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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 6/2019

01-06-2019 | Ultrasound | Review Paper

Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments

Authors: Andre Kumar, MD, John Kugler, MD, Trevor Jensen, MD

Published in: Journal of General Internal Medicine | Issue 6/2019

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Abstract

Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define “competency” with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users. As a framework, the assessment of competency should include evaluations that assess the acquisition and application of POCUS-related knowledge, demonstration of technical skill (e.g., proper probe selection, positioning, and image optimization), and effective integration into routine clinical practice. These assessments can be performed across a variety of settings, including web-based applications, simulators, standardized patients, and real clinical encounters. Several validated assessments regarding POCUS competency have recently been developed, including the Rapid Assessment of Competency in Echocardiography (RACE) or the Assessment of Competency in Thoracic Sonography (ACTS). However, these assessments focus mainly on technical skill and do not expand upon other areas of this framework, which represents a growing need. In this review, we explore the different methodologies for evaluating competency with POCUS as well as discuss current progress in the field of measuring trainee knowledge and technical skill.
Literature
1.
2.
Akkaya A, Yesilaras M, Aksay E, Sever M, Atilla OD. The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents. Am J Emerg Med 2013;31: 1509–1511.CrossRefPubMed
3.
Razi R, Estrada JR, Doll J, Spencer KT. Bedside hand-carried ultrasound by internal medicine residents versus traditional clinical assessment for the identification of systolic dysfunction in patients admitted with decompensated heart failure. J Am Soc Echocardiogr 2011;24: 1319–1324.CrossRefPubMed
4.
Dodge KL, Lynch CA, Moore CL, Biroscak BJ, Evans LV. Use of ultrasound guidance improves central venous catheter insertion success rates among junior residents. J Ultrasound Med 2012;31: 1519–1526.CrossRefPubMed
5.
Cavanna L, Mordenti P, Bertè R, et al. Ultrasound guidance reduces pneumothorax rate and improves safety of thoracentesis in malignant pleural effusion: report on 445 consecutive patients with advanced cancer. World J Surg Onc 2014;12: 139
6.
Testa A, Francesconi A, Giannuzzi R, Berardi S, Sbraccia P. Economic analysis of bedside ultrasonography (US) implementation in an Internal Medicine department. Intern Emerg Med 2015;10: 1015–1024.CrossRefPubMed
7.
Howard ZD, Noble VE, Marill KA, Sajed D, et al. Bedside ultrasound maximizes patient satisfaction. J Emerg Med 2014;46: 46–53.CrossRefPubMed
8.
Glomb N, D’Amico B, Rus M, Chen C. Point-Of-Care Ultrasound in Resource-Limited Settings. Clin Pediatr Emerg Med 2015;16: 256–261.CrossRef
9.
Bahner DP, Goldman E, Way D, Royall NA, Liu YT. The state of ultrasound education in U.S. medical schools: results of a national survey. Acad Med 2014;89: 1681–1686.CrossRefPubMed
10.
Hall JWW, Holman H, Bornemann P, et al. Point of Care Ultrasound in Family Medicine Residency Programs: A CERA Study. Fam Med 2015;47: 706–711.PubMed
11.
Schnobrich DJ, Gladding S, Olson APJ, Duran-Nelson A. Point-of-Care Ultrasound in Internal Medicine: A National Survey of Educational Leadership. J Grad Med Educ 2013;5: 498–502.CrossRefPubMedPubMedCentral
12.
Frankel HL, Kirkpatrick AW, Elbarbary M, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part I: General Ultrasonography. Crit Care Med journals.​lww.​com; 2015;43: 2479.
13.
Rudski LG, Lai WW, Afilalo J, Hua L, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23: 685–713; quiz 786–8.CrossRefPubMed
14.
Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2017;69: e27–e54.
15.
Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused Cardiac Ultrasound: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr Elsevier; 2013;26: 567–581.CrossRef
