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Ramirez JB, Chen XX, Ludwig N, Singh IS, Sebbag I. Point-of-Care Ultrasonography (POCUS) in obstetric anesthesia fellowship training: survey of North American programs. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024:844547. [PMID: 39103016 DOI: 10.1016/j.bjane.2024.844547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Juliana Barrera Ramirez
- Western University, Schulich School of Medicine & Dentistry, Department of Anesthesiology & Perioperative Medicine, London, Canada; BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver, Canada
| | - Xao Xu Chen
- McMaster University, Faculty of Health Sciences, Department of Medicine, Hamilton, Canada
| | - Nathan Ludwig
- Western University, Schulich School of Medicine & Dentistry, Department of Anesthesiology & Perioperative Medicine, London, Canada
| | - Indu Sudha Singh
- Western University, Schulich School of Medicine & Dentistry, Department of Anesthesiology & Perioperative Medicine, London, Canada
| | - Ilana Sebbag
- Western University, Schulich School of Medicine & Dentistry, Department of Anesthesiology & Perioperative Medicine, London, Canada; BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver, Canada.
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Kirkpatrick JN, Panebianco N, Díaz-Gómez JL, Adhikari S, Bremer ML, Bronshteyn YS, Damewood S, Jankowski M, Johri A, Kaplan JRH, Kimura BJ, Kort S, Labovitz A, Lu JC, Ma IWY, Mayo PH, Mulvagh SL, Nikravan S, Cole SP, Picard MH, Sorrell VL, Stainback R, Thamman R, Tucay ES, Via G, West FM. Recommendations for Cardiac Point-of-Care Ultrasound Nomenclature. J Am Soc Echocardiogr 2024; 37:S0894-7317(24)00222-0. [PMID: 39230540 DOI: 10.1016/j.echo.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Point-of-care ultrasound (POCUS) involves the acquisition, interpretation, and immediate clinical integration of ultrasonographic imaging performed by a treating clinician. The current state of cardiac POCUS terminology is heterogeneous and ambiguous, in part because it evolved through siloed specialty practices. In particular, the medical literature and colloquial medical conversation contain a wide variety of terms that equate to cardiac POCUS. While diverse terminology aided in the development and dissemination of cardiac POCUS throughout multiple specialties, it also contributes to confusion and raises patient safety concerns. This statement is the product of a diverse and inclusive Writing Group from multiple specialties, including medical linguistics, that employed an iterative process to contextualize and standardize a nomenclature for cardiac POCUS. We sought to establish a deliberate vocabulary that is sufficiently unrelated to any specialty, ultrasound equipment, or clinical setting to enhance consistency throughout the academic literature and patient care settings. This statement (1) reviews the evolution of cardiac POCUS-related terms; (2) outlines specific recommendations, distinguishing between intrinsic and practical differences in terminology; (3) addresses the implications of these recommendations for current practice; and (4) discusses the implications for novel technologies and future research.
