PURPOSE:Critical care ultrasonagraphy is useful for making diagnoses and guiding procedures. The American Board of Internal Medicine strongly recommends that critical care fellows demonstrate proficiency in ultrasonagraphy to guide thoracentesis and central line insertion. The purpose of this study is to evaluate a new method of training fellows in ultrasonagraphy.
METHODS:First year critical care fellows(n=23) from five New York programs were excused from clinical duties for a four day period in October 2007. Training consisted of lectures, videos and hands-on practice. Faculty consisted of intensivists with ultrasound experience who donated their time. As part of a series of conferences aimed at improving critical care in the New York City area, The Greater New York Hospital Association/United Hospital Fund provided space and models. Fellows incurred no cost for participation. The areas covered were physics, machine use and procedural guidance, as well as cardiac, vascular, abdominal, lung and pleural ultrasonagraphy. Participants were given a 20 question written examination before and after the course. The subjects were also given a practical examination on live models and mannequins where they were given four scenarios: shock, anuria, dyspnea and vascular access. The practical test required integrative skills, i.e, the dyspnea exam required proficiency in cardiac, thoracic and vascular ultrasonagraphy. Test scores are presented as means ± standard deviations. A t-test was used to compare pre-test and post-test scores.
RESULTS:Fellows scores improved from 10.3±2.5 (51.5%) on the pretest to 15.3±1.96 (76.5%) on the posttest (p<0.01). Scores on the practical test were dyspnea - 17.6/20 (88%), shock - 17.1/22 (77.7%), anuria - 6.6/8 (82.6%) and vascular access 4/4 (100%).
CONCLUSION:Fellows’ knowledge of critical care ultrasonagraphy increased as a result of the course. Individual aspects of critical care ultrasonagraphy can be integrated to investigate common problems. A collaboration by faculty from multiple institutions can achieve important educational goals. A six month test is planned to evaluate knowledge retention.
CLINICAL IMPLICATIONS:A four day course increased fellows’ knowledge of critical care ultrasonagraphy. This regional model of instruction has the potential for expansion.
DISCLOSURE:Lewis Eisen, None.