142 Teaching Point-of-Care Ultrasound in Emergency Medicine: A Systematic Review of Current Structured Methods

Abstract

Emergency medicine (EM) residents have traditionally been trained in point-of-care ultrasound (POCUS) through the apprenticeship model. While training is moving towards more structured methods, best practice for this training is unknown. We performed a systematic review of current structured methods for teaching POCUS, with the intention of studying characteristics and themes that would better inform best practice. The searches were developed and conducted by a trained health science librarian. Search strategies, using both subject heading and keyword methods, were created for PubMed, Cochrane Central Register of Controlled Trials (Wiley), ERIC (EBSCOhost), and Embase (Elsevier). The searches were conducted on November 21 and 28 of 2017. No date restrictions were applied. The PubMed and Embase searches were limited to English. Records were de-duplicated using standard methodology. Gray literature, reference lists and conference proceedings were hand searched. Only prospective studies which described a structured educational intervention for teaching POCUS to EM residents were included. Each study abstract was independently screened by two of three reviewers; the third reviewer mediated in cases lacking consensus. All three reviewers reviewed the final selected articles and classified the type of study, participants, study themes, and categories. The articles were evaluated for quality and risk of bias using MERSQI (Medical Education Research Study Quality Instrument). Individual articles were further classified as knowledge acquisition, image acquisition, knowledge assessment, skill assessment, and program assessment. A total of 3934 unique articles were retrieved from the database and gray literature. 384 articles were selected based on initial screening. After full manuscript review of each, 53 articles were selected. Each article was then evaluated with the MERSQI instrument. Scores varied from 6 to 14 (mean score 10), on a scale of 18 points. Classification of components of structured curricula are described in Table 1. This review demonstrates that current POCUS structured training uses one or a combination of didactics, hands-on methods and multimedia platforms. Several innovative training methods have been published. However, the majority of studies are observational or experimental, which limits our conclusions to the best practice in training POCUS. High quality research in structured training methods of POCUS is needed to elucidate best practice.