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Seth J. Koenig, MD; Mangala Narasimhan, DO, FCCP; Paul H. Mayo, MD, FCCP
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From the Department of Medicine, Long Island Jewish Medical Center.

Correspondence to: Seth J. Koenig, MD, Department of Medicine, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040; e-mail: Skoenig@nshs.edu

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

© 2012 American College of Chest Physicians

Chest. 2012;141(5):1366-1367. doi:10.1378/chest.12-0019
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To the Editor:

We thank Drs Kastelik and Arnold for their interest in our recent article in CHEST.1 They highlight a common and frequently discussed problem in medicine: competence and quality assurance. We agree that although a competency statement outlines what constitutes an acceptable thoracic ultrasound examination, it does not ensure adequate training on an individual basis, nor does it provide the means for ongoing quality assurance. Our fellows gain competence through experiential training and regular oversight by pulmonary/critical care attending physicians experienced in thoracic ultrasonography, but this may reflect local expertise and not general practice. The challenge remains to train pulmonary and critical care specialists in the important skill of thoracic ultrasonography.1

The American College of Chest Physicians (ACCP) has taken concrete steps to provide training in thoracic ultrasonography in the United States. Training in thoracic ultrasonography is a key component in the numerous courses that the college has given to >2,000 clinicians over the past 7 years. The ACCP has developed a comprehensive critical care ultrasonography training program that includes lung and pleural ultrasonography. This Certificate of Completion program requires 7 days of course work, a 20-h Internet training component, and a mandatory 250 image portfolio collection, followed by a hands-on and image-based examination that includes thoracic ultrasonography. The image portfolio, which is reviewed by the faculty, allows an experienced ultrasonographer to provide meaningful feedback to the learner, thereby increasing skill level.

In addition to the national ACCP program, we have developed a local ultrasound training course for fellows. Each summer, 80 first-year pulmonary/critical care fellows from New York City receive an intensive 3-day course in general critical care ultrasonography, including thoracic ultrasonography. Standardized training early in fellowship training ensures that, moving forward, these fellows will disseminate this valuable skill.

Finally, we could not agree more that point-of-care bedside thoracic ultrasonography performed by the treating pulmonologist must be integrated with the clinical history and physical examination. In this regard, thoracic ultrasonography is a powerful extension of the physical examination, providing immediate diagnostic and therapeutic benefit.

Koenig SJ, Narasimhan M, Mayo PH. Thoracic ultrasonography for the pulmonary specialist. Chest. 2011;1405:1332-1341. [CrossRef] [PubMed]




Koenig SJ, Narasimhan M, Mayo PH. Thoracic ultrasonography for the pulmonary specialist. Chest. 2011;1405:1332-1341. [CrossRef] [PubMed]
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