A Regional,Cost-Effective,Collaborative Model for Critical Care Fellows’ Ultrasonography Education

Abstract

Objective:

Training in critical care ultrasonography is an essential tool in critical care medicine and recommended for fellowship programs in pulmonary and critical care medicine. Major barriers to implementing competency-based training in individual fellowship programs include a lack of expert faculty, time, and funding. Our objective was to investigate whether regional collaboration to deliver an introductory critical care ultrasonography course for fellows might overcome these barriers while achieving international training standards.

Methods:

This was a retrospective review of course evaluation and learner assessment data from a 3-day ultrasonography course between 2012 and 2017. All critical care fellows (n = 545) attending the course completed pre- and postcourse surveys and postcourse knowledge and technical skills tests. Evaluation of educational outcomes was performed based on the Kirkpatrick model.

Results:

Fellows reported minimal prior formal training in ultrasonography, and ultrasound-guided vascular access was the most common area of prior training. The course was a blended model of didactic lectures coordinated with real-time demonstration scanning using live models, hands-on training on human models and task trainers, and interpretation of ultrasonography images with a wide range of pathology. Course content included basic echocardiography and general critical care ultrasonography (lung, pleural, vascular diagnostic, vascular access, and abdominal ultrasonography). At the conclusion of the course, fellows demonstrated high levels of knowledge and skill competence on a previously validated assessment tool and significantly improved confidence in all content areas. Barriers to training at individual programs were overcome through faculty cooperation, faculty development, and cost sharing. Success of this model is supported by the sustained growth of this course.

Conclusions:

A regional collaborative model for training fellows in ultrasonography is a feasible, efficient, and flexible model for delivering curricula, where expertise at individual programs is not routinely available.

Keywords

critical care ultrasonography fellowship education fellowship training ultrasonography training echocardiography training collaborative education competency-based education

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References

Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in critical care medicine. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/142_critical_care_medicine_2017-07-01.pdf?ver=2017-04-27-145212-687. Accessed April 14, 2018.

Accreditation Council for Graduate Medical Education. ACGME program requirements for graduate medical education in pulmonary disease and critical care medicine. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/156_pulmonary_critical_care_2017-07-01.pdf. Accessed April 14, 2018.

Eisen

Leung

Gallagher

Kvetan

. Barriers to ultrasound training in critical care medicine fellowships: a survey of program directors. Crit Care Med. 2010;38(10):1978–1983.

Mosier

Malo

Stolz

, et al. Critical care ultrasound training: a survey of US fellowship directors. J Crit Care. 2014;29(4):645–649.

International expert statement on training standards for critical care ultrasonography. Intensive Care Med. 2011;37(7):1077–1083.

Greenstein

Littauer

Narasimhan

Mayo

Koenig

. Effectiveness of a critical care ultrasonography course. Chest. 2017;151(1):34–40.

Carraccio

Englander

Van Melle

, et al. Advancing competency-based medical education: a charter for clinician-educators. Acad Med. 2016; 91(5):645–649.

McGaghie

Issenberg

Cohen

Barsuk

Wayne

. Medical education featuring mastery learning with deliberate practice can lead to better health for individuals and populations. Acad Med. 2011;86(11):e8–e9.

Bender

Rodriguez

. Focused echocardiography trainee curriculum and competency. Crit Care Med. 2013;41(8):2063–2064.

10.

Beraud

Rizk

Pearl

Liang

Patterson

. Focused transthoracic echocardiography during critical care medicine training: curriculum implementation and evaluation of proficiency. Crit Care Med. 2013;41(8):e179–e181.

11.

Dinh

Giri

Rathinavel

, et al. Impact of a 2-day critical care ultrasound course during fellowship training: a pilot study. Crit Care Res Pract. 2015;2015:675041.

12.

Hulett

Pathak

Katz

Montgomery

Chang

. Development and preliminary assessment of a critical care ultrasound course in an adult pulmonary and critical care fellowship program. Ann Am Thorac Soc. 2014;11(5):784–788.

13.

Patrawalla

Eisen

Shiloh

, et al. Development and validation of an assessment tool for competency in critical care ultrasound. J Grad Med Educ. 2015;7(4):567–573.

14.

Beckman

Cook

. Developing scholarly projects in education: A primer for medical teachers. Medical teacher. 2007;29(2-3):210–218.

15.

Mayo

Beaulieu

Doelken

, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest. 2009;135(4):1050–1060.