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Brant JA, D'Amico B, Orsborn J, Toney AG, Lam SHF, Mickley M, Ambroggio L. Characterizing Point-of-Care Ultrasound Credentialing in Pediatric Emergency Departments. Pediatr Emerg Care 2024; 40:e186-e194. [PMID: 38713835 DOI: 10.1097/pec.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE It is unclear which pediatric emergency departments (PEDs) have a point-of-care ultrasound (POCUS) credentialing process or if this process is consistent per expert guidelines. Our objective was to describe formalized POCUS credentialing processes across PEDs that are active in the pediatric emergency medicine POCUS (P2) Network. METHODS A survey was developed from nationally recommended credentialing guidelines. This anonymous survey was sent out to the P2 Network comprising more than 230 members involved in pediatric POCUS. The survey was analyzed using descriptive analysis with counts and percentages. RESULTS A total of 36 PEDs responded to the survey. All departments had a faculty member in charge of maintaining the credentialing process, and all faculty members had POCUS education available; 88.6% of education was scheduled didactics or bedside teaching. There were 80.6% of PEDs that had a process for internally credentialing faculty. Some PEDs offered protected education for POCUS, however, 44.8% had <50% of their faculty credentialed. There were 4 PEDs that offered incentives for completion of POCUS credentialing including salary bonuses; only 1 offered shift buy down as incentive. That PED had 100% of its faculty credentialed. All PEDs performed quality assurance on POCUS scans done in the ED, most done weekly. Billing for scans occurred in 26 PEDs. Skin/soft tissue and focused assessment with sonography for trauma were the 2 most common applications credentialed. CONCLUSIONS Among PEDs surveyed, there was a lack of standardization of POCUS resources and components of credentialing. Incentives may be beneficial in improving credentialing faculty and standardizing the credentialing process.
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Affiliation(s)
- Julia Aogaichi Brant
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Beth D'Amico
- Division of Pediatric Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Jonathan Orsborn
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Amanda G Toney
- Department of Emergency Medicine, Denver Health, Denver, CO
| | - Samuel H F Lam
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Megan Mickley
- Division of Pediatric Emergency Medicine, ChristianaCare, Newark, DE
| | - Lilliam Ambroggio
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
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Pai VV, Noh CY, Dasani R, Vallandingham S, Manipon C, Haileselassie B, Profit J, Balasundaram M, Davis AS, Bhombal S. Implementation of a Bedside Point-of-Care Ultrasound Program in a Large Academic Neonatal Intensive Care Unit. Am J Perinatol 2024; 41:e76-e84. [PMID: 35691294 DOI: 10.1055/s-0042-1750118] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES In the adult and pediatric critical care population, point-of-care ultrasound (POCUS) can aid in diagnosis, patient management, and procedural accuracy. For neonatal providers, training in ultrasound and the use of ultrasound for diagnosis and management is increasing, but use in the neonatal intensive care unit (NICU) is still uncommon compared with other critical care fields. Our objective was to describe the process of implementing a POCUS program in a large academic NICU and evaluate the role of ultrasound in neonatal care during early adaption of this program. STUDY DESIGN A POCUS program established in December 2018 included regular bedside scanning, educational sessions, and quality assurance, in collaboration with members of the cardiology, radiology, and pediatric critical care divisions. Core applications were determined, and protocols outlined guidelines for image acquisition. An online database included images and descriptive logs for each ultrasound. RESULTS A total of 508 bedside ultrasounds (76.8% diagnostic and 23.2% procedural) were performed by 23 providers from December 2018 to December 2020 in five core diagnostic applications: umbilical line visualization, cardiac, lung, abdomen (including bladder), and cranial as well as procedural applications. POCUS guided therapy and influenced clinical management in all applications: umbilical line assessment (26%), cardiac (33%), lung (14%), abdomen (53%), and cranial (43%). With regard to procedural ultrasound, 74% of ultrasound-guided arterial access and 89% of ultrasound-guided lumbar punctures were successful. CONCLUSIONS Implementation of a POCUS program is feasible in a large academic NICU and can benefit from a team approach. Establishing a program in any NICU requires didactic opportunities, a defined scope of practice, and imaging review with quality assurance. Bedside clinician performed ultrasound findings can provide valuable information in the NICU and impact clinical management. KEY POINTS · Use of point-of-care ultrasound is increasing in neonatology and has been shown to improve patient care.. · Implementation of a point-of-care ultrasound program requires the definition of scope of practice and can benefit from the support of other critical care and imaging departments and providers.. · Opportunities for point-of-care ultrasound didactics, imaging review, and quality assurance can enhance the utilization of bedside ultrasound..
