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Abstract

Introduction: Use of goal-directed ultrasound (GDUS) improves outcomes in critically ill and injured children and adults; however, no widely available GDUS courses for pediatric providers exist. As a quality improvement project, we are developing and evaluating a GDUS course for pediatric trainees focusing on applications relevant to emergency and critical care medicine: ultrasound (US) physics, transthoracic echocardiography (TTE), lung, abdomen, and neck vessels. Methods: Thirteen pediatric interns have been split into three groups, taught on separate dates, ending with written and hands-on evaluation. The written exam focused on recognizing structures and common pathologies, while the hands-on evaluation assessed ability to obtain standard views in healthy human volunteers. Each course has been adjusted based on previous exam performance and feedback. Results: Two six-hour courses (four hours of lecture and two of hands-on training) have been taught. Lecture time consisted of: 29% US physics, 35% TTE, 14% lung, 11% abdomen, and 11% vessels. Approximately 50% of hands-on training was spent on TTE and 50% on all the other modalities. The instructor/machine/model-to-trainee ratio was 1:2. Written and hands-on exams consisted of: US physics (23% written, 0% hands-on), TTE (68%, 64–72%), lung (13%, 9–11%), abdomen (0%, 9–19%), and vessels (3%, 8–9%). Median scores for the written exam were 70% (max 76%, min 60% for course 1; max 78%, min 59% for course 2). Those for the hands-on exam were 83% (max 86%, min 76%) and 68% (max 79%, min 54%). Most students had no difficulty with US physics and artifacts and in obtaining most TTE and vascular views. Most students had difficulty visualizing the aortic valve in parasternal short axis view, abdominal aorta and IVC in subcostal view, and identifying cardiac pathologies. Trainees found helpful that hands-on practice immediately followed the corresponding lectures and indicated a preference for a two-day course. Conclusions: This is the first report of a GDUS curriculum for pediatric trainees in the USA. They can be taught many basic GDUS modalities successfully. A two-day course may be preferable if the goal is to attain proficiency in all the mentioned applications.