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Affiliation(s)
- James N Kirkpatrick
- Division of Cardiology and Department of Bioethics and Humanities, Department of Medicine, University of Washington, Seattle, Washington
| | - Nova Panebianco
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - José L Díaz-Gómez
- Critical Care Institute, Integrated Hospital Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson, Arizona
| | | | - Yuriy S Bronshteyn
- Duke University School of Medicine, Durham Veterans Health Administrations, Durham, North Carolina
| | - Sara Damewood
- Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin
| | | | - Amer Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Bruce J Kimura
- Echocardiography and Vascular Ultrasound Lab, Scripps Mercy Hospital, San Diego, California
| | - Smadar Kort
- Division of Cardiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Arthur Labovitz
- Department of Cardiovascular Sciences, NCH Rooney Heart Institute, Naples, Florida
| | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Irene W Y Ma
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Mayo
- Division of Pulmonary, Critical Care, and Sleep Medicine LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Sharon L Mulvagh
- Dalhousie University, Women's Heart Health Clinic, Halifax, Nova Scotia, Canada
| | - Sara Nikravan
- Department of Anesthesia and Pain Medicine, University of Washington, Seattle, Washington
| | - Sheela Pai Cole
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California
| | - Michael H Picard
- Heart Center, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Vincent L Sorrell
- University of Kentucky, Gill Heart and Vascular Institute, Lexington, Kentucky
| | | | - Ritu Thamman
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Gabriele Via
- Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Frances Mae West
- Division of Pulmonary & Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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Mizubuti GB, Maxwell S, Shatenko S, Braund H, Phelan R, Ho AMH, Dalgarno N, Hobbs H, Szulewski A, Haji F, Arellano R. Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology. Can J Anaesth 2024; 71:967-977. [PMID: 38632162 DOI: 10.1007/s12630-024-02746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency. METHODS We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (n = 25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada's National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with < 50% agreement, revised those with 50-79% agreement based upon feedback provided, and maintained unrevised those items with ≥ 80% agreement. RESULTS We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies. CONCLUSION Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.
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Affiliation(s)
- Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston General Hospital Site, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Sarah Maxwell
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Sergiy Shatenko
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Hailey Hobbs
- Department of Critical Care Medicine, POCUS Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Adam Szulewski
- Departments of Emergency Medicine and Psychology, Educational Scholarship Lead & Resuscitation and Reanimation Medicine Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Faizal Haji
- Division of Neurosurgery, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
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Díaz-Gómez JL, Senussi MH. Letter From the Guest Editors. Semin Ultrasound CT MR 2024; 45:1-2. [PMID: 38211663 DOI: 10.1053/j.sult.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- José L Díaz-Gómez
- Baylor College of Medicine, Department of Anesthesiology and Critical Care Medicine, Texas Heart Institute at Baylor St Luke's Medical Center, 6720 Bertner Ave Suite 0-550, Houston, TX 77030.
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Curley JM, Ridley DJ, Kashkooli K, Tsang S. Intraoperative FoCUS: Training Practices and Views on Feasibility. J Cardiothorac Vasc Anesth 2023; 37:2482-2488. [PMID: 37690950 DOI: 10.1053/j.jvca.2023.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To investigate whether resident anesthesiologists perceive intraoperative focused cardiac ultrasonography (FoCUS) as feasible, the self-reported confidence of residents performing intraoperative FoCUS, and United States graduate medical education resident ultrasound training practices. DESIGN A cross-sectional survey. SETTING The United States Accreditation Council for Graduate Medical Education-listed anesthesiology programs over a 3-month period between June 2022 to September 2022. PARTICIPANTS United States anesthesiology residents. INTERVENTIONS A survey. MEASUREMENTS AND MAIN RESULTS Reported training practices were as follows: 87.3% of respondents reported formal FoCUS training, and the most commonly reported training was "lectures + live-model training under 5 hours annually" at 31%. Most respondents (82%) stated that faculty never or rarely performed bedside FoCUS, and most respondents (69%) reported no intraoperative FoCUS education exposure. The proportion of residents who reported a positive view on the perceived feasibility of intraoperative FoCUS was 53.2% for extremity surgery, 19.8% for laparoscopic surgery, 18.6% for exploratory laparotomy surgery, and 7.9% for robotic surgery. Most respondents (78.6%) indicated a lack of confidence in performing intraoperative FoCUS independently. The authors found no statistical difference in views on feasibility or reported confidence independently performing FoCUS across training years. Training that included "lectures + simulation" or "live-model" for more than 5 hours annually, faculty routinely using bedside FoCUS, and frequent exposure to intraoperative FoCUS increased the odds of reporting confidence. CONCLUSIONS The misconception that intraoperative FoCUS is infeasible appears prevalent, and most of the authors' respondents expressed a lack of comfort independently performing intraoperative FoCUS. Alterations of training practices, including increasing faculty usage of bedside ultrasonography, increasing trainee time performing FoCUS, and incorporating specific intraoperative ultrasound into the ultrasound curriculum, may address these deficiencies.
