Performance of Pediatric Emergency Medicine Faculty After Point-Of-Care Ultrasound Credentialing Implementation

Abstract

Objective: As point-of-care ultrasound (POCUS) continues to evolve, a national standardized curriculum for training and credentialing pediatric emergency medicine (PEM) physicians is still lacking. The goal of this study was to assess PEM faculty in performing and interpreting POCUS during implementation of a training curriculum.Methods: Sixteen full-time PEM faculty with either limited or no prior POCUS experience were trained to perform 4 ultrasound studies. Twelve of the 16 completed the training with a goal of credentialing within 12 months of implementation. For each faculty, we assessed competency by comparing precurriculum and postcurriculum test assessments and by evaluating quality of POCUS acquisition and accuracy of interpretation. We also monitored the amount of continuing medical education (CME) hours completed to ensure a minimum didactic component. Results:We found a significant improvement in POCUS competency comparing precurriculum to postcurriculum test assessments (55.4% vs 75.6%, P < 0.0002). One thousand two hundred seventy images were submitted over the course of the curriculum. Accuracy, sensitivity, and specificity were 98.23% (confidence interval [CI] = 97.18-98.97), 97.01% (CI = 92.53-99.81), and 98.43% (CI = 97.33-99.81), respectively. Faculty self-rating of image quality was significantly higher than expert reviewer rating of image quality (3.4 ± 0.86 vs 3.2 ± 0.56, P < 0.0001). We found no change in expert reviewer rating of image quality over time. Faculty completed a combined 232.5 CME hours (average, 17.4 ± 10.8), with the majority of hours coming from an institutional POCUS CME workshop.Conclusions: These results show that a structured curriculum can improve PEM faculty POCUS competency.

Pediatric Emergency Medicine Faculty Response to Point-of-Care Ultrasound Credentialing Curriculum

“…However, challenges to implementing these curricula exist in the form of perceived barriers common to POCUS education and training 4,5 . To our knowledge, because no current guidelines exist for PEM faculty credentialing, we previously developed a novel efficient core curriculum and assessed faculty attitudes and perceptions 6 …”

“…The curriculum was modeled after the 2001 American College of Emergency Physicians POCUS guidelines 7 and the AAP policy statement on POCUS 3 because no pediatric equivalent exists. The objectives of the faculty POCUS curriculum included 1) understanding clinical indications, 2) developing technical skills for image acquisition, 3) interpreting images, and 4) applying POCUS findings to medical decision making as previously described 6 . The ultimate goal was to complete institutional credentialing requirements within a 12-month period.…”

“…Qualitative data were collected from each examination reviewed by a fellowship-trained POCUS faculty member. Reviewed images were assessed for image quality, accuracy of interpretation, and whether the image met previously described 6 minimum criteria specific to each modality. The criteria included a QA rating from 1 (poor) to 5 (excellent), with a minimum of 3 required.…”

“…Other barriers to implementation have previously included access to training and achieving the skillset needed to become comfortable with image acquisition and interpretation, especially in the pediatric environment 5 . We previously described a training curriculum that showed that PEM faculty with limited previous experience in POCUS can improve their competency after implementation of a standardized curriculum for credentialing 6 . To understand faculty perception and barriers to this pediatric POCUS curriculum, we subsequently observed attitudes and responses to this training implementation.…”

Effect of a point-of-care ultrasound (POCUS) curriculum on emergency department soft tissue management

“…At the time of the study, 14 fellowship-trained pediatric emergency faculty and 8 pediatric emergency fellows took part in training. For the training, faculty were required to complete 1-h didactic sessions, hands-on instruction with supervision by a fellowship-trained POCUS expert, complete 4 h of continuing medical education (CME), successfully pass a competency assessment, and complete 25 quality assured soft tissue POCUS examinations as described previously [ 3 , 5 ]. Content covered during the didactic sessions included techniques, equipment selection, soft tissue anatomy, image acquisition, differentiating various SSTI and soft tissue edema pathology, differentiating common types of soft tissue foreign body and clinical integration.…”