Pediatric emergency medicine fellowship point‐of‐care ultrasound training in 2020

Abstract

Objectives The primary objective was to survey pediatric emergency medicine (PEM) leaders and fellows regarding point‐of‐care ultrasound (POCUS) training in PEM fellowship programs, including teaching methods, training requirements, and applications taught. Secondary objectives were to compare fellows' and program leaders' perceptions of fellow POCUS competency and training barriers. Methods This was a cross‐sectional survey of U.S. PEM fellows and fellowship program leaders of the 78 fellowship programs using two online group‐specific surveys exploring five domains: program demographics; training strategies and requirements; perceived competency; barriers, strengths, and weaknesses of POCUS training; and POCUS satisfaction. Results Eighty‐three percent (65/78) of programs and 53% (298/558) of fellows responded. All participating PEM fellowship programs included POCUS training in their curriculum. Among the 65 programs, 97% of programs and 92% of programs utilized didactics and supervised scanning shifts as educational techniques, respectively. Sixty percent of programs integrated numerical benchmarks and 49% of programs incorporated real‐time, hands‐on demonstration as training requirements. Of the 19 POCUS applications deemed in the literature as core requirements for fellows, at least 75% of the 298 fellows reported training in 13 of those applications. Although less than half of fellows endorsed competency for identifying intussusception, ultrasound‐guided pericardiocentesis, and transvaginal pregnancy evaluation, a higher proportion of leaders reported fellows as competent for these applications (40% vs. 68%, p ≤ 0.001; 21% vs. 39%, p = 0.003; and 21% vs. 43%, p ≤ 0.001). Forty‐six percent of fellows endorsed a lack of PEM POCUS evidence as a training barrier compared to 31% of leaders (p = 0.02), and 39% of leaders endorsed a lack of local financial support as a training barrier compared to 23% of fellows (p = 0.01). Conclusions Although most PEM fellowship programs provide POCUS training, there is variation in content and requirements. Training does conform to many of the expert recommended guidelines; however, there are some discrepancies and perceived barriers to POCUS training remain.

Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception

“…Our findings suggest that those with more POCUS experience may be best suited to perform this application in clinical practice. This has been suggested by one recent survey of PEM fellow and program leaders, which showed that PEM program leaders endorsed significantly greater competency for identifying intussusception on POCUS compared with fellows 14 . Similarly, it has been estimated that the sensitivity of POCUS for the identification of intussusception is 90% among PEM physicians with focused training in bowel sonography compared with 79% among those without formal training 8 .…”

“…This has been suggested by one recent survey of PEM fellow and program leaders, which showed that PEM program leaders endorsed significantly greater competency for identifying intussusception on POCUS compared with fellows. 14 Similarly, it has been estimated that the sensitivity of POCUS for the identification of intussusception is 90% among PEM physicians with focused training in bowel sonography compared with 79% among those without formal training. 8 More recently, Hsiao et al 31 showed that misdiagnosis of intussusception by POCUS decreased from 44% to 13% after the implementation of formal POCUS training; however, misdiagnosis rates improved more among senior compared with junior physicians with less clinical experience.…”

“…Despite these benefits, the identification of intussusception using POCUS is not routinely taught across pediatric residency or PEM fellowship programs. In a survey of PEM fellowship programs across the United States, only 64% of fellows reported specific POCUS training for intussusception 14 . However, the need for greater POCUS training for intussusception is also becoming increasingly recognized.…”

“…In a survey of PEM fellowship programs across the United States, only 64% of fellows reported specific POCUS training for intussusception. 14 However, the need for greater POCUS training for intussusception is also becoming increasingly recognized. Two recent modified Delphi studies outlined core content for PEM POCUS training, and both included identification of intussusception.…”

“…However, routine use of POCUS for the evaluation of intussusception has been limited, in part due to varying levels of sonography experience among staff members and the relative nascency of POCUS within the field of pediatric emergency medicine (PEM) 10–13 . Although nearly all PEM fellowship programs now include some form of POCUS training in their curriculum, both the educational content and competency requirements vary 14 . Given this variation in experience among clinicians, it is essential to understand the accuracy and reliability of POCUS findings among PEM physicians before the routine adoption of POCUS, particularly for more specific applications such as the identification of intussusception.…”