Intensive Care Medicine

, Volume 42, Issue 1, pp 63–71 | Cite as

Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists

  • K. C. SeeEmail author
  • V. Ong
  • S. H. Wong
  • R. Leanda
  • J. Santos
  • J. Taculod
  • J. Phua
  • C. M. Teoh



Guidelines recommend teaching of lung ultrasound for critical care, though little information exists on how much training is required for independent practice, especially for non-physician trainees. We thus aimed to elucidate a threshold number of cases above which competency for independent practice may be attained for respiratory therapists (RTs).


We conducted a prospective audit of lung ultrasound training between July 2014 and April 2015 in our 20-bed medical intensive care unit. Following theoretical instruction and self-learning, trainees acquired images from 12 lung zones under direct supervision and classified images into six patterns. Assistance during image acquisition and correct interpretation of ultrasound images were recorded.


Eleven ultrasound-naïve RTs scanned an average of 15 patients each (170 patients in total). Among supervisor-adjudicated lung ultrasound findings, 35.5 % were abnormal. Blinded verification of the adjudicated findings was done for the first 92 patients (1104 images), with an agreement of 95.4 %. As RTs scanned more patients, there was a significant decrease in the proportion of images requiring supervisor assistance (Cuzick’s P < 0.001), and a significant increase in the proportion of correctly identified images (Cuzick’s P = 0.008). After trainees performed at least ten scans, less than 2 % of images required assistance with acquisition and less than 5 % were wrongly interpreted.


Our training method allowed RTs to independently perform lung ultrasound after at least ten directly supervised scans. Given that RTs are likely to have less ultrasound knowledge and less clinical know-how compared to physicians, we believe that the same threshold number of scans may be also safely applied to the latter.


Lung Thorax Ultrasonography Curriculum Education Learning 



All the authors jointly conceived the study and prepared the manuscript. Dr. See, Ms. Wong, Mr. Leanda, Ms. Santos, and Mr. Taculod organized and implemented the training curriculum. Ms. Ong, and Ms. Wong performed the data extraction. Dr. See performed the data analysis. Dr. Phua and Dr. Teoh supervised the analysis and edited the article. Dr. See had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with ethical standards

Conflicts of interest

The authors have disclosed that they do not have any potential conflicts of interest.

Supplementary material

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Supplementary material 1 (MPG 320 kb)
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Supplementary material 4 (DOC 30 kb)
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Supplementary material 5 (DOC 77 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • K. C. See
    • 1
    • 2
    Email author
  • V. Ong
    • 1
    • 2
  • S. H. Wong
    • 3
  • R. Leanda
    • 3
  • J. Santos
    • 3
  • J. Taculod
    • 3
  • J. Phua
    • 1
    • 2
  • C. M. Teoh
    • 1
    • 2
  1. 1.Division of Respiratory and Critical Care Medicine, University Medicine ClusterNational University Health SystemSingaporeSingapore
  2. 2.Department of Medicine, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  3. 3.Respiratory Therapy, Inter-departmental Division of Critical CareNational University Health SystemSingaporeSingapore

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