Patient Care in Emergency and Critical Care Medicine: An Interview with Dr. Robert Arntfield

Dr. Robert Arntfield is a critical care intensivist and traumatologist at London Health Sciences Center where he also acts as the medical director of the Critical Care Trauma Unit. Originally interested in emergency medicine, he then carved his pathway to enter the realm of critical care. Dr. Arntfield is a world-renowned expert in critical care ultrasonography and lectures globally on the topic. He is currently working in collaboration with multiple artificial intelligence and technology companies to advance the applications of Point-of-Care Ultrasound (POCUS). We had the opportunity to talk to Dr. Arntfield about the field of critical care medicine at LHSC, in Canadian healthcare, and the significance of the POCUS within the field.

A Regional, Cost-Effective, Collaborative Model for Critical Care Fellows’ Ultrasonography Education

Objective: Training in critical care ultrasonography is an essential tool in critical care medicine and recommended for fellowship programs in pulmonary and critical care medicine. Major barriers to implementing competency-based training in individual fellowship programs include a lack of expert faculty, time, and funding. Our objective was to investigate whether regional collaboration to deliver an introductory critical care ultrasonography course for fellows might overcome these barriers while achieving international training standards. Methods: This was a retrospective review of course evaluation and learner assessment data from a 3-day ultrasonography course between 2012 and 2017. All critical care fellows (n = 545) attending the course completed pre- and postcourse surveys and postcourse knowledge and technical skills tests. Evaluation of educational outcomes was performed based on the Kirkpatrick model. Results: Fellows reported minimal prior formal training in ultrasonography, and ultrasound-guided vascular access was the most common area of prior training. The course was a blended model of didactic lectures coordinated with real-time demonstration scanning using live models, hands-on training on human models and task trainers, and interpretation of ultrasonography images with a wide range of pathology. Course content included basic echocardiography and general critical care ultrasonography (lung, pleural, vascular diagnostic, vascular access, and abdominal ultrasonography). At the conclusion of the course, fellows demonstrated high levels of knowledge and skill competence on a previously validated assessment tool and significantly improved confidence in all content areas. Barriers to training at individual programs were overcome through faculty cooperation, faculty development, and cost sharing. Success of this model is supported by the sustained growth of this course. Conclusions: A regional collaborative model for training fellows in ultrasonography is a feasible, efficient, and flexible model for delivering curricula, where expertise at individual programs is not routinely available.