The Hartnett Model: An effective low-resource training program that facilitates formal point-of-care ultrasound credentialing of emergency medicine trainees

Abstract

Introduction Training in point-of-care ultrasound (POCUS) is embedded within the curriculum framework of the Australasian College for Emergency Medicine (ACEM). However, formal credentialing in POCUS is often problematic due to lack of supervision and feedback. Within a supportive learning environment, it is expected that trainees would be more likely to satisfy the requirements of formal credentialing, such as the Australasian Society for Ultrasound in Medicine's Certificate in Clinician Performed Ultrasound (CCPU). Methods The Fiona Stanley Hospital (FSH) emergency department's Hartnett Model training program was devised to address traditional deficiencies in supervision and feedback during POCUS credentialing. The primary aim of this novel program is to assist ACEM trainees to acquire CCPU modules. Six emergency medicine registrars are selected for each six-month semester of the program through a formal selection process. Successful applicants nominate two CCPU modules for completion during the term and receive dedicated non-clinical time. For three hours once a week, an emergency physician holding formal POCUS credentials supervises a pair of trainees while they perform bedside scans on patients within the FSH emergency department. During these sessions, there are also opportunities for trainees' logbook scans to be reviewed. Formative and summative assessments occur as required by the CCPU module. Results The Hartnett Model has proven to be a successful method of assisting emergency medicine trainees in obtaining CCPU credentials. Over an 18-month period starting in 2017, eighteen registrars and four instructors were involved. All participants selected the E-FAST module; 13 chose Abdominal Aortic Aneurysm and 5 Basic Echo in Life Support. During their six-months in the training program, most trainees satisfied the requirements of both CCPU modules that they enrolled in (28/36 modules completed). Overall, the average number of scans in each module exceeded the requirements for the CCPU logbook. Approximately 40% of the scans were obtained by participants during the supervised sessions. Following their involvement in the program, trainees' perceived that undergoing POCUS training had significantly benefited their ability to manage patients. There was overwhelming support for the structure of the program. Conclusions The FSH emergency department's Hartnett Model is effective in assisting emergency medicine trainees to gain formal POCUS credentials. As it requires relatively little organisation, time and staffing, it could be adopted in many emergency departments around Australia.