Point-of-Care Ultrasound

Point-of-care ultrasound (PoCUS) is defined as “a diagnostic or procedural guidance ultrasound that is performed by a clinician during a patient encounter to help guide the evaluation and management of the patient” (1). PoCUS is not intended to replace comprehensive ultrasound imaging but is rather a focused, beside tool that facilitates clinician efficiency, independence, and confidence in medical decision making. Other benefits of PoCUS include portability, rechargeability, ease of use, a reduction in personnel required to use it, and the avoidance of patient exposure to ionizing radiation.

The use of portable ultrasound has risen in emergency departments all over the world and PoCUS is now incorporated into most emergency medicine residency programs in North America as a required competency.  There has been significant interest in employing this technology in low-and middle-income countries (LMIC). However, a major drawback to the successful broad implementation of PoCUS in LMIC is the lack of training in the majority of resource constrained settings. In fact, there is often little to no formal training for practicing physicians. Despite this fact, it has been shown that even short-training courses may lead to significant knowledge retention and an improvement in practical skills, even when prior ultrasound experience was minimal (2-5). With the recognition of the high value of PoCUS use within emergency medicine and the attainability of these skills, it is important that knowledge translation supports skill acquisition of emergency department physicians internationally within resource and training limited environments.

 

Providing PoCUS Training Opportunities

In Tanzania, there are portable ultrasound machines in some tertiary hospitals but there is a lack of training in how to use them. A recently completed needs assessment in 2017 identified a strong desire for PoCUS training by emergency physicians at Kilimanjaro Christian Medical Centre (KCMC), a hospital located in Moshi, Tanzania (6). A neighbouring community hospital also showed great interest in joining in and receiving PoCUS training and thus TPC Hospital will be another partnership for education and support. In order to help meet the needs of continued medical education, the goal of PoCUS Global is to provide education and hands-on, skills-based training in PoCUS for emergency physicians. This includes facilitating skills in image generation, interpretation, and use of ultrasound for procedural guidance. The vision of PoCUS Global is to achieve sustainability so that ultrasound skills and machines are maintained after the short-term training sessions provided by PoCUS Global have ended. To achieve this, online educational tools will be provided to encourage and motivate learners in preparation for in-person training sessions provided by the team within the environment of the learners daily practice. Skill acquisition will be taught in short daily sessions that focus on specific skills in digestible segments, followed by reinforcement of these skills with bedside, on-shift support by the team. Our team will be available for an entire week within the department to help support the team with real-world use of their newly acquired ultrasound skills within their actual working environment, thereby fostering sustainability. Following our time spent in person we will maintain ongoing communication and remote support for PoCUS through a variety of technology interfaces and have both regular and informal conferencing for ongoing education.

 

References

  1. Atkinson P, Bowra J, Jarman B, et al. International Federation for Emergency Medicine: Point-of-Care Ultrasound Guidelines. 2014: https://www.ifem.cc/Resources/PoliciesandGuidelines.aspx
  2. Shah S, Nbole VE, Umulisa I et al. Development of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda. Int J Emerg Med 2008: 1: 193-196
  3. Shah SP, Epino H, Bukhman G et al. Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights 2009: 9: 4
  4. Adler D, Mgalula K, Price D, Tyalor O. Introduction of a portable ultrasound unit into the health services of the Lugufu refugee camp, Kigoma District, Tanzania. Int J Emerg Med 2008: 1: 261-266
  5. Shmueli H, Burstein Y, Sagy I et al. Briefly trained medical students can effectively identify rheumatic mitral valve injury using a hand-carried ultrasound. Echocardiography 2013: 30: 621-626
  6. Cundall A, Tatham B. KCMC Needs Assessment 2017. In Progress