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Affiliation(s)
- Jonathan M Curley
- Departments of Anesthesiology and Critical Care Medicine, University of Virginia, Charlottesville, VA; Department of Critical Care Medicine, University of Virginia, Charlottesville, VA.
| | - Daniel J Ridley
- Departments of Anesthesiology and Critical Care Medicine, University of Virginia, Charlottesville, VA
| | - Kimia Kashkooli
- Departments of Anesthesiology and Critical Care Medicine, University of Virginia, Charlottesville, VA
| | - Siny Tsang
- Departments of Anesthesiology and Critical Care Medicine, University of Virginia, Charlottesville, VA
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Barriers to focused cardiac ultrasound training: A survey of anesthesiology program directors. J Clin Anesth 2023; 85:111013. [PMID: 36528959 DOI: 10.1016/j.jclinane.2022.111013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
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Remskar MH, Theophanous R, Bowman A, Simonson LE, Koehler J, Basrai Z, Manohar CM, Mader MJ, Nathanson R, Soni NJ. Current Use, Training, and Barriers of Point-of-Care Ultrasound in Anesthesiology: A National Survey of Veterans Affairs Hospitals. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00229-X. [PMID: 37120325 DOI: 10.1053/j.jvca.2023.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine current use, training needs, and barriers to point-of-care ultrasound (POCUS) use among anesthesiologists in practice. DESIGN Multicenter, prospective, observational study. SETTING Anesthesiology departments in the Veterans Affairs Healthcare System in the United States. PARTICIPANTS Chiefs of staff and chiefs of anesthesiology departments. INTERVENTIONS A web-based survey was conducted between June 2019 and March 2020. Chiefs of staff answered questions about facility-level POCUS use, training, competency, and policies. Anesthesiology chiefs responded to a follow-up survey with specialty-specific POCUS questions. The results of the 2020 survey were compared with a similar survey conducted by the authors' group in 2015. MEASUREMENTS AND MAIN RESULTS All chiefs of staff (n = 130) and 77% of anesthesiology chiefs (n = 96) completed the survey. The most common POCUS applications used were central and peripheral vascular access (69%-72%), peripheral nerve blocks (66%), and evaluation of cardiac function (29%-31%). Compared with 2015, there was a statistically significant increase in desire for training (p = 0.00015), but no significant change in POCUS use (p = 0.31). Training was most desired for volume-status assessment (52%), left ventricular function (47%), pneumothorax (47%), central line placement (40%), peripheral nerve blocks (40%), and pleural effusion (40%). The most common barriers to POCUS use were lack of funding for training (35%), trained providers (33%), and training opportunities (28%). CONCLUSIONS A significant increase in desire for POCUS training was seen among anesthesiologists practicing in the Veterans Affairs healthcare system since 2015, and lack of training continues to be a top barrier for POCUS use among anesthesiologists.
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Affiliation(s)
- Mojca H Remskar
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN; Anesthesiology Service, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN.
