Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting

Abstract

Background Lung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea. Methods A prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training. Results Nineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively. Conclusions Following 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.

New International Guidelines and Consensus on the Use of Lung Ultrasound

“…For education and training purposes, LUS can further be broken down into modalities with basic to advanced level qualification 280 . Learning curves may be described as steep 281 . Furthermore, it has been shown that the application of LUS by different non‐physician professions such as physiotherapists 282 or paramedics is feasible 283,284 …”

“…280 Learning curves may be described as steep. 281 Furthermore, it has been shown that the application of LUS by different non-physician professions such as physiotherapists 282 or paramedics is feasible. 283,284 Educational science assessing LUS proficiency longitudinally from "zero" to independent clinical competence will be hard to acquire.…”

Evaluation of Emergency and Critical Care Medicine residents’ diagnostic accuracy in lung ultrasound interpretation in Addis Ababa, Ethiopia: a cross-sectional study at two public teaching hospitals

“…Treatment accounted for the bulk of management changes (83.3%), followed by disposition (13.3%), and new consultations (2.7%). This study found that bedside lung ultrasonography had a significant impact on physician clinical decision-making, particularly in terms of patient diagnosis and treatment, in an emergency department in Nepal (4).…”

Prospective, multicentre observational study of point‐of‐care ultrasound practice in emergency departments across Australia and New Zealand: The POCUS‐ED Registry

“…It is also possible that lung US was performed and recorded as a component of indicated BELS scans. The use of this particular modality is well‐supported by literature demonstrating the ease of skill acquisition 19 and a growing evidence base to support its accurate findings, especially in patients with undifferentiated dyspnoea, 11 , 20 heart failure 10 or pneumonia. 21 This finding opens an opportunity for POCUS educators to emphasise the ease with which lung US can be both learnt and applied to a wide variety of clinical circumstances in the ED.…”