Emergency Point-of-Care Ultrasound Stewardship – A Joint Position Paper by EuSEM and EFSUMB and Endorsed by IFEM and WFUMB

Abstract

Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept. It has spread rapidly because of its intuitive, simple applicability and low equipment costs. The speed of its emerging growth frequently outpaces the development of quality assurance and education. Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education. Additional challenges are encountered such as remote or low resource medical practice. Here, EMPoCUS might be the only ad-hoc imaging modality available. Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills. However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones. This threatens to take quality assurance down the wrong path. It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking. In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation. This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.

Zusammenfassung

Der notfallmedizinische Point-of-Care-Ultraschall (EMPoCUS) ist ein überzeugendes Konzept. Es hat sich aufgrund seiner intuitiven, einfachen Anwendbarkeit und der geringen Gerätekosten rasch verbreitet. Die Geschwindigkeit des sich abzeichnenden Wachstums übertrifft häufig die Entwicklung der Qualitätssicherung oder der Ausbildung. In der Tat variieren die Ausbildungsstandards weltweit und scheinen in einigen Fällen die Grundsätze einer modernen kompetenzbasierten Ausbildung zu vernachlässigen. Hinzu kommen weitere Herausforderungen wie abgelegene oder ressourcenarme medizinische Institutionen. Hier könnte EMPoCUS die einzige ad-hoc verfügbare Bildgebungsmodalität sein. Wenn die Notfallärzte die EMPoCUS-Ausbildung abgeschlossen haben, sollten sie in der Lage sein, ihre Patienten unter Einsatz einer Vielzahl von PoCUS-Spielarten unabhängig und effizient zu versorgen. In den meisten Curricula werden diese Anforderungen jedoch nur unverbindlich und allgemein definiert oder es werden veraltete Maßstäbe verwendet – wie die Dauer der Ausbildung, die Selbsteinschätzung der durchgeführten Untersuchungen mit variabler Kontrolle oder administrative Maßstäbe zur Erstellung von Ausbildungsmeilensteinen. Damit droht die Qualitätssicherung in die falsche Richtung zu laufen. Es wurden Verhältnisse geschaffen, in denen es an konkreten Ergebniskriterien für EMPoCUS-Skills mangelt, welche die Ausbildungsziele realistisch widerspiegeln und gleichzeitig leicht beobachtbar und überprüfbar wären. Angesichts der Gefahren einer unzureichend kontrollierten EMPoCUS-Verbreitung und von fehlenden europäischen Richtlinien möchten wir auf der Grundlage einer kritischen Bestandsaufnahme zentrale Standards für eine europäische EMPoCUS-Stewardship setzen. Dieses Positionspapier, das gemeinsam von EuSEM und EFSUMB entwickelt und von IFEM und WFUMB unterstützt wurde, soll auch die EFSUMB/EuSEM-Leitlinien zu PoCUS begleiten, die derzeit zur Veröffentlichung vorbereitet werden.

