TOWARDS UNIVERSAL BASIC FLUENCY: A PILOT CURRICULUM IN CRITICAL CARE ULTRASOUND

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Critical care ultrasound (CCUS) continues to revolutionize how critically ill patients are cared for. CCUS refers to focused ultrasound performed by a treating practitioner to help detect and/or monitor life-threatening illnesses and to improve the safety of life-saving procedures. Although most critical care medicine (CCM) practitioners should have, at least, basic fluency in CCUS, academic institutions may find themselves ill-equipped to deliver comprehensive CCUS education to CCM trainees and practitioners. Challenges include a paucity of skilled faculty and lack of a standardized curriculum. In this study, we implement and evaluate a novel CCUS curriculum to resolve such concerns. METHODS: This is a pilot prospective study of implementation and evaluation of a longitudinal CCUS curriculum for CCM attendings, trainees, and nurse practitioners working across five medical-surgical intensive care units in Edmonton, Alberta (Canada). The curriculum was comprised of a custom online flipped-classroom learning environment, a one-day workshop, eight two-hour expert-led hands-on sessions, an image interpretation session, and longitudinal image/report-archiving with feedback. We used Kirkpatrick's Model of Evaluation to examine for pre/post-changes in perception (survey, Likert-scale 1-5), evidence of learning (30 question MCQ / psychomotor skill assessment), and behaviour change (survey). RESULTS: Fourteen CCM practitioners participated in the curriculum (7 attendings, 3 trainees, 4 nurse practitioners). The curriculum was halted at the end of the third month because of the COVID-19 pandemic. Participants reported increases in overall perceived performance and interpretation in CCUS (p=0.001) with a moderate effect size (Cohen's d=0.63). A comparison of mean exam scores (±SD) pre- and post-curriculum were 69% (± 15%) and 78% (± 11%) with a large effect size (p=0.007, d=0.86). Psychomotor skill assessment with a standardized entrustment scale demonstrated large effect sizes across all modalities (cardiac, lung, thoracic, abdominal, vascular) with effect sizes between 0.95 and 1.28. Thirteen of the fourteen participants reported an increase use of CCUS across all modalities. While participant feedback was overwhelmingly positive, some participants wanted a longer curriculum and others reported difficulty completing CCUS exam reports while caring for the critically ill. CONCLUSIONS: A longitudinal curriculum in CCUS delivered across five medical-surgical intensive care units resulted in increases in knowledge and skill with strong effect sizes. Feedback from participants emphasized the need to lengthen the curriculum, improve workflow for CCUS exam reporting, and further increase access to direct bedside mentorship. CLINICAL IMPLICATIONS: This curriculum provides a strong foundation for local CCUS education, a path to universal basic fluency, and a template with potential for national expansion. DISCLOSURES: No relevant relationships by Aws Alherbish, source=Web Response No relevant relationships by Brian Buchanan, source=Web Response No relevant relationships by Vijay Daniels, source=Web Response No relevant relationships by Jean Deschamps, source=Web Response no disclosure on file for Sean McAleer