Credentialing Pediatric Emergency Medicine Faculty in Point-of-Care Ultrasound

Abo, Alyssa; Alade, Kiyetta; Rempell, Rachel; Kessler, David; Fischer, Jason; Lewiss, Resa E.; Raio, Christopher; Marín, Jennifer R.

doi:10.1097/pec.0000000000001677

Cited by 36 publications

(57 citation statements)

References 56 publications

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“…This has policy implications for education guidelines based on an “average” learner. Specifically, our data suggest that a shift away from the current standard of recommending specific numbers of cases for POCUS proficiency (e.g., 25–50 cases) in favor of learners achieving a performance‐based competency benchmark . This approach is also in keeping with evolving performance‐based competency frameworks in residency training, which promote greater accountability and documentation of actual capability …”

Section: Discussionmentioning

confidence: 62%

“…The use of emergency point‐of‐care ultrasound (POCUS) in pediatric emergency medicine (PEM) can improve patient outcomes and expedite patient disposition . As such, learning POCUS has become an increasing priority in PEM, with the learning experience typically including introductory courses and skill acquisition that relies on case‐by‐case clinical exposure . However, this approach may lead to challenges in achieving POCUS proficiency across a wide range of learners .…”

mentioning

confidence: 99%

“…However, this approach may lead to challenges in achieving POCUS proficiency across a wide range of learners . Opportunities for bedside feedback may be limited by the number of POCUS‐trained attendings available at a given site . This deprives the learner of immediate feedback, one of the most powerful methods of skill acquisition .…”

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confidence: 99%

“…To facilitate learning of complex tasks, instructional design models recommend intentionally alternating part‐task with whole‐task training . In this light, e‐learning provides an opportunity to expose learners to an image interpretation learning experience (i.e., part‐task) that could complement the resource intensive face‐to‐face teaching and learning at the bedside that addresses all facets of POCUS (i.e., whole‐task) . However, to date, most POCUS simulation and online education focuses on image acquisition, specific conditions (e.g., cardiac tamponade), or adult applications .…”

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confidence: 99%

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The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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Objectives: To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners.Methods: This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computerbased image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4week period.Results: We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most.Conclusions: Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.From the

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Section: Discussionmentioning

confidence: 62%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

Kwan

Pusic

Pecaric³

et al. 2019

AEM Education and Training

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“…This also underscores the urgency that pediatric residencies follow the trend led by medical schools and adult specialties in developing ultrasound curricula(26-28). Given the technical skill required for POCUS (29), new practitioners need skilled preceptors to oversee and hone this important clinical skill. We did not ask trainees in our study if they were using POCUS unsupervised, but currently the trainees at our institution only have access to POCUS machines in the emergency department, neonatal intensive care unit, and pediatric intensive care unit -all departments where they have access to trained POCUS preceptors.…”

Section: Discussionmentioning

confidence: 99%

The Unmet Demand for Point-of-Care Ultrasound Among General Pediatricians: A Needs Assessment

McGinness

Lin‐Martore

Addo

et al. 2021

Preprint

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Background: Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal needs assessments of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings.Methods: In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. Results: Response rate was 20% (98/485). Compared to attendings (n=73), residents (n=25) endorsed more exposure to POCUS in medical school (32% vs 5%, p=0.003) and residency (12% vs 5%, p=0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. Conclusions: There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Our results could guide design of ultrasound curricula for general pediatricians.

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Development and Validation of a Point‐of‐Care‐Ultrasound Image Quality Assessment Tool

Dessie

Calhoun

Kanjanauptom

et al. 2022

J of Ultrasound Medicine

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Objectives-We aimed to develop a standardized scoring tool to measure pointof-care ultrasound (POCUS) image quality and to determine validity evidence for its use to assess lung ultrasound image quality.Methods-The POCUS Image Quality (POCUS IQ) scale was developed by POCUS-trained physicians to assess sonographers' image acquisition skills by evaluating image quality for any POCUS application. The scale was piloted using lung images of healthy standardized patients acquired by three expert sonographers compared to three novices before and after training. All images (experts, novices pretraining, novices post-training) were scored on the POCUS IQ scale by three blinded POCUS-trained physicians. Reliability was assessed with fully-crossed generalizability and decision studies. Validity was assessed using Messick's framework.Results-Content validity was supported by the tool's development process of literature review, expert consensus, and pilot testing. Response process was supported by reviewer training and the blinded scoring process. Relation to other variables was supported by scores relating to sonographer experience: median expert score = 10.5/14 (IQR: 4), median novice pre-training score = 6/14 (IQR: 2.25), and novices' improvement after training (median post-training score = 12/14, IQR: 3.25). Internal structure was supported by internal consistency data (coefficient alpha = 0.84, omega coefficient = 0.91) and the generalizability study showing the main contributor to score variability was the sonographer (51%). The G-coefficient was 0.89, suggesting very good internal structure, however, Gwet's AC 2 was 0.5, indicating moderate interrater reliability. The D study projected a minimum of 1 reviewer and 2 patients are needed for good psychometric reliability. Conclusions-The POCUS scale has good preliminary validity evidence as an assessment tool for lung POCUS image acquisition skills. Further studies are needed to demonstrate its utility for other POCUS applications and as a feedback tool for POCUS learners.

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Credentialing Pediatric Emergency Medicine Faculty in Point-of-Care Ultrasound

Cited by 36 publications

References 56 publications

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study

The Unmet Demand for Point-of-Care Ultrasound Among General Pediatricians: A Needs Assessment

Development and Validation of a Point‐of‐Care‐Ultrasound Image Quality Assessment Tool

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