Emergency medicine trainees' perceived barriers to training and credentialing in point‐of‐care ultrasound: A cross‐sectional study

Abstract

Introduction Point‐of‐care ultrasound (POCUS) is an important tool in emergency medicine (EM), with the Australasian College for Emergency Medicine (ACEM) recommending core modalities as part of fellowship training. In Australia, acquisition of these skills is certified via credentialing but is currently poorly undertaken by EM trainees. Methods We performed a cross‐sectional survey of EM trainees across two academic teaching hospitals in Gold Coast, Queensland, between December 2018 and January 2019, to determine the current state of training and perceived barriers to credentialing in POCUS. Results Fifty‐two (59%) eligible EM trainees participated. Although credentialing rates (15%) were low amongst respondents, the majority agreed that it was necessary (69%) and should form part of ACEM training (88%). Amongst these trainees, we identified the desire for increased POCUS training and several barriers including time constraints and the credentialing process itself. Conclusion Although there is general agreement amongst EM trainees for POCUS credentialing, barriers such as time limitations and technical difficulties were prohibitive for many. We propose the development of an internal structured POCUS training programme within mandatory training time to address these issues.

Serial image interpretation tasks improve accuracy and increase confidence in Level 1 echocardiography reporting: a pilot study

“…if users become inappropriately confident, and this influences decision making by them or others), and our study is not exempt from this. Nevertheless, many professionals use POCUS in their practice without any specific credentialling [ 11 , 12 ], and this is likely to increase as handheld US probes become less costly and there is a proliferation of free open access resources. While we believe that there are patient safety considerations attached to the ethical development of any educational resource, we do not suggest that completion of image interpretation tasks in isolation would be de facto evidence of competence or any form of accreditation.…”

“…It would allow participants to work through tasks at their own rate, at a time convenient to them. This reduces some of the logistical barriers to POCUS training, which have been identified to adversely affect engagement with accreditation programs [ 11 , 12 , 15 ]. Flexible learning, where possible, may be particularly important in widening access to people with complex work schedules and specific responsibilities outside work as well as those whose attendance at in person training is limited by geography, time zones, financial constraints or disability.…”

“…There is a precedent for ‘online asynchronous learning’ to increase learners’ clinical use in POCUS as well as their engagement with quality assurance review of their scanning and work towards credentialing [ 17 ]. Similar learning options reduce the attrition noted specifically in relation to focused echocardiography accreditation in the UK and internationally [ 11 , 12 , 15 , 18 ].…”

Point‐of‐care ultrasonography—An essential skill for medical graduates?

“…Paradoxically, despite obvious advantages, POCUS remains the 'technique of a few' in relation to the wider medical community. The thorny path and historic barriers to training, credentialing and utilisation have been examined in emergency medicine, 1 anaesthesia, 9 internal medicine 10 and intensive care literature. 11,12 The findings exposed repeated themes of overwhelming curriculums, lack of dedicated training and teaching time for the specialist trainees and the trainers alike, inadequate proportion of trainers in relation to the trainees, territorial mentality and lack of standardisation.…”

Evolution in training in ultrasound

“…Today, many ultrasound diagnoses are first made in the emergency room, and in this issue of the AJUM, Elsayed et al 1 present compelling data showing that advanced trainees in Emergency Medicine highly value ultrasound in their clinical management and training, yet significant barriers to both training and credentialling exist, that are both perceived and real. They propose structured internal training systems are needed to overcome these hurdles, including time restrictions, access to training and technical challenges.…”