Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

Abstract

BackgroundClinical lung ultrasound examinations are widely used in the primary assessment or monitoring of patients with dyspnoea or respiratory failure. Despite being increasingly implemented, there is no international consensus on education, assessment of competencies, and certification. Today, training is usually based on the concept of mastery learning, but is often unstructured and limited by bustle in a clinical daily life. The aim of the systematic review is to provide an overview of published learning studies in clinical lung ultrasound, and to collect evidence for future recommendations in lung ultrasound education and certification.MethodsAccording to PRISMA guidelines, three databases (PubMed, Embase, Cochrane Library) were searched, and two reviewers examined the results for eligibility. Included publications were described and assessed for level of evidence and risk of bias according to guidelines from Oxford Centre for Evidence-Based Medicine and Cochrane Collaboration Tool for Risk of Bias assessment.ResultsOf 7796 studies screened, 16 studies were included. Twelve pre- and post-test studies, three descriptive studies and one randomized controlled trial were identified. Seven studies included web-based or online modalities, while remaining used didactic or classroom-based lectures. Twelve (75%) studies provided hands-on sessions, and of these, 11 assessed participants’ hands-on skills. None of the studies used validated neither written nor practical assessment. The highest level of evidence score was 2 (n = 1), remaining scored 4 (n = 15). Risk of bias was assessed high in 11 of 16 studies (68.75%).ConclusionAll educational methods proved increased theoretical and practical knowledge obtained at the ultrasound courses, but the included studies were substantial heterogeneous in setup, learning-, and assessment methods, and outcome measures. On behalf of current published studies, it was not possible to construct clear guidelines for the future education and certification in clinical lung ultrasound, but the use of different hands-on training facilities tends to contribute to different aspects of the learning process. This systematic review proves a lack of learning studies within this content, and research with validated theoretical and practical tests for assessment is desired.

Point‐of‐care lung ultrasound in patients with COVID‐19 – a narrative review

“…This is facilitated in part by the typical sonographic characteristics of COVID-19-associated lung injury during disease progression and recovery [1]. Although there exists much evidence to support the clinical value of lung ultrasound [2], practice is underpinned through education, competency and associated governance procedures [3]. As with other point-of-care ultrasound areas, examinations should be conducted to answer a focused clinical question and procedures should be aligned with agreed national and local standards [4,5].…”

Training and standardization of general practitioners in the use of lung ultrasound for the diagnosis of pediatric pneumonia

“…Our training program provides a potential solution to the need for standardized and validated training programs for LUS . According to the literature, current training programs have only assessed pre‐ and posttraining knowledge, not long‐term standardization .…”

“…Our training program provides a potential solution to the need for standardized and validated training programs for LUS . According to the literature, current training programs have only assessed pre‐ and posttraining knowledge, not long‐term standardization . WHO developed a methodology for CXR interpretation in the epidemiological study to allow for improved diagnosis of bacterial pediatric pneumonia and generalizability of epidemiological studies .…”

“…15,25 According to the literature, current training programs have only assessed pre-and posttraining knowledge, not long-term standardization. 25 WHO developed a methodology for CXR interpretation in the epidemiological study to allow for improved diagnosis of bacterial pediatric pneumonia and generalizability of epidemiological studies. 16,26 A similar consensus methodology for LUS training and standardization may allow for better application of LUS for the diagnosis of pediatric pneumonia in low-resource settings.…”

Response

“…Many of those that do exist are based on fixed timeframes or number of examinations performed, neither of which is sufficient to ensure true competence, as seen time and again in other areas of clinical practice. 10 It is now the urgent responsibility of experts in this area to better define the means by which training in LUS, and the objective evaluation of the success of this same training occurs, 11,12 and incorporating this into widespread practice. The European Respiratory Society has recently launched an evidence-based training program based on these principles (see https://www.ersnet.org/professionaldevelopment/thoracic-ultrasound-training-programme), but there is still a long road to travel from this to routine implementation in everyday clinical practice.…”