| | - Rebecca Theophanous
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC; Emergency Medicine, Durham VA Healthcare System, Durham, NC
| | - Amber Bowman
- Department of Medicine, Duke University School of Medicine, Durham, NC; Medicine Service, Durham VA Healthcare System, Durham, NC
| | | | - Jessica Koehler
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI; Emergency Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Crystal M Manohar
- Department of Anesthesiology, University of Texas Health San Antonio, San Antonio, TX; Department of Anesthesiology Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Michael J Mader
- South Texas Veterans Health Care System, Research Service, San Antonio, TX
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX; Department of Medicine, University of Texas Health San Antonio, San Antonio, TX
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Ballard HA, Rivera A, Tsao M, Phillips M, Robles A, Hajduk J, Feinglass J, Barsuk JH. Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care. BJA OPEN 2022; 4:100101. [PMID: 37588791 PMCID: PMC10430828 DOI: 10.1016/j.bjao.2022.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 08/18/2023]
Abstract
Background We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. Methods A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Results Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. Conclusions After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adovich Rivera
- Institute of Public Health, Division of Health Services Outcomes Research, USA
| | - Michelle Tsao
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mitch Phillips
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alison Robles
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - John Hajduk
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Joe Feinglass
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H. Barsuk
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Clunie M, O'Brien J, Olszynski P, Bajwa J, Perverseff R. Competence of anesthesiology residents following a longitudinal point-of-care ultrasound curriculum. Can J Anaesth 2022; 69:460-471. [PMID: 34966971 PMCID: PMC8715842 DOI: 10.1007/s12630-021-02172-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/05/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) facilitates diagnostic, procedural, and resuscitative applications in anesthesiology. Structured POCUS curricula improve learner satisfaction, test scores, and clinical management, but the learning curve towards competency and retention of skills over time remain unknown. METHODS We conducted a prospective observational study to determine when anesthesiology trainees enrolled in a POCUS curriculum achieve competency in POCUS skills. We also investigated the learning curve of trainees' competency using a POCUS-specific competency-based medical education assessment. The structured, longitudinal POCUS curriculum included online lectures, journal articles, live model scanning sessions, video review of cases, and a portfolio of supervised scans. Point-of-care ultrasound scanning sessions on standardized patients were conducted in the simulation lab for 2.5 hr a week and each resident completed eight sessions (20 hr) per academic year. At each scanning session, timed image acquisition scores were collected and POCUS skills entrustment scale evaluations were conducted. The primary outcome was the number of supervised scans and sessions required to achieve a mean entrustment score of 4 ("may use independently"). Secondary outcomes included image acquisition scores and retention of skills after six months. RESULTS The mean (standard deviation) number of supervised scans required for trainees (n = 29) to reach a mean entrustment score of ≥ 4 was 36 (10) scans over nine sessions for rescue echo. A mean entrustment score of ≥ 4 was observed for lung ultrasound after a mean (SD) of 8 (3) scans over two sessions. CONCLUSIONS Our study shows that anesthesiology residents can achieve competence in rescue echo and lung ultrasound through participation in a structured, longitudinal POCUS curriculum, and outlines the learning curve for progression towards competency.
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Affiliation(s)
- Michelle Clunie
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Royal University Hospital, Room G525, 103 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Jennifer O'Brien
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Saskatoon, SK, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Jagmeet Bajwa
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Saskatoon, SK, Canada
| | - Rob Perverseff
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Saskatoon, SK, Canada
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Kim DJ, Olszynski P, Smith DJW, Lalande E, Woo MY. Point of care ultrasound training in Canadian emergency medicine residency programs. CAN J EMERG MED 2022; 24:329-334. [PMID: 35239169 DOI: 10.1007/s43678-022-00269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/17/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Point of care ultrasound (POCUS) has been endorsed as an important clinical tool by the Canadian Association of Emergency Physicians (CAEP) and is a training objective of emergency medicine (EM) residency programs accredited by both the Royal College of Physicians and Surgeons of Canada (RCPSC) and the College of Family Physicians of Canada (CFPC). Our objectives are to describe the national state of POCUS training in RCPSC-EM and CFPC-EM residency programs and to evaluate the implementation of the CAEP core POCUS curriculum in these programs. METHODS This was an online survey study of all POCUS education leads for both RCPSC-EM and CFPC-EM programs. The survey queried participants on program demographics, description of POCUS training, methods of POCUS assessment, and implementation of the CAEP core POCUS curriculum. RESULTS The response rate was 100% (39/39). All RCPSC-EM and CFPC-EM programs provide POCUS training for their residents, and 100% of RCPSC-EM programs and 91% (20/22) of CFPC-EM programs have a POCUS lead. All programs provide POCUS training for their residents, but there is variability in how POCUS is introduced to residents, ongoing POCUS instruction provided throughout residency, and POCUS assessment. Only 47% (8/17) of RCPSC-EM and 32% (7/22) of CFPC-EM programs have a quality assurance process for the use of POCUS by their residents. POCUS leads believe their residents are proficient in the CAEP core POCUS applications by the end of training except for advanced cardiac and thoracic ultrasound. CONCLUSIONS POCUS training in Canadian EM programs is prevalent, but there is variability in support for POCUS leads, delivery of training, determination of proficiency, and presence of quality assurance. While almost all programs deliver POCUS education aligning with the CAEP core POCUS curriculum position statement, more support is required both locally and nationally for sharing best practices for POCUS education.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada. .,Department of Emergency Medicine, Vancouver General Hospital, 855 12th Ave W, Vancouver, BC, V5Z 1M9, Canada.
