Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists
- 1.8k Downloads
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.
KeywordsLung 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.
- 6.Volpicelli G, Skurzak S, Boero E, Carpinteri G, Tengattini M, Stefanone V, Luberto L, Anile A, Cerutti E, Radeschi G, Frascisco MF (2014) Lung ultrasound predicts well extravascular lung water but is of limited usefulness in the prediction of wedge pressure. Anesthesiology 121:320–327CrossRefPubMedGoogle Scholar
- 11.Cholley BP, Mayo PH, Poelaert J, Vieillard-Baron A, Vignon P, Alhamid S, Balik M, Beaulieu Y, Breitkreutz R, Canivet JL, Doelken P, Flaatten H, Frankel H, Haney M, Hilton A, Maury E, McDermid RC, McLean AS, Mendes C, Pinsky MR, Price S, Schmidlin D, Slama M, Talmor D, Teles JM, Via G, Voga G, Wouters P, Yamamoto T, Expert Round Table on Ultrasound in ICU (2011) International expert statement on training standards for critical care ultrasonography. Intensive Care Med 37:1077–1083CrossRefGoogle Scholar
- 12.Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, Melniker L, Gargani L, Noble VE, Via G, Dean A, Tsung JW, Soldati G, Copetti R, Bouhemad B, Reissig A, Agricola E, Rouby JJ, Arbelot C, Liteplo A, Sargsyan A, Silva F, Hoppmann R, Breitkreutz R, Seibel A, Neri L, Storti E, Petrovic T, International Liaison Committee on Lung Ultrasound for International Consensus Conference on Lung Ultrasound (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591CrossRefPubMedGoogle Scholar
- 14.Royal College of Radiologists (2012) Ultrasound training recommendations for medical and surgical specialities. RCR, LondonGoogle Scholar
- 15.Ambrose SA (2010) How learning works: seven research-based principles for smart teaching. Jossey-Bass, San FranciscoGoogle Scholar
- 24.Mayo PH, Beaulieu Y, Doelken P, Feller-Kopman D, Harrod C, Kaplan A, Oropello J, Vieillard-Baron A, Axler O, Lichtenstein D, Maury E, Slama M, Vignon P (2009) American College of Chest Physicians/La Societe de Reanimation de Langue Francaise statement on competence in critical care ultrasonography. Chest 135:1050–1060CrossRefPubMedGoogle Scholar