POCUS · AMEE 2026
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AMEE 2026 · Research Paper
From Training to Practice從訓練到實踐 Long-Term Clinical Impact & Behavioral Changes after a National Hybrid POCUS Curriculum in Taiwan 台灣國家級混成 POCUS 課程後的長期臨床影響與行為改變
Wei-Jun Lin · Te-Fa Chiu · Mei-Jyun Shen · Tse-Chyuan Wong · Wei-Hsun Chen · Meng-Feng Tsai
Department of Medical Education, China Medical University Hospital, Taichung, Taiwan中國醫藥大學附設醫院 教學部，台灣台中
3-yearnational scale-up國家級三年計畫
n = 50 / 41Year-2 & Year-3 cohorts第二年/第三年世代
69.4%decisions influenced影響臨床決策
PLS-SEMbehavioral drivers行為驅動因子
Background & the Research Gap研究背景與缺口
Scaling point-of-care ultrasound (POCUS) to community and rural care將重點式超音波（POCUS）擴散至社區與偏鄉照護
A national, three-year programme國家級三年計畫
- Taiwan launched a three-year national programme to scale POCUS for rural and community clinicians.台灣推動三年期國家級計畫，將 POCUS 擴散至偏鄉與社區臨床人員。
- Delivery evolved deliberately: on-site workshops → online → a fully hybrid, flipped model.授課模式逐步演進：實體工作坊 → 線上 → 完全混成翻轉教室。
- Per-stage satisfaction stayed high (96.8 / 95.4 / 95.8) — but satisfaction is not durability.各階段滿意度皆高（96.8／95.4／95.8），但滿意度不等於持久性。
The Educational Gap教育缺口
“What happens after the workshop ends?工作坊結束之後呢？”
Satisfaction and immediate skills are well documented; the durability of POCUS use and its real clinical impact months after training remain uncertain.滿意度與即時技能已被充分記錄，但課後數月 POCUS 使用的持久性與真實臨床影響仍待釐清。
The pathway to clinical impact — our outcome is the hardest, final step通往臨床影響的路徑，本研究關注最困難的最後一步
Curriculum Evolution課程演進
From lecture-heavy to fully flipped — three iterations re-balanced theory and practice由講授為主走向完全翻轉，三次迭代重新平衡理論與實作
1
Year 1 · Basic V1.0
Traditional Workshop傳統工作坊
Lecture + hands-on practice講授＋實作練習
Issue: heavy theory, low practice問題：理論偏重、實作不足
Satisfaction滿意度 96.8/100
2
Year 2 · Basic V2.0
Hybrid Learning混成學習
Online pre-study + lecture & practice線上預習＋講授與實作
Enhance knowledge mastery強化知識掌握
Satisfaction滿意度 95.4/100
3
Year 3 · Basic V3.0 + Core
Flipped Classroom翻轉教室
100% online + 40-min review & hands-on100% 線上＋40 分鐘複習與實作
Maximise hands-on time最大化實作時間
Satisfaction滿意度 95.8/100
The hybrid flipped model in practice混成翻轉模式實景
1 · Online course1 · 線上課程
Self-paced modules completed before class課前自主完成的線上課程模組
2 · Focused review lecture2 · 大堂重點複習
Short, focused in-person review現場短時間重點複習
3 · Hands-on practice3 · 分站實作練習
Station-based, faculty-led deliberate practice分站進行、師資帶領的刻意練習
Course time allocation shifted to hands-on課程時間配置轉向實作
Online pre-study線上預習
Lecture講授
Hands-on practice實作練習
Course content: anatomy-based to symptom-based課程內容：解剖導向到症狀導向
Hover or tap a module to trace how each anatomy scan maps to symptom-based clinical scenarios.懸停或點選任一模組，追蹤每項解剖掃描如何對應到症狀導向的臨床情境。
BASIC COURSE · anatomy-based基礎課程 · 解剖導向
CORE COURSE · symptom-based核心課程 · 症狀導向
Hepatobiliary
肝膽
肝膽
Genitourinary /
Gynaecological
Gynaecological
Cardiac
心臟
心臟
Lung
肺部
肺部
Vascular access
(AV scan & PVC)
(AV scan & PVC)
Dyspnoea
呼吸困難
呼吸困難
Fever /
flank pain
flank pain
Abdominal pain
腹痛
腹痛
Trauma
創傷
創傷
Arthrocentesis /
ascites / pleural
ascites / pleural
Primary application主要應用FAST / trauma convergenceFAST／創傷匯聚
Study Design研究設計
