The Medical University of South Carolina
Charleston, SC
Abstract Authors: Branden W. Luna DO; Nicholas J. Pastis MD; and John T. Huggins, MD
Program Director: Nicholas J. Pastis, MD
Type of Program: Pulmonary/Critical Care
BACKGROUND
Critical care ultrasound (CCUS) is a noninvasive tool used to diagnose unspecified shock states, acute respiratory failure, assess volume resuscitation, identify a source in septic shock, and for procedural guidance. While ACGME guidelines recommend the use of ultrasound to improve safety and success of many procedures done in the ICU, no official statement has been published regarding formal CCUS training during pulmonary and critical care medicine (PCCM) fellowship. The authors aim to describe a comprehensive CCUS curriculum used to teach thoracic, abdominal, and vascular ultrasound, along with basic echocardiography.
METHODS
The curriculum consisted of three distinct educational domains: basic ultrasonography and knobology, image acquisition skills, and image interpretation skills. We included 3 phases of CCUS training: (1) Onboarding distance learning covering both basic ultrasonography/knobology and image interpretation skills; (2)a 1-day boot camp with traditional didactic teaching sessions, problem based learning sessions that emphasizes clinical application of CCUS findings, and hands-on preceptor led training sessions; (3) a longitudinal review which emphasizes building an image portfolio with periodic mentor review and multidisciplinary CCUS conferences. All content is based on learning objectives as recommended by the 2009 ACCP/ SRLF consensus statement on CCUS training. Evaluation of our subjects, which were 5 first year PCCM fellows, was done by traditional multiple choice written testing along with multimedia platform based questions and covered basic ultrasound objectives, image interpretation skills, and clinical application questions. These domains were tested prior to beginning our educational intervention and immediately after our boot camp sessions. Subjects were also tested on image acquisition skills prior to our educational intervention using a simulated patient and checklist based evaluation. They were then retested 4 months into the longitudinal experience using the same method as which they were pre-tested prior to the boot camp intervention.
RESULTS
Five first year fellows at our institution underwent the CCUS curriculum. Fellows were evaluated in image interpretation and problem based critical application of CCUS. Cumulative performance on pre-test and post-test evaluations was 57.3% and 92% respectively. We also evaluated image acquisition skills prior to and after our intervention and 4 months of structured image portfolio development and dedicated educational sessions on CCUS. The cumulative performance on pre-test and post-tests were 50.1% and 82.4% respectively.
DISCUSSION
CCUS curriculum incorporated into fellowship training which utilized online distance learning modules, traditional didactic sessions, problem based learning exercises, and hands-on training with preceptor oversight was successful in achieving initial and longitudinal competency in a small cohort of fellows.
