Impact of Critical Care Point-of-Care Ultrasound Short-Courses on Trainee Competence

Abstract

Objectives: Competence in point-of-care ultrasound is recommended/mandated by several critical care specialties. Although doctors commonly attend point-of-care ultrasound short-courses for introductory training, there is little follow-up data on whether they eventually attain competence. This study was done to determine the impact of point-of-care ultrasound short-courses on point-of-care ultrasound competence. Design: Web-based survey. Setting: Follow-up after point-of-care ultrasound short-courses in the Asia-Pacific region. Subjects: Doctors who attended a point-of-care ultrasound short-course between December 2015 and February 2018. Interventions: Each subject was emailed a questionnaire on or after 6 months following their short-course. They were asked if they had performed at least 30 structured point-of-care ultrasound scans and/or reached point-of-care ultrasound competence and their perceived reasons/challenges/barriers. They were also asked if they used point-of-care ultrasound as a clinical diagnostic aid. Measurements and Main Results: The response rate was 74.9% (182/243). Among the 182 respondents, only 12 (6.6%) had attained competence in their chosen point-of-care ultrasound modality, attributing their success to self-motivation and time management. For the remaining doctors who did not attain competence (170/182, 93.4%), the common reasons were lack of time, change of priorities, and less commonly, difficulties in accessing an ultrasound machine/supervisor. Common suggestions to improve short-courses included requests for scanning practice on acutely ill ICU patients and prior information on the challenges regarding point-of-care ultrasound competence. Suggestions to improve competence pathways included regular supervision and protected learning time. All 12 credentialled doctors regularly used point-of-care ultrasound as a clinical diagnostic aid. Of the 170 noncredentialled doctors, 123 (72.4%) reported performing unsupervised point-of-care ultrasound for clinical management, either sporadically (42/170, 24.7%) or regularly (81/170, 47.7%). Conclusions: In this survey of doctors attending point-of-care ultrasound short-courses in Australasia, the majority of doctors did not attain competence. However, the practice of unsupervised point-of-care ultrasound use by noncredentialled doctors was common. Further research into effective strategies to improve point-of-care ultrasound competence is required.

Personal protective equipment preparedness in Asia-Pacific intensive care units during the coronavirus disease 2019 pandemic: A multinational survey

“…(Table 1). 8,20,21 Since it was a multinational survey, the WHO recommendations were chosen as the reference standard. 2 Following ethical approval (approval number 2020/ETH00705), the survey weblink was distributed by email, text message and WhatsApp to qualified intensivists in the authors' professional network across Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India and Philippines, working in hospitals with a 24/7 Emergency/Casualty Department and an ICU capable of mechanically ventilating patients for >24 hours.…”

POINT: Should the Use of Diagnostic Point-of-Care Ultrasound in Patient Care Require Hospital Privileging/Credentialing? Yes

“…In the absence of structured follow-up training including didactics, mentored scanning, image interpretation, and longitudinal quality assurance (none of which are currently required by the ACGME), some trainees will neither achieve nor maintain competence. 12 The language surrounding diagnostic POCUS in the current ACGME program requirements for training in PCCM is telling, stating only that fellows "must demonstrate knowledge of imaging techniques commonly employed in the evaluation of patients with pulmonary disease or critical illness, including the use of ultrasound." 13 This is clearly inadequate and falls far short of the standard set by our emergency medicine and anesthesiology colleagues.…”

“…14 Short courses offered through annual society meetings or as institutional continuing medical education events provide useful introductions to POCUS but are of limited value if they are not paired with downstream longitudinal mentored training. 12 The question of how to best grow faculty expertise with POCUS is an important yet challenging one given the significant time investment required for robust training and the often limited number of faculty with the requisite expertise to oversee institutional educational programs.…”

Response

“…If POCUS is to achieve everything we hope it can in this, or indeed any, patient population, the operators must be trained to a clear standard with appropriate credentialing or qualifications, something that is not always currently the case. 9 There are no clear guidelines for the acquisition of competence in LUS or its objective assessment. Many of those that do exist are based on fixed timeframes or number of examinations performed, neither of which is sufficient to ensure true competence, as seen time and again in other areas of clinical practice.…”