American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part II: recommendations

Abstract

Point-of-care ultrasound (POCUS) is a critical skill for all regional anesthesiologists and pain physicians to help diagnose relevant complications related to routine practice and guide perioperative management. In an effort to inform the regional anesthesia and pain community as well as address a need for structured education and training, the American Society of Regional Anesthesia and Pain Medicine Society (ASRA) commissioned this narrative review to provide recommendations for POCUS. The recommendations were written by content and educational experts and were approved by the guidelines committee and the Board of Directors of the ASRA. In part II of this two-part series, learning goals and objectives were identified and outlined for achieving competency in the use of POCUS, specifically, airway ultrasound, lung ultrasound, gastric ultrasound, the focus assessment with sonography for trauma exam, and focused cardiac ultrasound, in the perioperative and chronic pain setting. It also discusses barriers to POCUS education and training and proposes a list of educational resources. For each POCUS section, learning goals and specific skills were presented in the Indication, Acquisition, Interpretation, and Medical decision-making framework.

FAST exam for the anesthesiologist

“…Not only does a structured framework aid in learning these skills, but one should ultimately strive for competency by following recommendations put forth by experts on optimal learning tools and numbers needed to gain the competency. Recently, expert recommendations were put forth by an American Society of Anesthesiology (ASA) ad-hoc committee 30 and an American Society of Regional Anesthesia and Pain Medicine (ASRA-Pain Medicine) 31,32 expert panel on how to best achieve competency in POCUS skills. Although this article will not cover those recommendations in detail, note that for the FAST exam both groups recommended a minimum of 30 supervised studies (personally performed and interpreted) and 20 additional supervised studies (interpreted but need not be personally performed) for a total of 50 exams.…”

Logistics of perioperative diagnostic point-of-care ultrasound: nomenclature, scope of practice, training, credentialing/privileging, and billing

“…Both Expert Panels emphasized that the 3 required curricular elements lend themselves to computer-based learning to varying degrees. 2,18 For instance, training in ultrasound basics and image acquisition could, in theory, be accomplished entirely through interactive computer-based modules that provide learners with automated feedback. Similarly, the early phase of image acquisition training could be facilitated with ultrasound simulators.…”

“…The panels also provided joint recommendations for the minimum number of supervised diagnostic PoCUS training studies needed to achieve competence. 2,18 To reach these recommendations, the panels reviewed 2 types of published data: (1) recommendations for minimum training numbers issued by other professional medical societies and (2) learning curve data of actual ultrasound use by PoCUS-naive trainees. Both sets of data were evaluated because published studies and the Expert Panel members' own clinical experiences suggested that the minimum training numbers recommended by other professional medical societies have sometimes underestimated the minimum number of training studies needed for "real world" learners to achieve competence.…”

“…The panels also provided joint recommendations for the minimum number of supervised diagnostic PoCUS training studies needed to achieve competence 2,18. To reach these recommendations, the panels reviewed 2 types of published data: (1) recommendations for minimum training numbers issued by other professional medical societies and (2) learning curve data of actual ultrasound use by PoCUS-naive trainees.…”

Point-of-Care Ultrasound (POCUS) Training for Anesthesiologists: Is it Time to Embrace and Attain Competency?

“…We welcome the American Society of Anesthesiologists' (ASA) Ad Hoc Committee for enabling training recommendations for diagnostic POCUS 12 . Some subspecialties, like the American Society of Regional Anesthesia (ASRA) and the Society for Critical Care Medicine, have already created POCUS guidelines to demonstrate physician competence [13][14][15] . Numerous courses and resources are currently available to attain POCUS knowledge, but creating a unique system to attain POCUS competency is essential.…”