PURPOSE: Lung and pleural ultrasound (LPUS) is an effective tool for rapid diagnosis and guiding therapy at bedside in the ICU. There are no recommendations regarding how to train house staff to achieve competency. The purpose of our study was to assess the efficacy of a training program for critical care fellows (CCF) to reach competence in LPUS.
METHODS: Prospective descriptive study in a critical care training program. New incoming PGY ≥ 4 CCF (n=13) completed a questionnaire before starting their training. The questionnaire was based on the 2009 ACCP competency statement for LPUS. The fellows later received a formal 1 hour didactic session which included theory, images and video clips of normal and abnormal findings on LPUS. They were also given access to a vodcast of the lecture. In small groups they received 90 minutes hands on training by a critical care attending physician (CCAP) trained in ultrasound. After completion of the training the CCF (n=9) were again tested using the questionnaire. Descriptive statistics and unpaired t tests (test scores for the CCF were blinded pre and post) were used to compare the performance on the questionnaire before and after training.
RESULTS: 8 of the 13 CCF (62%) indicated that they had no prior experience in LPUS. The average score post training increased from 15/36 (42%) to 29/36 (81%),an improvement by 39 % (p<0.0001). Comparing post-training to pre-training, the CCF were able to rule out and identify a pneumothorax (100% vs.53%: p<0.0001), pulmonary edema (86% vs.28%: p<0.0001), and consolidation (77% vs.46%: p=0.0241).
CONCLUSIONS: A dedicated training program involving a didactic lecture and 90 minutes hands on training by a CCAP trained in ultrasound will significantly improve the performance of CCF toward the achievement of competence in LPUS.
CLINICAL IMPLICATIONS: A brief training program can help CCF achieve competency in LPUS allowing reliable and rapid diagnosis of acute lung and pleural pathology.
DISCLOSURE: The following authors have nothing to disclose: Aditya Uppalapati, John Oropello, Satyanarayana Reddy Mukkera, Zafar Akram Jamkhana, Rosanna DelGiudice, Brian Sherman
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