Keywords

Stewardship - Point-of-care-ultrasound - Competency - Emergency Medicine

Publication History

Received: 08 November 2022

Accepted after revision: 20 February 2023

Article published online:
30 March 2023

• References

• 1 Diaz-Gomez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med 2021; 385 (17) 1593-1602
• 2 Patel MD, Horrow MM, Kamaya A. et al. Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound. J Am Coll Radiol 2021; 18 (01) 42-52
• 3 Marshburn TH, Hadfield CA, Sargsyan AE. et al. New heights in ultrasound: first report of spinal ultrasound from the international space station. J Emerg Med 2014; 46 (01) 61-70
• 4 Sabatino V, Caramia MR, Curatola A. et al. Point-of-care ultrasound (POCUS) in a remote area of Sierra Leone: impact on patient management and training program for community health officers. J Ultrasound 2020; 23 (04) 521-527
• 5 Doig M, Dizon J, Guerrero K. et al. Exploring the availability and impact of antenatal point-of-care ultrasound services in rural and remote communities: A scoping review. Australas J Ultrasound Med 2019; 22 (03) 174-185
• 6 Filly RA. Ultrasound: the stethoscope of the future, alas. Radiology 1988; 167 (02) 400
• 7 Greenbaum LD. It is time for the sonoscope. J Ultrasound Med 2003; 22 (04) 321-322
• 8 Filly RA. Is it time for the sonoscope? If so, then let’s do it right!. J Ultrasound Med 2003; 22 (04) 323-325
• 9 Hoffmann B. The future is not the sonoscope. J Ultrasound Med 2003; 22 (09) 997-998
• 10 Piscaglia F, Dietrich CF, Nolsoe C. et al. Birth of “Echoscopy”– The EFSUMB Point of View. Ultraschall in Med 2013; 34 (01) 92
• 11 Dietrich CF, Fraser AG, Dong Y. et al. Managing Incidental Findings Reported by Medical, Sonography and Other Students Performing Educational Ultrasound Examinations. Ultrasound Med Biol 2022; 48 (02) 180-187
• 12 Dietrich CF, Hoffmann B, Abramowicz J. et al. Medical Student Ultrasound Education: A WFUMB Position Paper, Part I. Ultrasound Med Biol 2019; 45 (02) 271-281
• 13 Nielsen MB, Cantisani V, Sidhu PS. et al. The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper. Ultraschall in Med 2019; 40 (01) 30-39
• 14 Dietrich CF, Bolondi L, Duck F. et al. History of Ultrasound in Medicine from its birth to date (2022), on occasion of the 50 Years Anniversary of EFSUMB. A publication of the European Federation of Societies for Ultrasound In Medicine and Biology (EFSUMB), designed to record the historical development of medical ultrasound. Med Ultrason 2022; 24 (04) 434-450
• 15 Jenssen C, Ewertsen C, Piscaglia F. et al. 50th years anniversary of EFSUMB: Initial roots, maturation, and new shoots. Ultraschall in Med 2022; 43 (03) 227-231
• 16 Wustner M, Radzina M, Calliada F. et al. Professional Standards in Medical Ultrasound – EFSUMB Position Paper (Long Version) – General Aspects. Ultraschall in Med 2022; 43 (05) e36-e48
• 17 Castro G. Top 10 health technology hazards for 2020. In,. https://www.jointcommissionorg/en/resources/news-and-multimedia/blogs/dateline-tjc/2020/01/top-10-health-technology-hazards-for-2020 2020
• 18 Tolsgaard MG, Todsen T, Sorensen JL. et al. International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey. PLoS One 2013; 8 (02) e57687
• 19 Jarman RD, McDermott C, Coclough A. et al. EFSUMB Clinical Practice Guidelines for Point-of-Care Ultrasound: Part One (Common Heart and Pulmonary Applications) LONG VERSION. Ultraschall in Med 2022;
• 20 Atkinson P, Bowra J, Lambert M. et al. International Federation for Emergency Medicine point of care ultrasound curriculum. CJEM 2015; 17 (02) 161-170
• 21 Kolb DA. The learning style inventory: Technical Manual. Boston: Mcber; 1976
• 22 Eppich WJ, Hunt EA, Duval-Arnould JM. et al. Structuring feedback and debriefing to achieve mastery learning goals. Acad Med 2015; 90 (11) 1501-1508
• 23 Sumeracki MA, Weinstein Y. Six Strategies for Effective Learning. Acad Med 2018; 93 (04) 666
• 24 Nebel C. Considerations for Applying Six Strategies for Effective Learning to Instruction. Med Sci Educ 2020; 30 (Suppl. 01) 9-10
• 25 Kolb DA. Learning styles and disciplinary differences. In: Chickering AW. The Modern American College. San francisco, LA: Jossey-Bass; 1981: 232-255
• 26 Kern DE, Thomas PA, Howard DM. et al. Curriculum development for medical education. Baltimore, MD: The Johns Hopkins University press; 1998
• 27 Damewood SC, Leo M, Bailitz J. et al. Tools for Measuring Clinical Ultrasound Competency: Recommendations From the Ultrasound Competency Work Group. AEM Educ Train 2020; 4 (Suppl. 01) S106-S112
• 28 Bellamkonda VR, Shokoohi H, Alsaawi A. et al. Ultrasound credentialing in North American emergency department systems with ultrasound fellowships: a cross-sectional survey. Emerg Med J 2015; 32 (10) 804-808
• 29 Shokoohi H, Duggan NM, Adhikari S. et al. Point-of-care ultrasound stewardship. J Am Coll Emerg Physicians Open 2020; 1 (06) 1326-1331
• 30 Anonymous. Ultrasound Education & Training – 2021 Curriculum (Royal College of Emergeny Medicine). In. 2021 https://rcem.ac.uk/ultrasound/
• 31 ACEP. Policy statement. Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine. American College of Emergency Physicians. 2016
• 32 Anonymous. Emergency ultrasound special interest group. Point-of-care ultrasound curriculum guidelines. International Federation for Emergency Medicine. 2014
• 33 Anonymous. In:. https://www.merriam-webster.com/dictionary/stewardship
• 34 Lewiss RE, Hoffmann B, Beaulieu Y. et al. Point-of-care ultrasound education: the increasing role of simulation and multimedia resources. J Ultrasound Med 2014; 33 (01) 27-32
• 35 Anonymous. Provision of focused ultrasound training and governance – Guidelines (COR742). In: Australasian College of Emergency Medicine. https://acem.org.au/
• 36 Jarman B. Teaching in the theatre. In: Peyton JWR. Teaching and learning in medical practice. Manticore Europe: 1998: 171-180
• 37 Anonymous. Emergency Ultrasound Fellowship Guidelines an Information Paper, A Consensus Document Developed by the ACEP Emergency Ultrasound Section.
• 38 Breckwoldt J, Brodmann M. Kompetenzbasierte Bildung – eine Einführung. SAEZ 2022; 103 (06) 170-173