| | - Paul Olszynski
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David J W Smith
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Centre Hospitalier de l'Université Laval (CHUL), CHU de Québec, Université Laval, Québec, QC, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Krishnan S, Bronshteyn YS. Role of diagnostic point-of-care ultrasound in preoperative optimization: a narrative review. Int Anesthesiol Clin 2022; 60:64-68. [PMID: 34686645 DOI: 10.1097/aia.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sundar Krishnan
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center
| | - Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center
- Durham VA Health Care System, Durham, North Carolina
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12
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Ranganna S, Kiefer JJ, Augoustides JG. Perioperative Transthoracic Echocardiography-Thoughtful Design and Delivery of Standardized Imaging Protocols for Anesthesiology Teams. J Cardiothorac Vasc Anesth 2021; 36:387-389. [PMID: 34922818 DOI: 10.1053/j.jvca.2021.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Shreyas Ranganna
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jesse J Kiefer
- Critical Care Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Gutierrez P, Berkowitz T, Shah L, Cohen SG. Taking the Pulse of POCUS: The State of Point-of-Care Ultrasound at a Pediatric Tertiary Care Hospital. POCUS JOURNAL 2021; 6:80-87. [PMID: 36895674 PMCID: PMC9979874 DOI: 10.24908/pocus.v6i2.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We aim to quantify and categorize point-of-care ultrasound (POCUS) usage by pediatric practitioners and trainees at our tertiary care center, and assess the degree of interest from pediatric residents, fellows, and program leaders for integrating POCUS into their training. Data was collected via online survey, evaluating the current use of POCUS in clinical decision making, desire for further formal training, and opinions on the importance of POCUS to future clinical practice. In total, 14 program directors/assistant program directors (PD/APDs) representing 10 of 15 training programs, 30 of 95 fellows representing 9 of 15 fellowships, and 32 of 82 residents responded. From PD/APDs, only 2 of the programs reported active use POCUS for clinical decision making, but 13 of the fellows and 9 residents reported doing so. In regard to desire for a formal POCUS program, 30.8% of PD/APDs, 43.8% of fellows without current curricula, and 87.5% of residents were interested in participating in such a program. When considering specialty, some non-acute care-based PD/APDs and fellows at our institution felt that POCUS was important to future practice. Pediatric subspecialty PD/APDs and their fellows had divergent outlooks on the importance of POCUS in future practice. Finally, an overwhelming majority of residents at our institution expressed a desire to learn, and half believing it will be important to future practice. Based on the degree of interest, medicolegal considerations, and trajectory of patient care, pediatric residency and fellowship programs should strongly consider integrating POCUS education into their curricula.