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Affiliation(s)
- Vidya V Pai
- Division of Neonatology, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Caroline Y Noh
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Reedhi Dasani
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shelby Vallandingham
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Christine Manipon
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Bereketeab Haileselassie
- Division of Pediatric Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- California Perinatal Quality Care Collaborative, Stanford, California
| | - Malathi Balasundaram
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Alexis S Davis
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Shazia Bhombal
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Rappaport C, Schwartz A, McConomy B, Choice S, Ten Eyck P, Smock J. Implementing a 3 year, longitudinal point of care ultrasound curriculum in an internal medicine residency program. J Ultrasound 2024; 27:123-127. [PMID: 37973677 PMCID: PMC10908930 DOI: 10.1007/s40477-023-00838-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. METHODS The POCUS instruction was delivered as a combination of pre-workshop self-study learning materials (monthly textbook chapters, online modules etc.), with short didactic sessions, and hands-on-scanning of healthy, male volunteers at 10-week intervals. RESULTS A total of 62 residents (23 Post-Graduate Year 1 (PGY), 24 PGY2, 15 PGY3) participated in the year-long curriculum. When pretest and post test data were analyzed at the end of the curriculum, we calculated the odds ratio for acquiring the correct image (score of 1) vs partial/incorrect acquisition (scores of 2 and 3). Significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86-20.74, p < 0.001), Inferior vena cava (IVC) (OR 5.05, 95% CI 1.91-13.35, p = 0.001) and bladder (OR 5.06, 95% CI 1.76-14.55, p = 0.003). Non-significant differences were found in acquisition of apical 4 chamber, pl (A-Line) and internal jugular vein (IJV). CONCLUSION We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper-level residents to include quantitative left ventricular and right ventricular function analysis, and including more case based pathologic image review.
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Affiliation(s)
- Charles Rappaport
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Andrei Schwartz
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Bryan McConomy
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Samuel Choice
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA.
| | - Patrick Ten Eyck
- University of Iowa Roy J. and Lucille A. Carver College of Medicine, 375 Newton Rd, Iowa City, IA, 52242, USA
| | - Justin Smock
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Koratala A, Reisinger N. Point-of-Care Ultrasound Training in Nephrology: A Leap Forward, Not Merely a Check Mark. Kidney Med 2024; 6:100752. [PMID: 38188457 PMCID: PMC10770553 DOI: 10.1016/j.xkme.2023.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nathaniel Reisinger
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, Pennsylvania
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Chelikam N, Vyas A, Desai R, Khan N, Raol K, Kavarthapu A, Kamani P, Ibrahim G, Madireddy S, Pothuru S, Shah P, Patel UK. Past and Present of Point-of-Care Ultrasound (PoCUS): A Narrative Review. Cureus 2023; 15:e50155. [PMID: 38192958 PMCID: PMC10771967 DOI: 10.7759/cureus.50155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
This article aims to conduct a literature review to gain insight into point-of-care ultrasound (PoCUS). PoCUS is a rapid, accurate, non-invasive, and radiation-free imaging modality that can be used in stable and unstable patients. PoCUS can be performed parallel to physical examination, resuscitation, and stabilization; repeated exams in critical patients are essential for improving sensitivity. The review highlights how PoCUS, which was initially used to detect free intraperitoneal fluid in trauma patients, has developed into a life-saving diagnostic tool that could be utilized by treating physicians during various stages of diagnosis, resuscitation, operation, and postoperative critical care when managing sick patients. The review also notes the barriers to the widespread uptake of PoCUS in general internal medicine and the recent commercial availability of "pocket" or handheld probes that have made PoCUS more readily available. This review concludes that adopting a focused binary decision-making approach can maximize PoCUS's value in many clinical settings, including emergency departments, intensive care units, and operation theatres. Overall, the review emphasizes the importance of awareness of common indications, limitations, and strengths of this evolving and promising technology to determine its future trajectory: Providing comprehensive PoCUS training within internal medicine curriculums and supporting trainers to do so.
