantly from before the course (P < 0.001). The median number of each US examination type (cardiac, lung, lower extremity DVT, and abdominal) after the course statistically significantly increased compared with before the course (P < 0.001). The immediate post-course and 4-month follow-up test scores for image interpretation skills, image acquisition skills, and confidence were statistically significantly higher than the pre-course test scores (P < 0.001). The results of the 4-month follow-up test showed no decline compared with immediate post-course scores. Conclusions Keeping a record after a POCUS simulation course increased the number of US examinations and improved knowledge, skills, and confidence. Keeping a record after simulation training led to positive behavior change and improved skills retention.