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Development and Efficacy of a 1-d Thoracic Ultrasound Training CourseThoracic Ultrasound Training Course FREE TO VIEW

John M. Wrightson, MBBChir; Kathryn M. Bateman, BM; Clare Hooper, MBBS; Fergus V. Gleeson, MBBS, FCCP; Najib M. Rahman, DPhil; Nicholas A. Maskell, DM
Author and Funding Information

From the Oxford Pleural Unit (Drs Wrightson, Gleeson, and Rahman), Oxford Centre for Respiratory Medicine, Churchill Hospital; National Institute for Health Research Biomedical Research Centre, Oxford (Drs Wrightson, Gleeson, and Rahman), University of Oxford; Department of Respiratory Medicine (Dr Bateman), University Hospitals Bristol National Health Service Foundation Trust; Department of Respiratory Medicine (Dr Hooper), Worcestershire Royal Hospital; Department of Thoracic Radiology (Dr Gleeson), Churchill Hospital; Academic Respiratory Unit (Dr Maskell), Department of Clinical Sciences, University of Bristol; and North Bristol National Health Service Trust Lung Centre (Dr Maskell), Southmead Hospital, University of Bristol.

Correspondence to: John M. Wrightson, MBBChir, Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, OX3 7LJ, England; e-mail: johnwrightson@thorax.org.uk


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. See online for more details.


Chest. 2012;142(5):1359-1361. doi:10.1378/chest.12-1797
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Thoracic ultrasound (TUS) improves the safety of pleural interventions,1-4 and guidelines strongly recommend that image guidance should be used for pleural fluid procedures.5 Adequately trained nonradiology physicians have a comparable safety profile to radiologists and are increasingly undertaking TUS,6 partially stimulated by physician training curricula that now require TUS skill acquisition in multiple specialties.7-10 Although several TUS qualifications exist (e-Table 1), a common requirement is the attendance of a training course to gain the essential background knowledge and skills.

Anticipating an increasing demand for TUS courses, the British Thoracic Society pleural diseases group set up a UK multicenter, 1-day theoretical and practical TUS course. Given a lack of data examining the appropriate TUS course format, we report a description and evaluation of the first six consecutive courses.

Twenty-four to 25 participants enrolled in each 1-day, not-for-profit course. The teaching faculty comprised attending physicians (consultants) and fellows in pleural diseases and thoracic radiologists. The lectures covered pathologic conditions (including case-based discussions), ultrasound physics, governance, and machine care (Table 1). Practical sessions allowed scanning of patients with pleural diseases and homemade phantom-based stations that simulated pleural and lymph node intervention (e-Appendix 1). Of 146 participants, the distribution of seniority was 62% for specialist registrars or year 3+ specialty trainees (senior residents and fellows), 26% for consultants and associate specialists (attending physicians), 10% for year 1 and 2 specialty trainees (junior residents), 1% for foundation year 1 and 2 physicians (interns), and 1% for nurses.

Table Graphic Jump Location
Table 1 —Format and Feedback of British Thoracic Society 1-d Thoracic Ultrasound Course
a 

Rating scale: 5=excellent, 4=good, 3=average, 2=below average, 1=poor.

b 

Rating for each statement was from 5=strongly agree to 1=strongly disagree.

To assess acquisition of knowledge and image recognition skills, participants undertook a test based on ultrasound videos and images at the start and end of the course, using both multiple choice and free-text questions. Participants were also contacted a minimum of 3 months after the course to undertake a further test and were asked whether they had attained TUS accreditation locally.

Participant performance significantly improved at the end of the course from a median of 53.8% (interquartile range [IQR], 46.2%-69.2%; n=119) to 84.6% (IQR, 76.9%-92.3%; n=129; P<.001) (Fig 1). Improvements ≥3 months after the course were slightly less marked but were still significant (median, 83.3%; IQR, 75.0%-91.7%; n=41; P<.001).

Figure Jump LinkFigure 1. Box and whisker plots of test scores at various time points. Circles show extreme values lying >1.5 times the interquartile range. *P<.001; ** P<.001 (related-samples Wilcoxon signed rank test). SPSS Statistics version 20 (IBM Corporation) software was used for the statistical analyses.Grahic Jump Location

At least 3 months after the course, 30% of participants (16 of 53) had attained TUS accreditation, which was lower than expected given that 79% (42 of 53) had access to a ward-based ultrasound machine. The primary reason for failure to attain TUS accreditation was poor availability of local mentors. Supervision was provided by a variety of trainers, including 38% pulmonology consultants (attending physicians), 34% thoracic radiologists, 17% pulmonology registrars (residents), and 11% nonthoracic radiologists.

To our knowledge, this report presents the first description and evaluation of a TUS course designed to meet the requirements of nonradiology physicians. A structured TUS course that covers theoretical knowledge and an introduction to patient scanning increases the standardization of training. Furthermore, the use of low-cost phantom stations (e-Appendix 1) introduces guided procedures and allows participants to develop psychomotor skills in a zero-risk environment.