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Affiliation(s)
- Nikhila Chelikam
- Clinical Research, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ankit Vyas
- Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, USA
| | - Rutikbhai Desai
- Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and Hospital, Ahmedabad, IND
| | - Nida Khan
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Karanrajsinh Raol
- Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College and General Hospital, Gandhinagar, IND
| | - Anusha Kavarthapu
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | | | - Garad Ibrahim
- Internal Medicine, Hennepin County Medical Center, Minneapolis, USA
| | | | | | - Parth Shah
- Hospital Medicine, Tower Health Medical Group, Reading, USA
| | - Urvish K Patel
- Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
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Breunig M, Hanson A, Huckabee M. Learning curves for point-of-care ultrasound image acquisition for novice learners in a longitudinal curriculum. Ultrasound J 2023; 15:31. [PMID: 37402989 DOI: 10.1186/s13089-023-00329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND A learning curve is graphical representation of the relationship between effort, such as repetitive practice or time spent, and the resultant learning based on specific outcomes. Group learning curves provide information for designing educational interventions or assessments. Little is known regarding the learning curves for Point-of-Care Ultrasound (POCUS) psychomotor skill acquisition of novice learners. As POCUS inclusion in education increases, a more thorough understanding of this topic is needed to allow educators to make informed decisions regarding curriculum design. The purpose of this research study is to: (A) define the psychomotor skill acquisition learning curves of novice Physician Assistant students, and (B) analyze the learning curves for the individual image quality components of depth, gain and tomographic axis. RESULTS A total of 2695 examinations were completed and reviewed. On group-level learning curves, plateau points were noted to be similar for abdominal, lung, and renal systems around 17 examinations. Bladder scores were consistently good across all exam components from the start of the curriculum. For cardiac exams, students improved even after 25 exams. Learning curves for tomographic axis (angle of intersection of the ultrasound with the structure of interest) were longer than those for depth and gain. Learning curves for axis were longer than those for depth and gain. CONCLUSION Bladder POCUS skills can be rapidly acquired and have the shortest learning curve. Abdominal aorta, kidney, and lung POCUS have similar learning curves, while cardiac POCUS has the longest learning curve. Analysis of learning curves for depth, axis, and gain demonstrates that axis has the longest learner curve of the three components of image quality. This finding has previously not been reported and provides a more nuanced understanding of psychomotor skill learning for novices. Learners might benefit from educators paying particular attention to optimizing the unique tomographic axis for each organ system.
