Learning Experiences Among GP Registrars After a Focused Cardiac Ultrasound Training Program: A Qualitative Interview Study

Abstract

Background: Until recently, clinical ultrasound technology was limited to the hospital-based disciplines, and few studies assessed training in focused cardiac ultrasound (FCU) in primary care. We designed an interview study among general practitioner (GP) registrars taking part in an FCU training program and discussed their experiences compared to their documented skills.Methods: This qualitative content analysis used an inductive approach. Five GP registrars and their tutor participated in semi-structured individual interviews during April–July 2017. Participants were interviewed after they each had conducted 20 supervised and 7–10 independent examinations and were encouraged to complete self-directed study using video tutorials on web-based platforms. FCU examinations of study patients recruited from primary care clinics were conducted with a hand-held device (Vscan 1.2) at the Centre of Clinical Research, Östersund Hospital, Sweden. Results: We identified two categories of information: the prerequisites of learning FCU and the acquisition of skills for professional development. Combining theoretical education with hands-on tutorials was an essential part of FCU learning. However, participants suggested that the training program should include group tutorials to give a deeper understanding of scanning positions and a reference standard for evaluating the FCU recordings. In skill acquisition, participants experienced more confidence in performing the technical aspects of FCU than in interpreting the images to evaluate cardiac function. The participants saw several possibilities for applying FCU in primary care, including as a screening tool in rural clinics or to support referrals to specialized care.Conclusions: After completing 20 supervised FCU training sessions, previously inexperienced examiners felt that assessment of cardiac function was more difficult than acquiring adequate ultrasound images. To gain confidence in assessment of cardiac function, respondents suggested personal feedback and group tutorials with discussion of clinical examples in smaller groups for improvement of learning. Demographic differences between patients seen in hospital wards and primary care clinics should also be considered in the design of FCU training programs. Trial registration: NTC02939157, ClinicalTrials.gov.