Learning strategies of general practitioners striving to achieve point-of-care ultrasound competence: a qualitative study

Abstract

Background: Point-of-care ultrasonography (POCUS) is increasingly used in general practice despite the lack of official educational programmes or guidelines for general practitioners (GPs).

Aim: To explore how GPs have learnt to use POCUS and which barriers they have encountered in their learning process.

Design and setting: Qualitative study conducted in office-based general practice in Denmark.

Methods: Semi-structured interviews were conducted with 13 GPs who had implemented POCUS without supporting guidelines or regulations. Analysis was carried out using systematic text condensation. The interview data for this study were collected along with data used in a previous study.

Results: The participating GPs described having composed their own ultrasound education following a continuous learning process. Basic POCUS competences were achieved through formalized training sessions at hospital departments or courses. The GPs further developed and expanded their scanning skills through additional courses and continuous self-study practice on patients often while consulting internet sources, textbooks or colleagues. Lack of available ultrasound courses, supervision, and clinical guidelines together with time constraints and financial aspects were mentioned as barriers to their ultrasound training.

Conclusion: This study showed how GPs had composed their own ultrasound education individually and differently, guided by their own experiences and beliefs about good clinical practice. Formalized ultrasound training was considered a prerequisite for achieving basic ultrasound competences while continuous practice was considered paramount to develop and maintain scanning skills. There were several obstacles to overcome in the learning process including lack of supervision, guidance, and opportunity for practicing skills.Key pointsLittle is known about the educational needs of general practitioners striving to achieve ultrasound competences.General practitioners described using formalized training to achieve basic scanning competences and continuous self-study and practice to further develop their skills.Lack of time, supervision, clinical guidelines and ultrasound courses were considered barriers in the learning process together with financial aspects.

Keywords: Diagnostic methods; education; family medicine; general practice; qualitative research; ultrasonography.

Figure 1.

Analytical process. The analysis was conducted using systematic text condensation [26].

Figure 2.

Learning process of general practitioners to obtain scanning proficiency. The general practitioners (GPs) described moving through a gradual learning process as they strived to obtain competence in performing point-of-care (POCUS) ultrasound examinations. The GPs had different starting points for learning POCUS; some had prior scanning experience, others started from scratch. Basic POCUS competences were obtained through practical training during courses or employment at hospitals. These competences were further developed through scanning on patients in general practice. Some GPs ended the learning process here. Other GPs returned to update their scanning skills on courses and most GPs started collecting new early experiences with scanning modalities aiming to obtain new competences.

Figure 3.

– Findings in relation to The Dreyfus and Dreyfus model. The Dreyfus and Dreyfus model [28] describes five competence levels that practitioners have to go through when they strive to learn a new competence. This figure illustrates our findings according to the model.

Figure 4.

Findings in relation to a model by Lam. The model by Lam [29] describes four types of knowledge. Embrained knowledge can be knowledge learned by reading textbooks or obtained at the theoretical part of an ultrasound course. Embodied knowledge is acquired through individual practical experience and as such it is difficult to transfer from one practitioner to another. Encoded knowledge is codified knowledge stored in procedures, guidelines, curricula etc. to standardize practice; typically provided by central health authorities. Embedded knowledge is collective, tacit knowledge stored in organizational routines based on shared beliefs and understandings in an organization or a community where people collaborate.