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Affiliation(s)
- Mike Breunig
- Division of Hospital Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Andrew Hanson
- Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael Huckabee
- Mayo Clinic PA Program, Mayo Clinic School of Health Sciences, 200 First Street SW, Rochester, MN, 55905, USA
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Bronshteyn YS, Blitz J, Hashmi N, Krishnan S. Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing. Int Anesthesiol Clin 2022; 60:1-7. [PMID: 35582953 DOI: 10.1097/aia.0000000000000369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yuriy S Bronshteyn
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Health Administration, Durham, North Carolina
| | - Jeanna Blitz
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Nazish Hashmi
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Sundar Krishnan
- Department of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina
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Wenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:443-451. [PMID: 32734612 DOI: 10.1002/jcu.22894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE We sought to understand current POCUS practices and comfort as well as assess opinions about POCUS across our medical system via a survey to guide program development. METHODS This study was conducted as a 19 question RedCap survey with multiple parts. Respondents were queried for demographics as well as experience with, attitudes toward, and clinical use of POCUS in common critical care scenarios. RESULTS The survey was completed by 343 individuals, a response rate of 30%. Most respondents "agreed" that POCUS is a needed skill and helped them provide safer care (78% and 86% agreement). Most faculty and trainees reported some POCUS training (62% and 88%) and at least weekly use. Trainees rated themselves more comfortable than faculty for most exam types. The majority of faculty rated their POCUS education as inadequate while trainees had mixed responses. CONCLUSIONS POCUS is a frequently used tool, yet users are less confident in their skills than expected. POCUS applications are viewed as needed for future practice but there is a substantial need for improved education among faculty and trainees. Pooling resources and sharing educational initiatives across multiple specialties may help improve POCUS implementation.
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Affiliation(s)
- Jesse Wenger
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Trevor C Steinbach
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - David Carlbom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reid Wd Farris
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Town
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
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Abstract
Purpose of the Review Point-of-care ultrasound using small ultrasound devices has expanded beyond emergency and critical care medicine to many other subspecialties. Awareness of the strengths and limitations of the technology and knowledge of the appropriate settings and common indications for point-of-care ultrasound is important. Recent Findings Point-of-care ultrasound is widely embraced as an extension of the physical exam and is employed in acute care and medical education settings. Echocardiography laboratories involved in education must individualize training to the intended scope of practice of the user. Advances in artificial intelligence may assist in image acquisition and interpretation by novice users. Summary Point-of-care ultrasound is widely available in a variety of clinical settings. The field has advanced substantially in the past 2 decades and will likely continue to expand with advancement in technology, reduced cost, and improved opportunities to assist new users.
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Affiliation(s)
- Linda Lee
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Ave., MC 9067, Chicago, IL, 60637, USA
| | - Jeanne M DeCara
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Ave., MC 9067, Chicago, IL, 60637, USA.
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Fox S, Fleshner M, Flanagan C, Robertson T, Fujita AW, Bhamidipati D, Sindi A, Purushothaman R, Bui T. Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track. POCUS JOURNAL 2020; 5:46-54. [PMID: 36896436 PMCID: PMC9979927 DOI: 10.24908/pocus.v5i2.14433] [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
Background: A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images. Methods: With minimal funding or protected faculty time, we successfully developed an effective remote quality assurance system between residents rotating internationally and faculty in the US. Results: 270 total exams were logged using this system (41 per resident over a 7 week period). Over the course of the implementation period, a significant increase was seen in average image quality (p = 0.030) and percent agreement with reviewer (p = 0.021). No significant increase was seen for percent images with quality rating 5/5 (p = 0.068) or for studies per resident per week (p = 0.30). Discussion/Conclusions: A quality assurance system for remote review and feedback of POCUS exams was successfully developed with limited available funding, using consumer-level software and an educational collaboration. Residents used the system regularly and demonstrated improvement in reviewer-rated image acquisition and interpretation skills. A similar system can be applied for physicians in any geographic area looking to learn POCUS, in partnership with local or international POCUS mentors. We detail a step-by-step approach, challenges encountered, and lessons learned, to help guide others seeking to implement similar programs.
