Overview
Since July 2024, the National Health Insurance Administration (NHIA) has been implementing a pilot Hospital-at-Home (HAH) Acute Care Program to curb hospital admissions. Point-of-Care Ultrasound (PoCUS) is considered the most promising imaging tool for this model. Replicating the hospital's familiar environment-its staffing patterns, diagnostic workflows, and medication protocols-in a patient's home or nursing facility is almost impossible, posing a major challenge to care teams. Medical-simulation training offers a solution, yet current PoCUS courses remain organ-based and lack scenario-based simulations that prepare physicians for HAH practice.
This two-year study will create a PoCUS curriculum and outcome-assessment tools tailored to HAH, adapting previously validated Entrustable Professional Activities (EPA) instruments to three HAH scenarios: pneumonia, urinary tract infection, and soft-tissue infection. Year 1 will develop scenario-based simulation courses and matching EPA tools, and train peer instructors who receive full PoCUS instruction for the three scenarios. Year 2 will randomly assign learners to compare two teaching models-peer training with remote supervision and scenario simulation versus traditional PoCUS training-evaluated with an Objective Structured Clinical Examination (OSCE) scored by EPA forms across multiple domains.
The project aims to establish normative standards for PoCUS training and assessment in HAH, confirm the feasibility of peer training with remote supervision, and provide a platform to train HAH medical teams nationwide, including those in rural areas.
Description
Background
PoCUS has evolved from hospital-based imaging to bedside diagnostic support, enabling rapid, problem-oriented assessments across trauma, shock, dyspnea, and resuscitation scenarios as portable devices matured in image quality and accessibility.
Recent medical education trends emphasize competency-based medical education (CBME), milestones, and EPAs, requiring structured assessment of indications, image acquisition, interpretation, and integration into management for skill-intensive technologies such as ultrasound.
Near-peer training can scale instruction without loss of effectiveness compared with faculty-led teaching, while remote supervision and simulation address logistical limits. However, online environments can attenuate nonverbal cues, underscoring the need for purposeful instructional design and validated evaluation tools.
Taiwan's National Health Insurance (NHI) launched a HAH pilot program in July 2024 focusing on acute infections-pneumonia, urinary tract infection (UTI), and soft tissue infection-where portable diagnostics and PoCUS can substitute or complement in-hospital imaging for timely home-based decisions.
Clinicians transitioning from hospital workflows to patients' homes and care facilities face new operational constraints, motivating scenario-based, high-fidelity simulation to rehearse dynamic conditions and multi-skill tasks that mirror real HAH care.
Objectives
The study aims to compare the effectiveness of a PoCUS curriculum using near-peer training with remote supervision and high-fidelity scenario simulation versus traditional on-site, in-person PoCUS teaching in the HAH context.
The study also aims to determine whether remote OSCE combined with EPA assessments are consistent with in-person evaluations and feasible for high-stakes skill appraisal. EPA-based assessment levels across four domains-Indication, Acquisition, Interpretation, and Integration-are anchored to OSCE cases aligned with HAH pneumonia, urinary tract infection, and soft tissue infection scenarios.
Methods
This is a two-year, prospective, randomized educational intervention study.
- Year 1: Development of HAH-focused scenario-based curricula; design of OSCE and EPA tools through expert consensus; and training of near-peer instructors who undergo rehearsal teaching with faculty observation and immediate feedback to qualify for Year 2 delivery roles.
- Year 2: Randomization of Post-Graduate Year (PGY) residents to receive either traditional PoCUS instruction (didactics plus on-site faculty-supervised hands-on training) or the new model (didactics plus near-peer hands-on training with remote supervision and scenario simulation). Outcomes will be measured by OSCE performance scored using EPA instruments.
Participants
The target population comprises PGY residents, internal medicine residents, and family medicine residents at National Taiwan University Hospital who volunteer to enroll, with a planned Year 2 sample size of approximately 100 participants.
Inclusion criteria are the above-mentioned residency trainees aged 20 years or older. Exclusion criteria include unwillingness to participate.
Outcomes
- Primary outcomes: Learning outcomes between traditional and near-peer training with remote supervision and simulation. Learning outcomes include self-assessment questionnaires and EPA-based OSCE scores.
- Secondary outcomes:
- Technology Acceptance Model (TAM) survey: Learners' feedback on the new curriculum, collected after the PoCUS course and before OSCE testing.
- OSCE survey: A post-OSCE survey on learner feedback regarding the examination itself.
- Inter-rater variability: Agreement between remote and in-person EPA-based OSCE ratings to establish feasibility and equivalence of the remote assessment tool.
Eligibility
Inclusion Criteria:
â– PGY, internal medicine, and family medicine residents at National Taiwan University Hospital.
Exclusion Criteria:
â– Unwillingness to participate in the study.