scholarly journals Tricuspid Regurgitant Jet Velocity Point-of-Care Ultrasound Curriculum Development and Validation

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 88-92
Author(s):  
Zachary W. Binder ◽  
Sharon E. O'Brien ◽  
Tehnaz P. Boyle ◽  
Howard J. Cabral ◽  
Joseph R. Pare
Keyword(s):  
Educational Intervention ◽  
Point Of Care ◽  
Exam Performance ◽  
Point Of Care Ultrasound ◽  
Post Intervention ◽  
Modified Delphi ◽  
Student Volunteers ◽  
Didactic Lecture ◽  
Multiple Choice Exam ◽  
Development And Validation

Introduction: The American College of Emergency Physicians (ACEP) recommends that Emergency Medicine physicians with advanced training can evaluate right ventricular (RV) pressures via point-of-care ultrasound (POCUS) by measuring a tricuspid regurgitant jet (TRJ).   We were unable to find a published curriculum to deliver education for this at any skill level.  Therefore, we developed, delivered, and evaluated a curriculum for the assessment of TRJ for novice physician sonographers. Methods: We designed an educational intervention for novice physician sonographers.  The curriculum was created using a modified Delphi methodology.  All novice sonographers participated in the educational intervention which consisted of a didactic lecture followed by hands-on-deliberate practice on healthy medical student volunteers with expert feedback in a simulated setting.  Sonographer’s knowledge was assessed at 3 time points: pre-intervention, immediately post-intervention, and 3 months post-intervention (retention assessment) by multiple choice exam. Results: Nine novice physician sonographers participated in the intervention.  Mean exam performance increased from 55.6% [standard deviation (SD) 11.3%] on the pre-intervention exam to 94.4% (SD 7.3%) on the post-intervention exam and 92.9% (SD 12.5%) on the retention exam.  The mean improvement between the pre- and post- exam was +38.9% (95% CI 31.8 - 46.0), and between the pre-exam and retention exam +37.1% (95% CI 22.3 - 52.0). Conclusion: Sonographer knowledge of TRJ assessment improved following a brief educational intervention as measured by exam performance.  Given the expanding role of POCUS it is increasingly important to provide effective resources for teaching these skills.  This work establishes the basis for further study and implementation of our TRJ curriculum.

scholarly journals Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Arif Hussain ◽  
Gabriele Via ◽  
Lawrence Melniker ◽  
Alberto Goffi ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Expert Panel ◽  
Point Of Care ◽  
Expert Consensus ◽  
Future Research ◽  
Point Of Care Ultrasound ◽  
The Past ◽  
Modified Delphi ◽  
Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

scholarly journals LO042: Sonography in Hypotension and Cardiac Arrest (SHoC) - Hypotension: derivation of an evidence-based consensus algorithm for the integration of point of care ultrasound into resuscitation of hypotensive patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S44-S44 ◽  
Author(s):  
P. Atkinson ◽  
J. Bowra ◽  
J. Milne ◽  
M. Lambert ◽  
B. Jarman ◽  
...  
Keyword(s):  
Point Of Care ◽  
Disease Incidence ◽  
Left Ventricular ◽  
Consensus Algorithm ◽  
Professional Organizations ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi ◽  
Delphi Approach

Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.

scholarly journals LO85: Development of a competency based assessment tool for emergency department point of care ultrasound

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S38-S39
Author(s):  
C. McKaigney ◽  
C. Bell ◽  
A. Hall
Keyword(s):  
Delphi Method ◽  
Assessment Tool ◽  
Point Of Care ◽  
Image Acquisition ◽  
Clinical Indication ◽  
Point Of Care Ultrasound ◽  
Clinical Integration ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Image Optimization

