Pulmonary Critical Care Fellows’ Use of and Self-reported Barriers to Learning Bedside Ultrasound During Training

The Learners’ Voice

“…2,6,10,12,13 Whether it is by sonographers, radiologists, or pulmonologists with appropriate skill, this is an established standard for ultrasound training with widespread support. The results reported by Brady et al 7 suggest a consistent relationship between expert review and learner comfort. They are right to describe their finding that expert review was available to just 26% of their respondents as "problematic," and one hopes this might have improved in the years since their survey.…”

“…Finally, in the cohort of Brady et al, 7 90.5% of respondents were from programs with six or more fellows, and almost 30% were from one with at least 16 fellows; trainees from smaller training programs reported more difficulty with access to ultrasound machines. Many training programs worldwide are smaller than those represented in this study, and one wonders about the effect of access to devices on training in countries where the price of an ultrasound machine is prohibitive.…”

“…13 One might argue that, as our current trainees become faculty, the issue of inadequate supervision for new trainees will reduce; indeed, Eisen et al 5 made this reasonable suggestion in their 2010 article. Unfortunately, Sivakumar et al 4 and now Brady et al 7 demonstrate that, by 2017, this had not occurred. Ongoing efforts to ensure trainee learning (and, ultimately, patient safety) are required to overcome this deficiency.…”

“…In this issue of CHEST, Brady et al 7 The choice to measure self-reported comfort with performing bedside ultrasound scanning and ultrasound-guided procedures aligns with their method: a survey asking trainees for their perceptions of their training. However, comfort or confidence does not correlate necessarily with competence, an issue that Brady et al 7 explore.…”

Guidelines for Ultrasound Training in Critical Care

“…Many barriers had been described, such as the lack of trainers or agreed competences. 5,9 Moreover, the optimal method of training has yet to be defined and supported with highquality evidence, as previously described by Rajamani et al 6 The review by Rajamani et al 7 shows the lack of highquality guidelines; however, it is still not demonstrated that application of systematic methods during guideline development will result in outcome improvement in training and competence on BCCE. The highest quality guideline still requires being applicable in the field.…”