Design of a point‐of‐care ultrasound curriculum for pediatric emergency medicine fellows: A Delphi study

Abstract

Objectives There has been a steady increase in the growth and utilization of point‐of‐care ultrasound (POCUS) in pediatric emergency medicine (PEM). POCUS has been established as an Accreditation Council for Graduate Medical Education (ACGME) core requirement for accreditation of PEM fellowship programs. Despite this requirement, training guidelines regarding POCUS knowledge and skills have yet to be developed. The purpose of this project was to develop a curriculum and a competency checklist for PEM fellow POCUS education. Methods We formed a core leadership group based on expertise in one or more key areas: PEM, POCUS, curriculum development, or Delphi methods. We recruited 29 PEM POCUS or ultrasound education experts from North America to participate in a three‐round electronic Delphi project. The first Delphi round asked experts to generate a list of the core POCUS knowledge and skills that a PEM fellow would need during training to function as an autonomous practitioner. Subsequent rounds prioritized the list of knowledge and skills, and the core leadership group organized knowledge and skills into global competencies and subcompetencies. Results The first Delphi round yielded 61 POCUS areas of knowledge and skills considered important for PEM fellow learning. After two subsequent Delphi rounds, the list of POCUS knowledge and skills was narrowed to 38 items that addressed elements of six global competencies. The core leadership group then revised items into subcompetencies and categorized them under global competencies, developing a curriculum that defined the scope (depth of content) and sequence (order of teaching) of these POCUS knowledge and skill items. Conclusions This expert, consensus‐generated POCUS curriculum provides detailed guidance for PEM fellowships to incorporate POCUS education into their programs. Our curriculum also identifies core ultrasound knowledge and skills needed by PEM fellows to perform the specific POCUS applications recommended in prior publications.

Red Code Management in a Pediatric Emergency Department: A Retrospective Study

“…In recent years, we have assisted in the widespread adoption of POCUS in pediatric EDs; the international literature has emphasized its usefulness in the pediatric emergency setting, representing a non-invasive and rapidly performed technique, performable even on unstable patients during resuscitative maneuvers and useful not only in the diagnostic process but also in the primary assessment [9,15,25]. Unexpectedly, in our study, ultrasound was performed in only one-third of the patients, considering both bedside and specialistic exams: this could be, in part, attributed to the limited use of e-FAST US in polytrauma, which was more commonly managed through the execution of a CT scan, which provided pathological findings in a great portion of cases.…”

Red Code Management in Pediatric Emergency Department: A Retrospective Study

“…In recent years, we have assisted to a widespread adoption of bedside US in pediatric ED; international literature has emphasized its usefulness in the pediatric emergency setting, representing a non-invasive and rapidly performed technique, performable even on unstable patients during resuscitative maneuvers and useful not only in the diagnostic process but also in the primary assessment [9,15,23]. Unexpectedly, in our study ultrasound was performed in only one third of the patients, considering both bedside and specialistic exams: this could be in part attributed to the limited use of e-FAST US in polytrauma, that was more commonly managed through the execution of CT scan, which provided pathological findings in a great portion of cases.…”

A consensus list of ultrasound competencies for graduating emergency medicine residents

“…This may also reflect the challenge of performing sufficient pediatric ultrasound studies to develop competency, which is a challenge faced even by pediatric EM fellows who spend their clinical time in the pediatric environment. 60 …”

“…Our panel did not include pediatric EM–trained physicians, which may explain why bowel pathologies outside of SBO did not meet consensus criteria for inclusion—as the use of ultrasound to diagnose intussusception, appendicitis, and pyloric stenosis is more prevalent in pediatric populations. This may also reflect the challenge of performing sufficient pediatric ultrasound studies to develop competency, which is a challenge faced even by pediatric EM fellows who spend their clinical time in the pediatric environment 60 …”

“…This may also reflect the challenge of performing sufficient pediatric ultrasound studies to develop competency, which is a challenge faced even by pediatric EM fellows who spend their clinical time in the pediatric environment. 60 The organ systems included in our consensus list represent the most common types of exams completed in the emergency department. 61 A recurring theme during our discussion was the consistent expectation that residents should be able to recognize the absence of normal anatomy and function as opposed to specific pathologic diagnoses.…”