Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study

Abstract

Background The introduction of portable and pocket ultrasound scanners has potentiated the use of ultrasound in primary care, whose many applications have been studied, analyzed and collected in the literature. However, its use is heterogeneous in Europe and there is a lack of guidelines on the necessary training and skills. Objectives To identify the fundamental applications and indications of ultrasound for family physicians, the necessary knowledge and skills, and the definition of a framework of academic and pragmatic training for the development of these competencies. Methods A modified 3-round Delphi study was carried out in Catalonia, with the participation of 65 family physicians experts in ultrasound. The study was carried out over six months (from September 2020 to February 2021). The indications of ultrasound for family physicians were agreed (the > = 75th percentile was considered) and prioritised, as was the necessary training plan. Results The ultrasound applications in primary care were classified into seven main categories. For each application, the main indications (according to reason for consultation) in primary care were specified. A progressive training plan was developed, characterised by five levels of competence: A (principles of ultrasound and management of ultrasound scanners); B (basic normal ultrasound anatomy); C (advanced normal ultrasound anatomy); D (pathologic ultrasound, description of pathological images and diagnostic orientation); E (practical skills under conditions of routine clinical practice). Conclusion Training family physicians in ultrasound may consider seven main applications and indications. The proposed training plan establishes five different levels of competencies until skill in real clinical practice is achieved.

Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

“…The skill mentioning appendicitis got only relatively agreed in our study. The gynecological applications were not very detailed [ 6 ]. The assessment of pancreatitis was not proposed in our initial list and was not added by the experts after the 1st round.…”

“…In 2017, ​​T he American Academy of Family Physicians (AAFP) created curriculum guidelines for POCUS in graduate medical education [ 4 ]. Since 2020, several European studies have tried to describe a list of indications and applications in General Practice obtained by consensus of Scandinavian [ 5 ] and Spanish [ 6 ] general practitioners. In France, the French Health Authority conducted a literature review in 2022 that identified a lack of data on the use of POCUS by general practitioners [ 7 ].…”

Is it worth trying? A cross-sectional study on the implementation of point-of-care ultrasound in Hungarian primary care

“…In Catalonia, Spain, based on the consensus of GPs experienced in PoCUS, a training curriculum was developed for the main indications of PoCUS in primary care, in which competence levels were also de ned. [20]. The Danish and Spanish consensus-building methods could be good examples for the development of a detailed curriculum of PoCUS in Hungarian primary care, given our ndings that there is a strong need to develop it.…”

The potential of point-of-care ultrasound in UK general practice

“…The Catalan Institute for Health provided portable ultrasound machines to a number of health centres within their locality during the COVID-19 pandemic, seeing their benefit to communityfocussed care. The Catalan Society of for PoCUS (Conangla-Ferrin et al, 2022). More recently a mobile app -EcoAPP has been developed providing a rapid access basic guide to clinical ultrasound in primary care (CAMFiC, 2023).…”