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.
None
None
Parallel
Remote supervision + simulation
Other interventionteacher use remote supervision to assist peer training Hospital-at-Home scenario simulation
OSCE total and subscale scores on EPA-based PoCUS
The effectiveness of the curriculum will be evaluated approximately one month after completing the PoCUS course for both the experimental and control groups, using OSCE assessments incorporating EPA constructs. The OSCE will be evaluated independently by two reviewers(on site and remote), with the final score calculated as the average of their individual assessments. Students' performance will be analyzed based on their total OSCE scores as well as their scores for each construct of the EPA.
Technology Acceptance Model (TAM) questionnaire total and subscale scores
Learners' feedback on the new curriculum, using the Technology Acceptance Model (TAM) will be collected after the PoCUS course and before the OSCE testing.
Post-OSCE survey score
After the OSCE, a survey on the feedback on OSCE test will also be conducted.
Inter-rater reliability of EPA-based OSCE ratings
Agreement between remote and in-person EPA-based OSCE ratings to establish feasibility and equivalence of this remote tool
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National Taiwan University Hospital
Lead sponsor
National Science and Technology Council
Collaborator
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