2066741 Surgical Critical Care and Ultrasound Training: Changing the Paradigm

Abstract

The ideal method to train physicians in point of care ultrasound (POCUS) remains unclear. In surgical critical care, there is no standard. The training for Fellows at the Shock Trauma center (STC) includes a one month rotation in the Critical Care Ultrasound Program (CCUP), with an emphasis on US for trauma and hemodynamic echocardiography. Noting gaps in our training, we have modernized our training pathway and aim to validate it against historical means. Outgoing Critical Care Fellows from the 2013-2014 year group were tested in the areas of US knowledge, image interpretation, acquisition and technical skills. FAST, lung, cardiac, vascular, and US physics were tested. Confidence was also evaluated. Incoming fellows completed an identical testing algorithm prior to the academic year and again after taking ‘The Leading Edge,’ a one day ultrasound introduction course. Fellows have continued assessments quarterly as the new algorithm is validated. Eleven outgoing and 30 incoming fellows (Surgical and Medical) comprised the study group (n=41). 59% were surgeons. Pre-identified training gaps included image interpretation, advanced cardiac imaging, and lung ultrasound. Knowledge and skills scores were significantly less in both incoming fellows groups than the OF group. Image interpretation was not different amongst the groups. After a one day course, incoming fellows skills significantly increased from initial testing (p=0.007, 0.0001 respectively), and approached skills of the OF group. Notably, after the one day course there continued to be a significant difference in the post scores between the ISF and IMF (p=0.0029). Knowledge gaps in our current curriculum prompted a change in training, which remains to be validated. Preliminary results reveal that the one day and one month courses led to equivalent skills and knowledge for Critical Care fellows. A significant difference existed amongst those from a medical background regarding the FAST exams. The prior training led to improved confidence and self-reported competence in all other categories amongst OF group. Long term retention of knowledge and skills remains to be seen, and we have ongoing data collection directed at answering this question.