Innovation Concept: Assessment of residents' Point of Care Ultrasound (PoCUS) competency currently relies on heterogenous and unvalidated methods, such as the completion of a number of proctored studies. Although number of performed studies may be associated with ability, it is not necessarily a surrogate for competence. Our goal was to create a single Ultrasound Competency Assessment Tool (UCAT) using domain-anchored entrustment scoring. Methods: The UCAT was developed as an anchored global assessment score, building on a previously validated simulation-based assessment tool. It was designed to measure performance across the domains of Preparation, Image Acquisition, Image Optimization, and Clinical Integration, in addition to providing a final entrustment score (i.e., OSCORE). A modified Delphi method was used to establish national expert consensus on anchors for each domain. Three surveys were distributed to the CAEP Ultrasound Committee between July-November 2018. The first survey asked members to appraise and modify a list of anchor options created by the authors. Next, collated responses from the first survey were redistributed for a re-appraisal. Finally, anchors obtaining >65% approval from the second survey were condensed and redistributed for final consensus. Curriculum, Tool or Material: Twenty-two, 26, and 22 members responded to the surveys, respectively. Each anchor achieved >90% final agreement. The final anchors for the domains were: Preparation – positioning, initial settings, ensures clean transducer, probe selection, appropriate clinical indication; Image Acquisition – appropriate measurements, hand position, identifies landmarks, visualization of target, efficiency of probe motion, troubleshoots technical limitations; Image Optimization – centers area of interest, overall image quality, troubleshoots patient obstacles, optimizes settings; Clinical Integration – appropriate interpretation, understands limitations, utilizes information appropriately, performs multiple scans if needed, communicates findings, considers false positive and negative causes of findings. Conclusion: The UCAT is a novel assessment tool that has the potential to play a central role in the training and evaluation of residents. Our use of a modified Delphi method, involving key stakeholders in PoCUS education, ensures that the UCAT has a high degree of process and content validity. An important next step in determining its construct validity is to evaluate the use of the UCAT in a multi-centered examination setting.

Use of Critical Items in Determining Point-of-Care Ultrasound Competence

2020 ◽  
pp. 016327872097583
Author(s):  
Janeve Desy ◽  
Vicki E. Noble ◽  
Michael Y. Woo ◽  
Michael Walsh ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Interrater Reliability ◽  
Delphi Technique ◽  
Point Of Care ◽  
Critical Item ◽  
Intraclass Correlation ◽  
Point Of Care Ultrasound ◽  
Cut Scores ◽  
Modified Delphi ◽  
Global Ratings ◽  
Modified Delphi Technique

We previously developed a workplace-based tool for assessing point of care ultrasound (POCUS) skills and used a modified Delphi technique to identify critical items (those that learners must successfully complete to be considered competent). We performed a standard setting procedure to determine cut scores for the full tool and a focused critical item tool. This study compared ratings by 24 experts on the two checklists versus a global entrustability rating. All experts assessed three videos showing an actor performing a POCUS exam on a patient. The performances were designed to show a range of competences and one included potentially critical errors. Interrater reliability for the critical item tool was higher than for the full tool (intraclass correlation coefficient = 0.84 [95% confidence interval [CI] 0.42–0.99] vs. 0.78 [95% CI 0.25–0.99]). Agreement with global ratings of competence was higher for the critical item tool (κ = 0.71 [95% CI 0.55–0.88] vs 0.48 [95% CI 0.30–0.67]). Although sensitivity was higher for the full tool (85.4% [95% CI 72.2–93.9%] vs. 81.3% [95% CI 67.5–91.1%]), specificity was higher for the critical item tool (70.8% [95% CI 48.9–87.4%] vs. 29.2% [95% CI 12.6–51.1%]). We recommend the use of critical item checklists for the assessment of POCUS competence.

Development Of A Novel Pediatric Point‐of‐care Ultrasound Question Bank Using A Modified Delphi Process

2021 ◽  
Author(s):  
Kiyetta H. Alade ◽  
Jennifer R. Marin ◽  
Erika Constantine ◽  
Atim Ekpenyong ◽  
Susan E. Farrell ◽  
...  
Keyword(s):  
Point Of Care ◽  
Delphi Process ◽  
Point Of Care Ultrasound ◽  
Modified Delphi

scholarly journals Development and Validation of an Assessment Tool for Competency in Critical Care Ultrasound

