Implementation of a Successful Incentive-based Ultrasound Credentialing Program for Emergency Physicians

Abstract

Introducion:With the rapid expansion of emergency ultrasound, resident education in ultrasound has become more clearly developed and broadly integrated. However, there still exists a lack of guidance in the training of physicians already in practice to become competent in this valuable skill. We sought to employ a step-wise, goal-directed, incentive-based credentialing program to educate emergency physicians in the use of emergency ultrasound. Successful completion of this program was the primary outcome.Methods:The goal was for the physicians to gain competency in 8 basic ultrasound examinations types: aorta, focused assessment with sonography in trauma, cardiac, renal, biliary, transabdominal pelvic, transvaginal pelvic, and deep venous thrombosis. We separated the 2.5 year training program into 4 distinct blocks, with each block focusing on 2 of the ultrasound examination types. Each block consisted of didactic and hands-on sessions with the goal of the physician completing 25 technically-adequate studies of each examination type. There was a financial incentive associated with completion of these requirements.Results:A total of 31 physicians participated in the training program. Only one physician, who retired prior to the end of the 2.5 year period, did not successfully complete the program. All have applied for and received hospital privileging in emergency ultrasound and incorporated it into their daily practice.Conclusion:We found that a step-wise, incentive-based ultrasound training program with a combination of didactics and ample hands-on teaching was successful in the training of physicians already in practice.

Poor return on investment: investigating the barriers that cause low credentialing yields in a resource-limited clinical ultrasound training programme

“…The low credentialing success (19.7%) of the Cape Town clinical ultrasound training programme is concerning considering the time and resource investments made. The rate is significantly lower than six peer international training programmes, whose credentialing success ranged between 30.2 and 100%; however, all six studies were conducted in high resource settings [ 10 – 12 , 14 – 16 ]. Of more concern, Cape Town’s credentialing success was most likely an overestimate of the national study population since the Cape Town sample represented 50% of the study population but also accounted for 90% of the national credentialing success.…”

“…All these training programmes had low credentialing success rates (30.2 to 44.9%) but still higher than Cape Town’s. Training programmes that divided their training capacity between only a few hospitals with a proper trainer and ultrasound machine access had the highest credentialing outcomes (67.7 to 100%) [ 12 , 16 ]. Their trainees reported logistical barriers, related to their training programme curriculum, as their highest perceived barriers to credentialing.…”

Current status of emergency department attending physician ultrasound credentialing and quality assurance in the United States

“…However, if no EUS fellowship program is present, there is a greater likelihood that the QA process is not being conducted on a weekly basis. However, studies have shown that a weekly QA process is the optimal method to provide feedback, performance improvement, and assurance that ultrasounds are being performed and interpreted correctly [ 7 ].…”

Web-based teaching in point-of-care ultrasound: an alternative to the classroom?

“…Unlike residents, attendings are more likely to have established practice patterns that make POC US implementation more difficult, they may have less time to devote to voluntary didactic learning, and their role during clinical shifts differs such that learning a new clinical skill like POC US during a shift may be more challenging. 4 …”