An embedded longitudinal & perception study — two complementary arms嵌入課程的縱貫追蹤與感知研究，兩個互補分支
Participant flow資料篩選流程
115
Completed the course完成課程
→51%
59
Responded to the 3–6 month survey回覆 3-6 月問卷
→43%
50
Responded to the 1-year survey回覆 1 年問卷
Surveys were voluntary and unincentivised; percentages are response rates relative to the 115 course completers.問卷為非強制性、無獎勵填答；百分比為相對於 115 位完成課程者的回覆率。
Arm 1 · Longitudinal分支一 · 縱貫追蹤
Year-2 · n = 50第二年 · n = 50
- Surveys at baseline, 3–6 months, 1 year課前、3-6 月、1 年問卷
- Monthly POCUS use每月 POCUS 使用次數
- % cases where POCUS confirmed / changed diagnosis or managementPOCUS 確認/改變診斷或處置之個案比例
Arm 2 · Perception分支二 · 感知量表
Year-3 · n = 41第三年 · n = 41
- 26-item, 7-point Likert instrument26 題、七點李克特量表
- 5 constructs: usefulness, ease of use, feasibility, self-efficacy, intention五構面：有用性、易用性、可行性、自我效能、行為意向
- Open-ended items on benefits & barriers開放式效益與障礙題項
Analysis分析方法
Quantitative + qualitative量化＋質性
- PLS-SEM for total effects on behavioural intentionPLS-SEM 分析對行為意向之總效應
- Reliability / validity: Cronbach’s α, AVE信效度：Cronbach’s α、AVE
- Thematic analysis of open responses開放回饋之主題分析
Who Were the Learners?學員是誰？
Year-2 cohort (n = 50): a non-physician, frontline workforce — many with no prior POCUS experience第二年世代（n = 50）：以非醫師之第一線人員為主，許多人無 POCUS 經驗
Professional role職類分布 · tap a slice點選色塊
Prior POCUS experience先前 POCUS 經驗
38% had never performed POCUS, and only 34% had over a year of experience — a novice-heavy cohort that raises the bar for durable adoption.從未操作過 POCUS，僅 34% 有一年以上經驗；以新手為主的世代，使持續採用更具挑戰性。
Practice setting執業場域
42% work in community / home-care or clinic settings (not hospitals) — precisely the rural-access workforce the programme targets.在社區／居家或診所場域服務（非醫院），正是本計畫鎖定的偏鄉照護人力。
0%Non-physicians非醫師
0%No prior experience無先前經驗
0%Hospital-based醫院場域
Result 1 — Adoption Sustained at One Year結果一 — 一年後仍持續採用
Monthly POCUS use rose sharply, then settled above baseline每月 POCUS 使用大幅上升後回穩，仍高於基線
Mean monthly POCUS use (times / month)每月平均 POCUS 使用次數
Baseline課前
3–6 months課後3-6月
1 year1 年
Peaked at 3–6 months (+61%); +16% above baseline at 1 year.課後 3-6 月達峰（+61%）；1 年仍較基線高 +16%。
From never-users to sustained users從未使用者到持續使用者
14 / 16
Of the 50 learners, 16 had never performed POCUS before the course — one year later, 14 of them were still using it regularly.50 位學員中有 16 位課前從未執行過 POCUS，課程一年後其中 14 位維持固定使用。
Already using pre-course (34)課前已使用（34）
Never-user → regular use at 1 yr (14)課前未使用→一年後固定使用（14）
Not sustained (2)未持續（2）
The only 2 non-users at one year were former users whose clinical need had declined.一年後僅有的 2 位未使用者為原使用者，因臨床需求下降而停用。
Monthly Use — Distribution Over Time每月使用次數 — 隨時間的分布
Explore how the whole cohort’s usage frequency shifted — switch cohort and time-point探索整個世代使用頻率的變化 — 切換世代與時間點
Cohort世代
Time-point時間點
Year-2 was followed to one year; Year-3 (31 valid responses of 41) has baseline and 3–6 month data so far. 第二年追蹤至一年；第三年（41 人中回收 31 份有效問卷）目前有課前與課後 3-6 月資料。
Result 2 — POCUS Changed Real Decisions結果二 — POCUS 改變真實決策
Year-2 cohort · 1-year survey — impact defined as POCUS further confirming or changing the diagnosis or management第二年學員 · 一年後問卷統計結果，定義為更加確認或改變醫療診斷或處置