2015 ◽  
Vol 7 (4) ◽  
pp. 567-573 ◽  
Author(s):  
Paru Patrawalla ◽  
Lewis Ari Eisen ◽  
Ariel Shiloh ◽  
Brijen J. Shah ◽  
Oleksandr Savenkov ◽  
...  
Keyword(s):  
Critical Care ◽  
Delphi Method ◽  
Assessment Tool ◽  
Point Of Care ◽  
Critical Care Medicine ◽  
Competency Assessment ◽  
Point Of Care Ultrasound ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Critical Care Ultrasound

ABSTRACT Background Point-of-care ultrasound is an emerging technology in critical care medicine. Despite requirements for critical care medicine fellowship programs to demonstrate knowledge and competency in point-of-care ultrasound, tools to guide competency-based training are lacking. Objective We describe the development and validity arguments of a competency assessment tool for critical care ultrasound. Methods A modified Delphi method was used to develop behaviorally anchored checklists for 2 ultrasound applications: “Perform deep venous thrombosis study (DVT)” and “Qualify left ventricular function using parasternal long axis and parasternal short axis views (Echo).” One live rater and 1 video rater evaluated performance of 28 fellows. A second video rater evaluated a subset of 10 fellows. Validity evidence for content, response process, and internal consistency was assessed. Results An expert panel finalized checklists after 2 rounds of a modified Delphi method. The DVT checklist consisted of 13 items, including 1.00 global rating step (GRS). The Echo checklist consisted of 14 items, and included 1.00 GRS for each of 2 views. Interrater reliability evaluated with a Cohen kappa between the live and video rater was 1.00 for the DVT GRS, 0.44 for the PSLA GRS, and 0.58 for the PSSA GRS. Cronbach α was 0.85 for DVT and 0.92 for Echo. Conclusions The findings offer preliminary evidence for the validity of competency assessment tools for 2 applications of critical care ultrasound and data on live versus video raters.

scholarly journals Development of Core Contents of Point-of-Care Ultrasound Curriculum for Pediatric Emergency Medicine Physician Training: A Modified Delphi Survey

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 757
Author(s):  
Jae-Hyun Kwon ◽  
Jin-Hee Lee ◽  
Young-Rock Ha ◽  
June-Dong Park ◽  
Keyword(s):  
Emergency Medicine ◽  
Point Of Care ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Modified Delphi ◽  
Experience Teaching ◽  
Emergency Medicine Physician ◽  
Medicine Physician ◽  
Point Of Care Ultrasonography

Background: As the frequency of ultrasound use in pediatric emergency departments increases, it is necessary to train pediatric emergency medicine (PEM) physicians on pediatric point-of-care ultrasonography (POCUS). We discussed the core content of POCUS applications and proposed a POCUS training curriculum for PEM physicians in South Korea. Methods: Twenty-three experts were included if had performed over 1500 POCUS scans, had at least three years of experience teaching POCUS to physicians, were POCUS instructors or had completed a certified pediatric POCUS program. Experts rated 61 possible POCUS applications in terms of the importance of their inclusion in a PEM POCUS curriculum using the modified Delphi technique. Results: In round one, twelve (52.2%) out of 23 experts responded to the email. Eleven experts satisfied the inclusion criteria. Eleven experts participated in round one of a survey and agreed on 27 (44.3%) out of a total of 61 items. In round two, all 11 experts participated in the survey; they agreed on two (5.9%) of the remaining 34 items, and no items were excluded. Conclusion: Using the Delphi method, 61 applications were discussed, and a consensus was reached on 29 core applications.

Research: Emergency medicine residents’ acquisition of point-of-care ultrasound knowledge and their satisfaction with the flipped classroom andragogy

POCUS Journal ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 2-5
Author(s):  
Khalid Bashir, MD ◽  
Aftab Azad, MD ◽  
Kaleelullah Saleem Farook, MD ◽  
Shahzad Anjum, MD ◽  
Sameer Pathan, MD ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Flipped Classroom ◽  
Teaching Method ◽  
Point Of Care ◽  
Teaching Model ◽  
Point Of Care Ultrasound ◽  
Post Intervention ◽  
Face To Face ◽  
Teaching Models ◽  
The Difference

