Instituting Ultrasound-Guided FNA for Thyroid Nodules into a General Surgery Residency Program: What We Learned

• Published in: Journal of surgical education 2018-05, Vol.75 (3), p.594-600
• Main Authors: Davis, James R., Hale, Allyson L., Ewing, Joseph A., Lokey, Jonathan S.
• Format: Article
• Language: English
• Subjects: curriculum; fine needle aspiration; Patient Care; Practice-Based Learning and Improvement; simulation; Systems-Based Practice; thyroid biopsy; ultrasound
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2017.09.031

Evaluation of a thyroid nodule is a common referral seen by surgeons and frequently requires ultrasound-guided fine needle aspiration (US-guided FNA). While surgical residents may have sufficient exposure to thyroid surgery, many lack exposure to office-based procedures, such as US-guided FNA. General surgery residents should be provided with knowledge and practical skills in the application of diagnostic and interventional neck ultrasound to manage the common workup of a thyroid nodule. This study sought to instruct and measure surgical residents' performance in thyroid US-guided FNA and evaluate their views regarding instituting such a formal curriculum. Twelve (n = 12) senior residents completed a written pretest and questionnaire, then watched an instructional video and practiced a simulated thyroid US-guided FNA on our created model. Then residents were evaluated while performing actual thyroid US-guided FNAs on patients in our clinic. Residents then completed the same written exam and questionnaire for objective measure. Eight of the chief residents (62%) felt “not comfortable” with the procedure on the pre-course survey; this was reduced to 0% on the post-course survey. Moderate comfort level increased from 15% to 50% and extreme comfort increased from 0% to 8%. From the 11 residents who completed the pre- and post-test exam, 82% (n = 9) significantly improved their score through the curriculum (pre-test: 40.9 vs. post-test: 61.8; p = 0.05). With focused instruction, residents are able to learn ultrasound-guided thyroid biopsy with improvement in subjective confidence level and objective measures. Resident feedback was positive and emphasized the importance of such training in surgical residency curriculum.