Key question: does performing POCUS change the medical decision — diagnosis or management?核心問題：有沒有做 POCUS，會不會改變醫療決策（診斷或處置）？
Clinic / Home診所／居家
Ambulance / Transfer救護車／轉送
Hospital醫院
→
→
Share of cases where POCUS changed the decisionPOCUS 改變決策的個案比例
Frequent users reporting POCUS further confirmed or changed diagnosis / management高頻率使用者中，回報 POCUS 更加確認或改變診斷／處置者
0%
23 / 25
9 of the 25 frequent users (36%) reported impact in more than 60% of their cases.25 位高頻率使用者中有 9 位（36%）在超過 60% 的個案中產生影響。
Result 3 — How POCUS Helped結果三 — POCUS 如何幫助
Open responses clustered into three consistent themes開放回饋歸納為三個一致主題
Faster differentiation加速鑑別
Quicker recognition and ruling-out of critical, time-sensitive conditions at the point of care.在照護現場更快辨識與排除急重症與時效性病況。
Safer, more precise care更安全精準的處置
More accurate procedures and better-guided fluid management, reducing avoidable risk.更精準的操作與體液管理導引，降低可避免的風險。
Confidence & teaching信心與教學
Greater confidence in decision-making, and the ability to teach and supervise colleagues.提升決策信心，並能教學與督導同仁。
Voices from practice來自臨床現場的聲音
Tap a real case to read a learner’s own account of how POCUS changed care.點選任一真實個案,閱讀學員親述 POCUS 如何改變照護。
Objective evidence: learner-acquired scans客觀佐證：學員實際操作之超音波影像
Bedside images submitted in post-course feedback — direct proof that training became real-world scanning. Tap to enlarge.學員於課後回饋提交的床邊影像,直接證明訓練已轉化為實際操作。點選可放大。
Images de-identified and shown with the study team’s consent as evidence of utilisation.影像已去識別化,經研究團隊同意作為實際使用之佐證。
Result 4 — Strong, Validated Perceptions結果四 — 高分且具信效度的感知
Year-3 (n = 41) · post-course survey results: high scores across all five constructs, with robust reliability and validity第三年（n = 41）· 課程結束後問卷統計結果：五構面皆高分，信效度穩健
Mean construct scores (7-point scale)各構面平均分（七點量表）
α = 0.825 – 0.946
Cronbach’s alpha (internal consistency)Cronbach’s α（內部一致性）
AVE = 0.655 – 0.939
Average variance extracted (convergent validity)平均變異萃取（收斂效度）
Result 5 — Self-Efficacy Is the Key Driver結果五 — 自我效能是關鍵驅動
PLS-SEM (n = 41): structural model, path coefficients, and total effects on behavioural intentionPLS-SEM（n = 41）：結構模型、路徑係數與對行為意向的總效應
Structural model & path coefficients結構模型與路徑係數
Significant path（** p < 0.01）顯著路徑（** p < 0.01）
Non-significant path (p ≥ 0.05)不顯著路徑（p ≥ 0.05）
Standardised coefficients; hover a path for exact β and p. R² reported per PLS-SEM convention (adj.: 0.667 / 0.793).標準化係數；懸停路徑可見精確 β 與 p 值。R² 依 PLS-SEM 慣例標註（調整後：0.667／0.793）。
Total effects on behavioural intention, ranked對行為意向的總效應排序
Self-efficacy自我效能
Usefulness有用性
Ease of use易用性
0.641 →
0.447 →
−0.099 →
Behavioural Intention行為意向
to keep using POCUS持續使用 POCUS
R² = 0.814 (adj. 0.793)
R² = 0.814
Substantial explanatory power (Hair et al.: ≥0.75 substantial). The model explains 81% of variance in behavioural intention.解釋力佳（Hair 等人標準：≥0.75 為高）。模型可解釋行為意向 81% 的變異。
Substantial explanatory power (Hair et al.: ≥0.75 substantial). The model explains 81% of variance in behavioural intention.解釋力佳（Hair 等人標準：≥0.75 為高）。模型可解釋行為意向 81% 的變異。
Behavioural intention is substantially explained by the model.行為意向獲模型高度解釋。
Reported per international PLS-SEM convention (R² of endogenous constructs).依國際 PLS-SEM 報告慣例標註內生變項之 R²。
