Ultrasonography training and utilization in surgical critical care fellowships: a program director's survey

Fellowships in Podiatric Medicine

Graduating podiatric medicine and surgery residents are increasingly likely to pursue fellowship training. Nonetheless, there has been a lack of formal characterization of fellowship training in the field. The present study aimed to characterize fellowship training through an online survey. Two separate surveys were created, 1 for fellowship directors and 1 for fellows. Fellowship directors and fellows were asked questions pertaining to daily responsibilities, quality of training, work-life balance, the application process, fellow selection, and program selection. A total of 33 fellowship directors and 49 fellows responded to the survey, which was delivered over a 2-year period. Overall, fellows were generally satisfied with their respective programs, though greater satisfaction was associated with increased time allowed for research, as well as greater perceived quality of research training, clinical training, surgical training, and practice management training. When selecting a program, the 3 highest-rated factors were focus of the program, reputation of the fellowship director, and career options, and the 3 most important foot and ankle topics were hindfoot/ankle arthrodesis surgery, arthroscopy, and trauma. Open-ended responses from both fellowship directors and fellows reflected a range of opinions and recommendations, which may be helpful for future fellows or for fellowship program faculty. Notably, both fellowship directors and fellows commonly reported that the application process was in need of improvement, with increased standardization of the application process suggested. The results of the present study reflect baseline data on the topic, and may help facilitate improvement of the fellowship experience.

Surgical Intensivist-Led Training in Critical Care Ultrasound Improves Performance

BACKGROUND

Critical care ultrasound (CCUS) is essential in modern practice, with CCUS including cardiac and noncardiac ultrasound. The most effective CCUS training is unknown, with a diverse skill set and knowledge needed for competence. The objective of this project was to evaluate the effect of a surgical intensivist-led training program on CCUS competence in critical care fellows.

METHODS

This was a single institution retrospective review from 2016 to 2018 at the R Adams Cowley Shock Trauma Center. Our yearlong surgical intensivist (SI)-led CCUS training program for critical care fellows includes a daylong CCUS training class, CCUS lectures, a CCUS rotation, and bedside CCUS instruction during rotations. Fellows take a knowledge test and skills test before (pretest) and after (posttest) this program. Critical care ultrasound skill was graded on a scale from 1-5, with 4 (minimal help) or 5 (no help) considered competent. Emergency medicine, surgery, and medicine-trained critical care fellows were included.

RESULTS

Forty-two critical care fellows were included. Mean posttest scores increased significantly for 21/22 (96%) of skills tested and for 14/30 (47%) of knowledge questions compared to pretest scores. The mean composite skill score increased from 3.25 to 4.82 from pretest to posttest (P < .001). The mean composite knowledge score increased from 60% to 80% from pretest to posttest (P < .001).

CONCLUSION

SI-led training improves CCUS competence and knowledge despite the breadth of CCUS.

Identifying barriers to the use of ultrasound in the perioperative period: a survey of southwestern Ontario anesthesiologists

Background

Ultrasound (US) can be used for many perioperative procedures, but evidence is lacking as to its frequency of use and barrier of application. The objectives of this survey were to determine i) how often US guidance was used perioperatively for vascular access placement, nerve blocks, and heart and lung assessment, and ii) to identify the barriers and the limitations of using US amongst anesthesiologists in southwestern Ontario.

Methods

We conducted a web-based survey in over 40 academic or community hospitals at southwestern Ontario.

Results

Of 266 surveys sent, 66 complete surveys were obtained (response rate of 25%). Most respondents (> 80%) reported that US was commonly used for central venous catheter (CVC) insertion, followed by regional blocks; the uses were less frequent for neuraxial blockade and cardiopulmonary assessment. Most respondents wanted to use US more frequently as part of their practice and felt that they already had adequate US training. However, most respondents (59%) reported limited access to US machines in their working institutes as being the major barrier to incorporating US in their daily practice.

Conclusion

The most common uses of US in anesthesia practice in southwestern Ontario were for CVC insertion and regional blocks. Most anesthesiologists in southwestern Ontario are interested to incorporate US in their daily practice but most were limited by the lack of US resources. Apparently, only providing knowledge and skills teaching may not be sufficient to further improve the US utilization in our region; a matched administrative effort appears to be the next challenge.