Education of general practitioners in the use of point-of-care ultrasonography: a systematic review

Abstract

Objective To systematically review and synthesize the published literature regarding the education of general practitioners (GPs) and GPs in training (GPTs) in the use of ultrasonography. Design This systematic review was prospectively registered in PROSPERO, conducted according to the Cochrane recommendations. We combined studies identified in a previous systematic review with studies from an updated literature search using the same search string. We searched the following databases: MEDLINE via Pubmed, EMBASE via OVID, Cinahl via Ebsco, Web of Science and Cochrane Register of Controlled Trials using the words ‘ultrasonography’ and ‘general practice’. Two reviewers independently screened articles, extracted data and assessed the quality of included papers according to the Down and Black quality assessment tool. Disagreements were resolved by involving a third reviewer. Results Thirty-three papers were included. Ultrasound training was described to include both theoretical and practical training sessions. Theoretical training was achieved through introductory e-learning and/or didactic lectures. Practical training included focussed hands-on training sessions, while some papers described additional longitudinal practical training through proctored scans during clinical work or through self-study practice with continuous feedback on recorded scans. Conclusion There was a large variation in ultrasound training programs for GPs and GPTs, with an overall emphasis on focussed practical training. Few studies included a longitudinal learning process in the training program. However, diagnostic accuracy seemed to improve with hours of practical training, and studies including continuous feedback on scans conducted during clinical patient encounters showed superior results.

Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

“…Previous studies [ 12 , 13 ] have described how GPs achieve ultrasound proficiency through focused practical training sessions. This study confirms that focused hands-on training is considered an important educational element for GPs striving to master the technical ability to produce ultrasound images.…”

“…Some medical specialties have developed POCUS guidelines and educational programme recommendations [ 1 , 8 ]. Though POCUS is also used in primary care [ 9–11 ] there is generally a lack of formal training programmes and educational recommendations for general practitioners (GPs) [ 12 , 13 ].…”

“…A systematic review [ 13 ] concerning training programmes for GPs found that the programmes were largely adapted from secondary care and varied considerably in amount of training and educational elements. Little attention has been given to explore the educational needs of office-based GPs or experiences of GPs, who had adopted POCUS without support or guidelines.…”

General Practitioners’ Perspectives on Appropriate Use of Ultrasonography in Primary Care in Denmark: A Multistage Mixed Methods Study

“…Our findings confirm that achieving and maintaining POCUS competence requires continuous use and practice. A recent review 30 described skills assessments after short training programs for GPs, but how busy GPs will be able to maintain and develop their skills over time is an area ripe for scientific investigation. Reports have emphasized visual knowledge in relation to skills development 31,32 and international recommendations for continuous training under supervision.…”

The Use of Point-of-Care Ultrasound (POCUS) in the Diagnosis of Deep Vein Thrombosis

“…Another study found that resident physicians initially failed to demonstrate sufficient sensitivity in a cohort of critically-ill patients due to a high rate of missing femoral vein thrombosis (6/21, 28%) [30]. After a 2 h course in vascular POCUS, resident physicians showed substantial agreement with radiologists for the diagnosis of clinically-relevant DVT [30,47]. A meta-analysis conducted by Lee et al revealed that the initial POCUS performer and training before the study were sources of heterogeneity.…”