Point-of-care ultrasound training is hampered by many factors, including availability of courses, time required to complete the course, and associated costs.
“There has been an explosion of interest in the use of spot ultrasound,” says Nilam J. Soni, MD, MS, SFHM, FACP. “It doesn’t take much to convince doctors that there’s a need for better technology at the bedside, and point-of-care ultrasound provides that. So the question is, we’ve established that this is a better way to deliver care, and the technology is available, but why isn’t everyone using it? »
For a study published in the Journal of Hospital MedicineDr. Soni, Jason P. Williams, MD, and colleagues aimed to determine the current use of point-of-care ultrasound (POCUS), as well as training needs and barriers related to the use of POCUS among heads of hospital medicine groups at Veterans Affairs medical centers.
“Only in this study, we wanted to characterize changes in POCUS use over time,” notes Dr. Williams. “We were able to do this by comparing the results of this study to a previous survey conducted by our group from 2015.”
‘Huge gap’ between current use of POCUS and desire for training
The study team reported a 90% response rate among the 117 hospital medicine groups surveyed and continued use of POCUS in 64% of the groups. Between 2015 and 2020, the use of procedural POCUS decreased by 19%, but the use of diagnostic POCUS increased by 8% for cardiac applications, 7% for pulmonary applications and 8% for abdominal applications.
“I was very impressed that 64% of hospital medicine groups said at least one person used POCUS,” says Dr. Soni. “However, the number of bands using POCUS has not increased substantially as we had expected.”
Of the barriers to using POCUS reported by hospital chief physicians, lack of training was the most common (89%), and only 34% of hospital medicine groups had access to such training. (Table). Access to ultrasound equipment was the least common barrier to use, at 57%, and the proportion of hospital medicine groups with one or more ultrasound devices increased from 29% to 71 % from 2015 to 2020.
According to Dr. Soni, “there is a huge gap” in the current use of POCUS versus the desire for training. He cited several reasons for the discrepancy, including the inability to use technology without training, the inability to access training, and, at least initially, the inability to access equipment.
“We have made progress from an equipment availability perspective between 2015 and 2020,” says Dr. Soni. “Only about 30% of hospital medicine groups had one or more ultrasound scanners in 2015, but that has risen to about 70% in 2020. It’s the lack of training that persists in 2020.”
Identify and remove barriers to training
The results show that “there needs to be an investment in training and infrastructure” for the use of POCUS to grow, Dr Williams notes.
“It’s not just training that physicians need access to,” says Dr. Soni. “It’s the training-related factors, including taking time off work to participate, finding an available class, and getting to class, that are challenging for clinicians’ families and partners. There is also the question of who pays for the training.
The implications “are based on specific needs within a health system,” he continues, including whether training is available, whether clinicians can access the training, and whether equipment is available for practice.
“There are many training models, and they vary a lot,” says Dr. Soni. “I haven’t seen much research on the best or most effective training model for learners to achieve the skills for POCUS independently. What is the ideal course length? How many exams a clinician need to perform before being considered competent? We currently don’t have a lot of evidence on educational outcomes in terms of how to achieve competence effectively.”
Finally, the researchers agree that it will likely take 10 to 20 years before all clinicians who want to use POCUS are fully trained in the technology.
“Some specialty training programs, whether residencies or fellowships, require training in ultrasound, including critical care, emergency medicine, and endocrinology, but general practice programs – family medicine , internal medicine, pediatrics – currently do not,” says Dr. Soni. . “Once it becomes a requirement, it will allow us to get the resources to put the training infrastructure in place for everyone.”
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