Implementation of a Longitudinal Critical Care Fellowship Ultrasound Curriculum

Abstract

Background: The use of point-of-care ultrasound as a diagnostic and interventional tool is rapidly becoming standard of care in critical care medicine; a standardized training curriculum is needed to ensure provider proficiency.

Objective: This study aimed to describe a longitudinal critical care ultrasound (CCUS) curriculum in a pulmonary critical care medicine (PCCM) fellowship training program. It evaluated the curriculum's impact on fellows' knowledge, skills, and self-reported confidence and retention of these attributes.

Methods: We conducted a prospective observational study of a longitudinal CCUS training program within a single PCCM fellowship training program. Knowledge, skills, and confidence of 22 fellows were assessed at baseline; after initial training; and at 6, 12, and 18 months in five domains (ultrasound basics, vascular, lung/pleural, abdomen, and cardiac). We quantified changes in CCUS knowledge, confidence, and skills by fellowship class and assessed for longitudinal retention of these three attributes. The difference in scores between new first-year fellows undergoing formal training and second-year fellows with previous informal training was compared at matched time points.

Results: After the initial formal training, there was a significant increase in knowledge, skills, and confidence scores, which were maintained or continued to increase up to 18 months. Fellows with 1 year of formal training also had a higher level of knowledge and skills than fellows with 1 year of informal training, although they had similar levels of self-reported confidence in their skills.

Conclusion: A formal, longitudinal CCUS curriculum implemented in a PCCM fellowship program improves trainees' knowledge and skills in various ultrasound domains in addition to their confidence in using ultrasound for patient care. A longitudinal curriculum results in retention of all three attributes and appeared to be more effective than an informal training program based on teaching during rounds, but this needs to be replicated in a larger cohort.

Keywords: diagnostic imaging; education; intensive care; ultrasonography.

Figure 1.

Training and assessment timeline. Training sessions and assessments occurred at baseline, 6 months, and 18 months. Additional assessments were conducted at 12 months. There were five cohorts of fellows; three cohorts (A–C) underwent the baseline training session, and two cohorts (D and E) joined fellowship during the longitudinal follow up. Arrows denote the ongoing period of fellowship training, “X” represents graduation or end of fellowship, and closed circles indicate the start of fellowship for individual cohorts. Solid lines represent periods of formal training, and dashed lines represent historical periods of informal training. The black closed squares and lines symbolize the time periods for comparison between the informal training program (cohort B at baseline) and the formal training program (cohort C at 12 months). See the Methods for more details.

Figure 2.

Change in (A) knowledge, (B) confidence, and (C) skills scores from precourse to immediately postcourse, grouped by fellowship training levels. Plots show the median with interquartile range together with data points for individual participants.

Figure 3.

(A) Knowledge and (B) confidence scores at precourse baseline and 12 months and 18 months of follow up for Cohort C. Plots show the median with interquartile range together with data points for individual participants. Maximum scores are denoted by the dotted line. P value is for Friedman’s test for repeated measures.

Figure 4.

(A) Knowledge, (B) confidence, and (C) skills scores for Cohort C after 1 year of formal POCUS training compared with Cohort B at baseline after receiving 1 year of informal POCUS training (see Methods). Maximum scores are denoted by the dotted line.