The postcourse results show that completion of TUS accreditation remains problematic for some nonradiology physicians because of poor availability of local training mentors (partially a consequence of radiologists already being responsible for the supervision of their own trainees). These difficulties should improve with time as more pulmonologists gain TUS accreditation and become able to supervise trainees.

Additional information: The e-Appendix and e-Table can be found in the “Supplemental Materials” area of the online article.

Wrightson JM, Maskell NA. Thoracic ultrasound for beginners: utility and training issues for clinicians. Br J Hosp Med (Lond). 2011;72(6):325-330. [PubMed]
 
Wrightson JM, Helm EJ, Rahman NM, Gleeson FV, Davies RJO. Pleural procedures and pleuroscopy. Respirology. 2009;14(6):796-807. [CrossRef] [PubMed]
 
Wrightson JM, Fysh E, Maskell NA, Lee YC. Risk reduction in pleural procedures: sonography, simulation and supervision. Curr Opin Pulm Med. 2010;16(4):340-350. [CrossRef] [PubMed]
 
Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170(4):332-339. [CrossRef] [PubMed]
 
Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(suppl 2):i61-i76. [CrossRef]
 
Rahman NM, Singanayagam A, Davies HE, et al. Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound. Thorax. 2010;65(5):449-453. [CrossRef] [PubMed]
 
Sloan J. Core (level 1) ultrasound curriculum. The College of Emergency Medicine website.http://www.collemergencymed.ac.uk/Training%2DExams/Curriculum/Curriculum%20from%20August%202010/. Accessed June 1, 2012.
 
Loddenkemper R, Séverin T, Eiselé J, et al. HERMES: a European core syllabus in respiratory medicine. Breathe. 2006;3(1):59-70.
 
Joint Royal Colleges of Physicians Training Board.Speciality Training Curriculum for Respiratory Medicine. JRCPTB website.http://www.jrcptb.org.uk/trainingandcert/ST3-SpR/Documents/2010%20Respiratory%20Medicine%20Curriculum.pdf. Accessed June 1, 2012.
 
Accreditation Council for Graduate Medical Education.ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease (Internal Medicine). ACGME website.http://www.acgme.org/acWebsite/downloads/RRC_progReq/149_pulmonary_disease_int_med_07012012.pdf. Accessed June 1, 2012.
 

Figures

Figure Jump LinkFigure 1. Box and whisker plots of test scores at various time points. Circles show extreme values lying >1.5 times the interquartile range. *P<.001; ** P<.001 (related-samples Wilcoxon signed rank test). SPSS Statistics version 20 (IBM Corporation) software was used for the statistical analyses.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Format and Feedback of British Thoracic Society 1-d Thoracic Ultrasound Course
a 

Rating scale: 5=excellent, 4=good, 3=average, 2=below average, 1=poor.

b 

Rating for each statement was from 5=strongly agree to 1=strongly disagree.

References

Wrightson JM, Maskell NA. Thoracic ultrasound for beginners: utility and training issues for clinicians. Br J Hosp Med (Lond). 2011;72(6):325-330. [PubMed]
 
Wrightson JM, Helm EJ, Rahman NM, Gleeson FV, Davies RJO. Pleural procedures and pleuroscopy. Respirology. 2009;14(6):796-807. [CrossRef] [PubMed]
 
Wrightson JM, Fysh E, Maskell NA, Lee YC. Risk reduction in pleural procedures: sonography, simulation and supervision. Curr Opin Pulm Med. 2010;16(4):340-350. [CrossRef] [PubMed]
 
Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010;170(4):332-339. [CrossRef] [PubMed]
 
Havelock T, Teoh R, Laws D, Gleeson F; BTS Pleural Disease Guideline Group Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(suppl 2):i61-i76. [CrossRef]
 
Rahman NM, Singanayagam A, Davies HE, et al. Diagnostic accuracy, safety and utilisation of respiratory physician-delivered thoracic ultrasound. Thorax. 2010;65(5):449-453. [CrossRef] [PubMed]
 
Sloan J. Core (level 1) ultrasound curriculum. The College of Emergency Medicine website.http://www.collemergencymed.ac.uk/Training%2DExams/Curriculum/Curriculum%20from%20August%202010/. Accessed June 1, 2012.
 
Loddenkemper R, Séverin T, Eiselé J, et al. HERMES: a European core syllabus in respiratory medicine. Breathe. 2006;3(1):59-70.
 
Joint Royal Colleges of Physicians Training Board.Speciality Training Curriculum for Respiratory Medicine. JRCPTB website.http://www.jrcptb.org.uk/trainingandcert/ST3-SpR/Documents/2010%20Respiratory%20Medicine%20Curriculum.pdf. Accessed June 1, 2012.
 
Accreditation Council for Graduate Medical Education.ACGME Program Requirements for Graduate Medical Education in Pulmonary Disease (Internal Medicine). ACGME website.http://www.acgme.org/acWebsite/downloads/RRC_progReq/149_pulmonary_disease_int_med_07012012.pdf. Accessed June 1, 2012.
 
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