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Affiliation(s)
- Peter Gutierrez
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Tal Berkowitz
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Lekha Shah
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
| | - Stephanie G Cohen
- Emory University School of Medicine Atlanta, GA.,Children's Healthcare of Atlanta Atlanta, GA
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Musuku SR, Cherukupalli D, Di Capua C, Fitzpatrick M, Sirigaddi K, Bughrara N, Singh C, DeLago A. Point-of-Care Ultrasound Before and After Transfemoral Transcatheter Aortic Valve Implantation. Turk J Anaesthesiol Reanim 2020; 48:491-496. [PMID: 33313589 PMCID: PMC7720838 DOI: 10.5152/tjar.2020.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/12/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Surgical aortic valve replacement requires a comprehensive transoesophageal echocardiography (TEE) assessment before and after the intervention by cardiac anaesthesiologists. For patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI), TEE is not routinely used. We started using transthoracic echocardiography (TTE) as a diagnostic and monitoring modality during TF-TAVI procedures. The aim of this study is to examine the usefulness of TTE before and after TF-TAVI. We hypothesised that TTE can serve as a screening tool in TF-TAVI patients and help rule out significant paravalvular leaks (PVLs), and serve as a monitoring tool. METHODS A retrospective, observational study of 24 patients who underwent TF-TAVI with perioperative TTE over a 3-month period was conducted. Intraoperatively, two TTE examinations were performed. The first was a baseline pre-procedural TTE examination after anaesthetic induction, and the second was performed after TAVI valve implantation. Both pre- and post-procedural examinations included five focused TTE views. PVLs were graded as none, non-significant (trace or mild) or significant (moderate or severe). RESULTS The average age and median body mass index of the patients were 82 years and 28.5 kg m-2, respectively. The average time recorded for the pre- and post-TAVI TTE examinations were approximately 4 and 5.5 min, respectively. Non-significant PVL was detected in 6 (25%) patients, and no leak was detected in 18 (75%) patients. CONCLUSION A focused TTE examination was found to be a useful adjunct during TF-TAVI for a cardiac anaesthesiologist in the absence of TEE, and useful in ruling out significant PVLs.
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Affiliation(s)
| | | | | | | | | | - Nibras Bughrara
- Department of Anaesthesiology, Albany Medical Center, Albany, USA
| | | | - Augustin DeLago
- Department of Anaesthesiology, Albany Medical Center, Albany, USA
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15
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Meineri M, Arellano R, Bryson G, Arzola C, Chen R, Collins P, Denault A, Desjardins G, Fayad A, Funk D, Hegazy AF, Kim H, Kruger M, Kruisselbrink R, Perlas A, Prabhakar C, Syed S, Sidhu S, Tanzola R, Van Rensburg A, Talab H, Vegas A, Bainbridge D. Canadian recommendations for training and performance in basic perioperative point-of-care ultrasound: recommendations from a consensus of Canadian anesthesiology academic centres. Can J Anaesth 2020; 68:376-386. [DOI: 10.1007/s12630-020-01867-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022] Open
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16
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Consensus guidelines for perioperative point-of-care ultrasound: the devil is in the (implementation) details. Can J Anaesth 2020; 68:285-287. [PMID: 33219480 DOI: 10.1007/s12630-020-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022] Open
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17
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Schwarz SKW, Prabhakar C. What to do when perioperative point-of-care ultrasound shows evidence of a full stomach despite fasting? Can J Anaesth 2020; 67:798-805. [DOI: 10.1007/s12630-020-01669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022] Open
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18
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Wong J, Montague S, Wallace P, Negishi K, Liteplo A, Ringrose J, Dversdal R, Buchanan B, Desy J, Ma IWY. Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. Ultrasound J 2020; 12:19. [PMID: 32307598 PMCID: PMC7167384 DOI: 10.1186/s13089-020-00167-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Point-of-care ultrasound (POCUS) is increasingly used in internal medicine, but a lack of trained faculty continues to limit the spread of POCUS education. Using a framework based on organizational change theories, this study sought to identify barriers and enablers for hospital-based practicing internists to learn and use POCUS in clinical practice. Methods We invited practicing internists at six North American institutions to participate in an electronic survey on their opinions regarding 39 barriers and enablers. Results Of the 342 participants invited, 170 participated (response rate 49.3%). The top barriers were lack of training (79%), lack of handheld ultrasound devices (78%), lack of direct supervision (65%), lack of time to perform POCUS during rounds (65%), and lack of quality assurance processes (53%). The majority of participants (55%) disagreed or strongly disagreed with the statement “My institution provides funding for POCUS training.” In general, participants’ attitudes towards POCUS were favourable, and future career opportunities and the potential for billing were not considered significant factors by our participants in the decision to learn or use POCUS. Conclusions This survey confirms the perceived importance of POCUS to practicing internists. To assist in closing faculty development gap, interventions should address training, supervision, quality assurance processes, availability of handheld devices, as well as dedicated time to perform POCUS during clinical care.
