Development of a multisystem point of care ultrasound skills assessment checklist.

BACKGROUND: Many institutions are training clinicians in point-of-care ultrasound (POCUS), but few POCUS skills checklists have been developed and validated. We developed a consensus-based multispecialty POCUS skills checklist with anchoring references for basic cardiac, lung, abdominal, and vascular ultrasound, and peripheral intravenous line (PIV) insertion. METHODS: A POCUS expert panel of 14 physicians specializing in emergency, critical care, and internal/hospital medicine participated in a modified-Delphi approach to develop a basic POCUS skills checklist by group consensus. Three rounds of voting were conducted, and consensus was defined by ≥ 80% agreement. Items achieving < 80% consensus were discussed and considered for up to two additional rounds of voting. RESULTS: Thirteen POCUS experts (93%) completed all three rounds of voting. Cardiac, lung, abdominal, and vascular ultrasound checklists included probe location and control, basic machine setup, image quality and optimization, and identification of anatomical structures. PIV insertion included additional items for needle tip tracking. During the first round of voting, 136 (82%) items achieved consensus, and after revision and revoting, an additional 21 items achieved consensus. A total of 153 (92%) items were included in the final checklist. CONCLUSIONS: We have developed a consensus-based, multispecialty POCUS checklist to evaluate skills in image acquisition and anatomy identification for basic cardiac, lung, abdominal, and vascular ultrasound, and PIV insertion.

Teaching vs learning: Impact of deliberate practice and formative feedback on developing point of care ultrasound skills.

PURPOSE: The study investigators hypothesized that Point of Care Ultrasound (POCUS) training through bolus didactic and workshop experiences may be sufficient for trainees to learn the cognitive aspects, while an extended period of exposure with formative feedback is responsible for developing the psychomotor skills critical for POCUS. METHODS: The investigators studied trainees over the course of an academic year. They compared trainees' performance on written (cognitive) and observed image acquisition (psychomotor) exams at baseline and at each subsequent quarter, using a stepped-wedge design. They performed linear regression analysis to determine which variables contributed to knowledge and psychomotor skill development. RESULTS: Twenty-six trainees met the study requirements and participated in the POCUS curriculum. Participating in a POCUS rotation was consistently associated with an increase in psychomotor scores. There was no consistent variable to predict an increase in trainee's score on written knowledge assessments. CONCLUSIONS: Extended exposure to POCUS over a 4-week rotation with direct and indirect formative feedback can explain difference in scores on psychomotor skills assessments. Trainees scored similarly on the written assessment with or without a POCUS rotation. Training through didactic and workshop experiences may be sufficient to learn the cognitive aspects, but not psychomotor skills required for POCUS.

What's in a Name? Factors Associated with Documentation and Evaluation of Incidental Pulmonary Nodules.

RATIONALE: Radiologist reports of pulmonary nodules discovered incidentally on computed tomographic (CT) images of the chest may influence subsequent evaluation and management. OBJECTIVES: We sought to determine the impact of the terminology used by radiologists to report incidental pulmonary nodules on subsequent documentation and evaluation of the nodules by the ordering or primary care provider. METHODS: We conducted a retrospective cohort study of patients with incidentally discovered pulmonary nodules detected on CT chest examinations performed during 2010 in a large urban safety net medical system located in northeastern Ohio. MEASUREMENTS AND MAIN RESULTS: Twelve different terms were used to describe 344 incidental pulmonary nodules. Most nodules (181 [53%]) were documented in a subsequent progress note by the provider, and 140 (41%) triggered subsequent clinical activity. In a multivariable analysis, incidental pulmonary nodules described in radiology reports using the terms density (odds ratio [OR], 0.06; 95% confidence interval [CI], 0.01-0.47), granuloma (OR, 0.07; 95% CI, 0.01-0.65), or opacity (OR, 0.09; 95% CI, 0.01-0.68) were less likely to be documented by the provider than those that used the term mass. Patients with nodules described in radiology reports using the term nodule (OR, 0.15; 95% CI, 0.02-0.99), nodular density (OR, 0.09; 95% CI, 0.01-0.63), granuloma (OR, 0.06; 95% CI, 0.01-0.69), or opacity (OR, 0.05; 95% CI, 0.01-0.43) were less likely to receive follow-up than were patients with nodules described using the term mass. The factor most strongly associated with follow-up of pulmonary nodules was documentation by the provider (OR, 5.85; 95% CI, 2.93-11.7). CONCLUSIONS: Within one multifacility urban health system in the United States, the terms used by radiologists to describe incidental pulmonary nodules were associated with documentation of the nodule by the ordering physician and subsequent follow-up. Standard terminology should be used to describe pulmonary nodules to improve patient outcomes.