Harvard Medical Center
Boston, MA
Program Description
Thoracic ultrasound is a necessary skill for the practicing intensivist. Formal training has not been widely incorporated into pulmonary and critical care training programs, and many faculty and fellows are not competent with this technology. We have developed an innovative thoracic ultrasound curriculum that combines web-based didactics and hands-on training. The impact of the curriculum is now being investigated, and we anticipate that our standardized approach will be sustainable and exportable to other training programs.
Type of Program
Combined Fellowship
Number of Fellows in Program
30
Abstract Authors
Nancy E. Lange MD MPH2,3, JakobI. McSparron MD1,3, Anthony Massaro MD2,3, Rebecca M. Baron MD2,3
1Carl J. Shapiro Institute for Education & Research, Beth Israel Deaconess Medical Center and
2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s
Hospital and 3Harvard Medical School
Submitter(s) of Abstract
Jakob McSparron
RATIONALE
Critical care ultrasound (CCUS) is becoming a necessary skill for the practicing intensivist. With high sensitivity and specificity for identifying the etiology of respiratory failure, thoracic ultrasonography is particularly relevant in the intensive care unit. Furthermore, ultrasound-guided thoracentesis decreases complications and can be performed safely in mechanically ventilated patients. Formal training has not been widely incorporated into pulmonary/critical care fellowships, and many faculty and fellows are not competent with this technology. Research exploring training in thoracic ultrasound is limited with marked variability among training programs. Our innovative curriculum based on available literature that combines web-based didactics and hands-on training offers a standardized approach for programs seeking to implement ultrasound training. We have developed a CCUS curriculum focused on lung/pleural ultrasound and are investigating the impact of the curriculum with pre/post-tests, assessment of skills using simulation, and evaluating the need for periodic refresher training. Skill retention is assessed using follow-up testing at periodic intervals following initial training.
METHODS
This is a prospective interventional pre-post study of 10 attending intensivists and 20 critical care fellows. The curriculum is a combination of interactive web-based didactics, clinical case discussions, and hands-on training. Subjects complete a written pretest and perform an observed thoracentesis on a simulator to evaluate baseline knowledge and skills. A written posttest and simulated thoracentesis is performed upon course completion and at 6 months to assess the impact of the curriculum and retention of skills. Half of the group is randomized to a refresher course at 3 months after initial training. Pre- and post-test scores are compared by individual subjects and in aggregate as well as between subjects who underwent refresher training and those who did not.
RESULTS
Based on a thorough literature review, a thoracic ultrasound curriculum for medical intensivists was created including both a web-based lecture and hands-on skill sessions. We anticipate this short and feasible curriculum will effectively train faculty and fellows in the use of lung and pleural ultrasound, including performance of ultrasound-guided thoracentesis. We expect that those who undergo refresher training will have improved performance on testing than those who do not.
CONCLUSIONS
Ultrasound training is becoming essential for pulmonary and critical care fellowships. Our study assesses the effectiveness of a comprehensive and feasible curriculum for medical intensivists. We anticipate that our innovative design using web-based didactics has the potential to facilitate sustainability from year to year and makes our curriculum easily exported and implemented by other programs.
FUNDING
This project is supported by a grant from the Partners Centers of Expertise in Education.