16.
17.
Sabath BF, Singh G. Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now. J Community Hosp Intern Med Perspect 2016;6: 33094.CrossRefPubMed
18.
Beal EW, Sigmond BR, Sage-Silski L, Lahey S, Nguyen V, Bahner DP. Point-of-Care Ultrasound in General Surgery Residency Training: A Proposal for Milestones in Graduate Medical Education Ultrasound. J Ultrasound Med 2017;36: 2577–2584.CrossRefPubMed
19.
Deshpande R, Montealegre-Gallegos M, Matyal R, Belani K, Chawla N. Training the Anesthesiologist in Point-of-Care Ultrasound. Int Anesthesiol Clin 2016;54: 71–93.CrossRefPubMed
20.
Association of Family Medicine Residency Directors. Consensus statement for procedural training in Family Medicine residency. [online] Available at: https://​binged.​it/​2HGV9hY. Accessed 4 Oct 2018; 2014
21.
22.
Baltarowich OH, Di Salvo DN, Scoutt LM, Brown DL, Cox CW, DiPietro MA, et al. National ultrasound curriculum for medical students. Ultrasound Q 2014;30: 13–19.CrossRefPubMed
23.
Lewiss RE, Pearl M, Nomura JT, et al. CORD-AEUS: consensus document for the emergency ultrasound milestone project. Acad Emerg Med 2013;20: 740–745.CrossRefPubMed
24.
Schmidt JN, Kendall J, Smalley C. Competency Assessment in Senior Emergency Medicine Residents for Core Ultrasound Skills. West J Emerg Med 2015;16: 923–926.CrossRefPubMedPubMedCentral
25.
Bahner DP, Adkins EJ, Nagel R, Way D, Werman HA, Royall NA. Brightness mode quality ultrasound imaging examination technique (B-QUIET): quantifying quality in ultrasound imaging. J Ultrasound Med 2011;30: 1649–1655.CrossRefPubMed
26.
Amini R, Adhikari S, Fiorello A. Ultrasound competency assessment in emergency medicine residency programs. Acad Emerg Med 2014;21: 799–801.CrossRefPubMed
27.
Tarique U, Tang B, Singh M, Kulasegaram KM, Ailon J. Ultrasound Curricula in Undergraduate Medical Education: A Scoping Review. J Ultrasound Med 2018;37: 69–82.CrossRefPubMed
28.
Kumar A, Liu G, Chi J, Kugler J. The Role of Technology in the Bedside Encounter. Med Clin North Am 2018;102: 443–451.CrossRefPubMed
29.
30.
Hempel D, Sinnathurai S, Haunhorst S, et al. Influence of case-based e-learning on students’ performance in point-of-care ultrasound courses: a randomized trial. Eur J Emerg Med 2016;23: 298–304.CrossRefPubMed
31.
Ali SH, Ruit KG. The Impact of item flaws, testing at low cognitive level, and low distractor functioning on multiple-choice question quality. Perspect Med Educ 2015;4: 244–251.CrossRefPubMedPubMedCentral
32.
Townsend NT, Kendall J, Barnett C, Robinson T. An Effective Curriculum for Focused Assessment Diagnostic Echocardiography: Establishing the Learning Curve in Surgical Residents. J Surg Educ 2016;73: 190–196.CrossRefPubMed
33.
Millington SJ, Hewak M, Arntfield RT, et al. Outcomes from extensive training in critical care echocardiography: Identifying the optimal number of practice studies required to achieve competency. J Crit Care 2017;40: 99–102.CrossRefPubMed
34.
Johri AM, Durbin J, Newbigging J, Tanzola R, Chow R, De S, et al. Cardiac Point-of-Care Ultrasound: State of the Art in Medical School Education. J Am Soc Echocardiogr 2018;31(7):749–760.CrossRef
35.
Knudson MM, Sisley AC. Training residents using simulation technology: experience with ultrasound for trauma. J Trauma 2000;48: 659–665.CrossRefPubMed
36.
Damewood S, Jeanmonod D, Cadigan B. Comparison of a multimedia simulator to a human model for teaching FAST exam image interpretation and image acquisition. Acad Emerg Med 2011;18: 413–419.CrossRefPubMed
37.
Sisley AC, Johnson SB, Erickson W, Fortune JB. Use of an Objective Structured Clinical Examination (OSCE) for the assessment of physician performance in the ultrasound evaluation of trauma. J Trauma 1999;47: 627–631.CrossRefPubMed
38.
Lucas BP, Tierney DM, Jensen TP, et al. Credentialing of Hospitalists in Ultrasound-Guided Bedside Procedures: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2018;13: 117–125.PubMed
39.