Background: One of the traditional approaches for knowledge transfer in medical education is through face-to-face (F2F) teaching. We aimed to evaluate the acquisition of knowledge about point-of-care ultrasound (POCUS) and learner’s satisfaction with the flipped classroom (FC) teaching approach. Methods: This was a prospective, mixed-method, crossover study and included 29 emergency medicine (EM) residents in current training program. Over a period of three months, each resident was exposed to F2F and FC teaching models in a crossover manner. There was a multiple-choice questions (MCQ) test before and after each educational intervention (F2F & FC). Two months after each educational intervention a final MCQ test was administered to assess the retention of knowledge between the two approaches. After each educational approach feedback was sought from a selected group of residents concerning the acceptability of the two educational approaches through a semi structured interview. Results: A total of 29 EM residents participated in this study. The numbers of residents by year of post-graduation training were seven (24.14%) PGY-1, eight (27.59%) PGY-2, six (20.69%) PGY-3, and eight (27.59%) PGY-4. The baseline mean score was 15.82 using MCQs test mean scores. For the face-to-face teaching model, the difference between pre and post-intervention scores was 2.7 (95% CI 2.1 to 3.3, p=0.001); whereas, for the flipped classroom teaching model, the difference was 3.93 (95% CI 3.2 to 4.5, p= 0.001). At two months post-intervention, for face-to-face teaching model, the MCQ assessment showed an increase of 1.7 (95% CI 1.1 to 2.2, p= 0.001) mean scores when compared to the pre-intervention mean scores; whereas, for the flipped classroom model this difference was significantly higher, recorded as 4.48 (95% CI 3.7 to 5.1, p= 0.001). Finally, the difference between mean scores for F2F and FC teaching models was 2.75 (95% CI 1.87 to 3.64, p=0.001) at two months post-intervention.  Overall, the participants expressed a preference for the FC teaching methodology. Conclusion: Both F2F and FC teaching methods resulted in significant and sustained improvements in POCUS knowledge base. The FC teaching method accomplished higher test scores than the F2F teaching method both at the end of the teaching and after two months of completing the educational program.

scholarly journals International Federation for Emergency Medicine Consensus Statement: Sonography in hypotension and cardiac arrest (SHoC): An international consensus on the use of point of care ultrasound for undifferentiated hypotension and during cardiac arrest

CJEM ◽  
2016 ◽  
Vol 19 (06) ◽  
pp. 459-470 ◽  
Author(s):  
Paul Atkinson ◽  
Justin Bowra ◽  
James Milne ◽  
David Lewis ◽  
Mike Lambert ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Inferior Vena ◽  
Consensus Statement ◽  
Point Of Care ◽  
Disease Incidence ◽  
International Federation ◽  
Point Of Care Ultrasound ◽  
International Consensus ◽  
Modified Delphi

Abstract Introduction The International Federation for Emergency Medicine (IFEM) Ultrasound Special Interest Group (USIG) was tasked with development of a hierarchical consensus approach to the use of point of care ultrasound (PoCUS) in patients with hypotension and cardiac arrest. Methods The IFEM USIG invited 24 recognized international leaders in PoCUS from emergency medicine and critical care to form an expert panel to develop the sonography in hypotension and cardiac arrest (SHoC) protocol. The panel was provided with reported disease incidence, along with a list of recommended PoCUS views from previously published protocols and guidelines. Using a modified Delphi methodology the panel was tasked with integrating the disease incidence, their clinical experience and their knowledge of the medical literature to evaluate what role each view should play in the proposed SHoC protocol. Results Consensus on the SHoC protocols for hypotension and cardiac arrest was reached after three rounds of the modified Delphi process. The final SHoC protocol and operator checklist received over 80% consensus approval. The IFEM-approved final protocol, recommend Core, Supplementary, and Additional PoCUS views. SHoC-hypotension core views consist of cardiac, lung, and inferior vena vaca (IVC) views, with supplementary cardiac views, and additional views when clinically indicated. Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions, are recommended as core views for SHoC-cardiac arrest; supplementary views are lung and IVC, with additional views when clinically indicated. Both protocols recommend use of the “4 F” approach: fluid, form, function, filling. Conclusion An international consensus on sonography in hypotension and cardiac arrest is presented. Future prospective validation is required.

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