Hover or tap a driver to read its total effect.懸停或點選任一驅動因子,查看其總效應說明。
Barriers at One Year一年後的主要障礙
Where sustained use breaks down — and what to design against持續使用受阻之處，以及應對的設計方向
Most-reported barriers最常回報的障礙
Design implications設計啟示
- Accessible mentorship & remote feedback loops after the course課後可近用的導師制與遠距回饋機制
- Protected time and shared / portable equipment access保障時間與共享／可攜式設備
- Deliberate-practice resources that build self-efficacy建立自我效能的刻意練習資源
Each barrier maps onto self-efficacy — the lever from Result 5.每項障礙都指向自我效能 — 結果五的關鍵槓桿。
Theoretical Framing, Strengths & Limitations理論框架、優勢與限制
Why the model is what it is — and how far the findings can travel模型背後的理論依據,以及研究發現的適用範圍
✓ Strengths研究優勢
- Two real national cohorts with longitudinal follow-up to one year — behaviour, not just satisfaction.兩個真實國家級世代,縱貫追蹤至一年,衡量行為而非僅滿意度。
- Outcomes span adoption and clinical decision impact, plus a psychometrically validated instrument (α, AVE).結果涵蓋採用與臨床決策影響,並使用具信效度的量表（α、AVE）。
- Mixed methods: PLS-SEM modelling triangulated with thematic analysis of open responses.混合方法:PLS-SEM 建模與開放回饋主題分析交叉驗證。
△ Limitations & future directions限制與未來方向
- Self-reported use and impact — objective utilisation logs and patient-level outcomes are needed.使用與影響為自陳資料,未來需客觀使用紀錄與病人層級結果。
- Single national programme, no control arm; multi-site replication would test generalisability.單一國家計畫、無對照組;需多中心複製以檢驗外推性。
- Year-3 one-year data pending; responder subset (31/41) invites non-response bias checks.第三年一年資料待收;回覆子集（31/41）需檢核無回應偏誤。
- Linking durability to competency frameworks (EPA / milestones) is a natural next step.將持續性連結至能力框架（EPA／里程碑）為下一步。
Discussion & Take-Home Messages討論與重點訊息
✓ What the programme achieved計畫達成
- Sustained POCUS adoption to one year in community / rural care社區／偏鄉場域中採用持續至一年
- POCUS changed decisions for 88% of users (only 12% reported no change) — real clinical impact88% 使用者之決策受影響（僅 12% 回報無改變）— 真實臨床影響
- Uniformly high, psychometrically validated perceptions感知一致高分且具信效度
△ What must be strengthened仍須強化
- Utilisation partially wanes after the 3–6-month peak使用率於 3-6 月峰值後部分回落
- Self-efficacy — not ease — is the principal driver of lasting intention自我效能（非易用性）是持久意向的主要驅動
- Build mentorship, feedback & deliberate practice into post-course support將導師、回饋與刻意練習納入課後支持
1 · Hybrid scale-up works混成擴展可行
A national hybrid POCUS curriculum can produce sustained adoption and real decision impact in community care.國家級混成 POCUS 課程可在社區照護帶來持續採用與真實決策影響。
2 · Self-efficacy is the engine自我效能是引擎
Self-efficacy is the principal driver of feasibility and behavioural intention; ease of use is not enough.自我效能是可行性與行為意向的主要驅動；易用性並不足夠。
3 · Design the after-course設計課後支持
Faculty feedback, mentorship and deliberate-practice resources should be built into post-course support by design.應將師資回饋、導師與刻意練習資源納入課後支持設計。
From training back to the field從訓練回到在地場域
Assignment photos submitted after the course: learners performing POCUS with real patients back in their own settings — home visits, home care, facilities and clinics — direct evidence that training carried over into everyday practice.課後繳交的作業照片：學員回到自身場域為真實病患執行 POCUS，涵蓋居家訪視、居家照護、機構與診間，直接證明訓練延續到日常臨床實務。
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