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Affiliation(s)
- Steven Fox
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Michelle Fleshner
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Collin Flanagan
- Allegheny General Hospital, Internal Medicine Pittsburgh, PA
| | | | - Ayako Wendy Fujita
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Divya Bhamidipati
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Abdulrahman Sindi
- Department of Emergency Medicine, King Abdulaziz University Jeddah Saudi Arabia
| | | | - Thuy Bui
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
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Olszynski P, Kim DJ, Ma IWY, Clunie M, Lambos P, Guzowski T, Butz M, Thoma B. The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan. Ultrasound J 2019; 11:28. [PMID: 31624937 PMCID: PMC6797680 DOI: 10.1186/s13089-019-0142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards. METHODS A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan's annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system. RESULTS The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents. CONCLUSION The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.
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Affiliation(s)
- Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michelle Clunie
- Department of Anesthesia and Perioperative Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Peggy Lambos
- Department of Pediatrics, University of Saskatchewan, Prince Albert, Canada
| | - Tom Guzowski
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Matthew Butz
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
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Kumar A, Kugler J, Jensen T. Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments. J Gen Intern Med 2019; 34:1025-1031. [PMID: 30924088 PMCID: PMC6544692 DOI: 10.1007/s11606-019-04945-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define "competency" with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users. As a framework, the assessment of competency should include evaluations that assess the acquisition and application of POCUS-related knowledge, demonstration of technical skill (e.g., proper probe selection, positioning, and image optimization), and effective integration into routine clinical practice. These assessments can be performed across a variety of settings, including web-based applications, simulators, standardized patients, and real clinical encounters. Several validated assessments regarding POCUS competency have recently been developed, including the Rapid Assessment of Competency in Echocardiography (RACE) or the Assessment of Competency in Thoracic Sonography (ACTS). However, these assessments focus mainly on technical skill and do not expand upon other areas of this framework, which represents a growing need. In this review, we explore the different methodologies for evaluating competency with POCUS as well as discuss current progress in the field of measuring trainee knowledge and technical skill.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA.
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA
| | - Trevor Jensen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Elhassan M, Gandhi KD, Sandhu C, Hashmi M, Bahl S. Internal medicine residents' point-of-care ultrasound skills and need assessment and the role of medical school training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:379-386. [PMID: 31213943 PMCID: PMC6549795 DOI: 10.2147/amep.s198536] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/10/2019] [Indexed: 05/02/2023]
Abstract
Introduction: Point-of-care-ultrasound (POCUS) as a useful bedside tool is growing. Few studies have examined residents' attitude towards POCUS or compared POCUS image interpretation skills between residents with and without POCUS training in medical school. Material and Methods: We distributed an anonymous survey and image interpretation test to assess residents' attitude towards POCUS, confidence, and skills in interpreting POCUS images and videos. Using independent samples t-tests, we compared mean confidence levels and test scores between residents with and without prior POCUS training. Results: Fifty-two residents responded to survey (response rate 68%) and 59 took the image interpretation test (77%). Most residents (90%) reported being interested in POCUS. Residents with prior POCUS training (n=13) were either PGY-1 (9) or PGY-2 (4). No PGY-3 resident had prior training. Most residents (83%) thought POCUS could be extremely useful in the inpatient setting compared to 29% for outpatient setting. PGY-1 residents with prior training had a higher mean confidence level than PGY-1 residents without prior training, but the difference was not statistically significant (3.26 vs 2.64; p=0.08). PGY-1 with prior training had a mean confidence level that was close to that of PGY-3 residents. PGY-1 residents with prior training scored significantly higher than PGY-1 residents without prior training in image interpretation test (10.25 vs 7; p=0.01). Residents felt most confident in interpreting inferior vena cava images (mean 3.7; max. 5), which also had the highest score in image interpretation test (correct response rate of 88%). Conclusion: Our residents seem very interested in POCUS. PGY-1 residents with prior POCUS training in medical school seem to have higher confidence in their POCUS skills than PGY-1 residents without prior training and outperformed them in image interpretation test. The study is very instructive in building our future POCUS curriculum for residents.