Smith MA, Atherly AJ, Kane RL, Pacala JT. Peer review of the quality of care. Reliability and sources of variability for outcome and process assessments. JAMA 1997;278: 1573–1578.CrossRefPubMed
40.
Kameoka J, Okubo T, Koguma E, Takahashi F, Ishii S, Kanatsuka H. Development of a peer review system using patient records for outcome evaluation of medical education: reliability analysis. Tohoku J Exp Med 2014;233: 189–195.CrossRefPubMed
41.
Mathews BK, Zwank M. Hospital Medicine Point of Care Ultrasound Credentialing: An Example Protocol. J Hosp Med 2017;12: 767–772.CrossRefPubMed
42.
Kimura BJ, Sliman SM, Waalen J, Amundson SA, Shaw DJ. Retention of Ultrasound Skills and Training in “Point-of-Care” Cardiac Ultrasound. J Am Soc Echocardiogr 2016;29: 992–997.CrossRefPubMed
43.
Soni NJ, Tierney DM, Jensen TP, Lucas BP. Certification of Point-of-Care Ultrasound Competency. J Hosp Med 2017;12: 775–776.CrossRefPubMed
44.
Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II: Cardiac Ultrasonography. Crit Care Med 2016;44: 1206.CrossRefPubMed
45.
46.
Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr onlinejase.​com; 2013;26: 567–581.
47.
Millington SJ, Arntfield RT, Hewak M, et al. The Rapid Assessment of Competency in Echocardiography Scale: Validation of a Tool for Point-of-Care Ultrasound. J Ultrasound Med 2016;35: 1457–1463.CrossRefPubMed
48.
Millington SJ, Arntfield RT, Guo RJ, et al. The Assessment of Competency in Thoracic Sonography (ACTS) scale: validation of a tool for point-of-care ultrasound. Crit Ultrasound J 2017;9: 25.CrossRefPubMedPubMedCentral
49.
Skaarup SH, Laursen CB, Bjerrum AS, Hilberg O. Objective and Structured Assessment of Lung Ultrasound Competence. A Multispecialty Delphi Consensus and Construct Validity Study. Ann Am Thorac Soc 2017;14: 555–560.CrossRefPubMed
50.
Todsen T, Tolsgaard MG, Olsen BH, Henriksen BM, et al. Reliable and valid assessment of point-of-care ultrasonography. Ann Surg 2015;261: 309–315.CrossRefPubMed
51.
Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart. 2017;103: 987–994.CrossRefPubMed
52.
Amini R, Stolz LA, Javedani PP, Gaskin K, et al. Point-of-care echocardiography in simulation-based education and assessment. Adv Med Educ Pract 2016;7: 325–328.CrossRefPubMedPubMedCentral
53.
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 2015;147: 1659–1670.CrossRefPubMed
54.
Keil-Ríos D, Terrazas-Solís H, González-Garay A, Sánchez-Ávila JF, García-Juárez I. Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis. Intern Emerg Med 2016;11: 461–466.CrossRefPubMed
55.
Kameda T, Taniguchi N. Overview of point-of-care abdominal ultrasound in emergency and critical care. J Intensive Care Med 2016;4: 53.CrossRef
56.
Dickman E, Tessaro MO, Arroyo AC, Haines LE, Marshall JP. Clinician-performed abdominal sonography. Eur J Trauma Emerg Surg 2015;41: 481–492.CrossRefPubMed
57.
Steinemann S, Fernandez M. Variation in training and use of the focused assessment with sonography in trauma (FAST). Am J Surg 2018;215: 255–258.CrossRefPubMed
58.
59.
60.
Wallenstein J, Ander D. Objective structured clinical examinations provide valid clinical skills assessment in emergency medicine education. West J Emerg Med 2015;16: 121–126.CrossRefPubMed
61.
Berendonk C, Schirlo C, Balestra G, et al. The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group. GMS Z Med Ausbild 2015;32:40.
62.
Liao SC, Hunt EA, Chen W. Comparison between inter-rater reliability and inter-rater agreement in performance assessment. Ann Acad Med Singap 2010;39: 613–618.PubMed
63.
Mitchell JD, Amir R, Montealegre-Gallegos M, Mahmood F, Shnider M, et al. Summative Objective Structured Clinical Examination Assessment at the End of Anesthesia Residency for Perioperative Ultrasound. Anesth Analg 2018;126(6): 2065–2068.CrossRefPubMed
Metadata
Title
Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments
Authors
Andre Kumar, MD
John Kugler, MD
Trevor Jensen, MD
Publication date
01-06-2019
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 6/2019
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-04945-4

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