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Affiliation(s)
- Jonathan Wong
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Steven Montague
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Paul Wallace
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kay Negishi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Ringrose
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Renee Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian Buchanan
- Department of Critical Care, University of Alberta, Edmonton, AB, Canada
| | - Janeve Desy
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Irene W Y Ma
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
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19
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Li L, Yong RJ, Kaye AD, Urman RD. Perioperative Point of Care Ultrasound (POCUS) for Anesthesiologists: an Overview. Curr Pain Headache Rep 2020; 24:20. [DOI: 10.1007/s11916-020-0847-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Gonzalez Fiol A, Elder RW, Chou JC, Kohari K, Alian A. Making the case to acquire a transthoracic echocardiogram probe. Int J Obstet Anesth 2019; 41:127-128. [PMID: 31204096 DOI: 10.1016/j.ijoa.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 05/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- A Gonzalez Fiol
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
| | - R W Elder
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT, USA
| | - J C Chou
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT, USA
| | - K Kohari
- Department of Obstetrics and Gynecology (Maternal Fetal Medicine), Yale School of Medicine, New Haven, CT, USA
| | - A Alian
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA
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21
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Point-of-care ultrasound (POCUS) of the upper airway. Can J Anaesth 2018; 65:473-484. [PMID: 29349733 DOI: 10.1007/s12630-018-1064-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 12/25/2022] Open
Abstract
Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes. Ultrasonography can differentiate tracheal, esophageal, and endobronchial intubation. Ultrasonography of the neck can accurately localize the cricothyroid membrane for emergency airway access and similarly identify tracheal rings for US-guided tracheostomy. In addition, US can identify vocal cord dysfunction and pathology before induction of anesthesia. A rapidly growing body of evidence showing ultrasonography used in conjunction with hands-on management of the airway may benefit patient care. Increasing awareness and use of POCUS for many indications have resulted in technologic advancements and increased accessibility and portability. Upper airway POCUS has the potential to become the first-line non-invasive adjunct assessment tool in airway management.
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Core point-of-care ultrasound curriculum: What does every anesthesiologist need to know? Can J Anaesth 2018; 65:417-426. [DOI: 10.1007/s12630-018-1063-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 01/06/2023] Open
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Focused assessment with sonography in trauma: a review of concepts and considerations for anesthesiology. Can J Anaesth 2017; 65:360-370. [PMID: 29204875 DOI: 10.1007/s12630-017-1030-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022] Open
Abstract
The use of point-of-care ultrasound in trauma provides diagnostic clarity and routinely influences management. A scanning protocol known as the Focused Assessment with Sonography in Trauma (FAST) has been widely adopted by trauma providers of all specialties. The FAST exam addresses a broad array of pathologic conditions capable of causing instability, including hemoperitoneum, hemopericardium, hemothorax, and pneumothorax. The exam is an integral component to the primary assessment of injured patients and an iconic application of point-of-care ultrasound.This review article aims to summarize the application of the FAST exam with special consideration, where relevant, to anesthesiologists. The scope of the FAST exam, technical considerations, and clinical decision-making in trauma are explored.
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