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Affiliation(s)
- Mohammed Elhassan
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Kevin D Gandhi
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Charnjeet Sandhu
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Mohammad Hashmi
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
| | - Sameer Bahl
- Department of Internal Medicine, UCSF Fresno Medical Education Program, Fresno, CA, USA
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Focus on POCUS: it is time for the kidney doctors to upgrade their physical examination. Clin Exp Nephrol 2019; 23:982-984. [PMID: 30734163 DOI: 10.1007/s10157-019-01707-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/24/2019] [Indexed: 12/17/2022]
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15
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Collins K, Collins C, Kothari A. Point-of-care ultrasound in obstetrics. Australas J Ultrasound Med 2019; 22:32-39. [PMID: 34760534 PMCID: PMC8411729 DOI: 10.1002/ajum.12133] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Point-of-care ultrasound, or PoCUS, where imaging is undertaken at the bedside, clinic or emergency department (ED) by the clinician overseeing treatment, is a rapid form of assessment that may be undertaken alongside or as an alternative to traditional, formal ultrasound performed by a radiology service. PoCUS reduces the time to diagnosis, thus allowing lifesaving treatment to be initiated. This is particularly relevant in Obstetrics and Gynaecology (OBGYN), where delayed diagnosis of pregnancy complications is often fatal or highly debilitating to the mother or fetus. The literature suggests that PoCUS is particularly useful in areas that are inadequately resourced, as it is relatively cheap and accessible. High-quality training is essential to ensure that the staff performing the scans are adequately qualified to deliver the service. Clinicians who perform PoCUS in their practice should be aware of the appropriate indications, as well as when to refer for formal imaging.
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Affiliation(s)
- Kelly Collins
- Northwest Private Hospital137 Flockton streetEverton ParkQueensland4053Australia
| | - Craig Collins
- Redcliffe HospitalAnzac AvenueRedcliffeQueensland4020Australia
| | - Alka Kothari
- Redcliffe HospitalAnzac AvenueRedcliffeQueensland4020Australia
- University of QueenslandSt LuciaQueensland4072Australia
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16
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Soni NJ, Schnobrich D, Mathews BK, Tierney DM, Jensen TP, Dancel R, Cho J, Dversdal RK, Mints G, Bhagra A, Reierson K, Kurian LM, Liu GY, Candotti C, Boesch B, LoPresti CM, Lenchus J, Wong T, Johnson G, Maw AM, Franco-Sadud R, Lucas BP. Point-of-Care Ultrasound for Hospitalists: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:E1-E6. [PMID: 30604779 PMCID: PMC8021128 DOI: 10.12788/jhm.3079] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many hospitalists incorporate point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision-making processes surrounding POCUS program management.
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Affiliation(s)
- Nilam J Soni
- Division of General and Hospital Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA.
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Daniel Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Benji K Mathews
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - David M Tierney
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ria Dancel
- Division of Hospital Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California; USA
| | - Renee K Dversdal
- Division of Hospital Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Gregory Mints
- Division of Hospital Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - Linda M Kurian
- Division of Hospital Medicine, Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York, USA
| | - Gigi Y Liu
- Hospitalist Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carolina Candotti
- Division of Hospital Medicine, University of California Davis, Davis, California, USA
| | - Brandon Boesch
- Division of Hospital Medicine, Alameda Health System-Highland Hospital, Oakland, California, USA
| | - Charles M LoPresti
- Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joshua Lenchus
- Division of Hospital Medicine, University of Miami, Miami, Florida, USA
| | - Tanping Wong
- Division of Hospital Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Gordon Johnson
- Division of Hospital Medicine, Legacy Healthcare System, Portland, Oregon, USA
| | - Anna M Maw
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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Affiliation(s)
- Nilam J Soni
- Division of General & Hospital Medicine, The University of Texas School of Medicine at San Antonio, San Antonio, Texas, USA.
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - David M Tierney
- Abbott Northwestern Hospital, Department of Medical Education, Minneapolis, Minnesota, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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