Implementation and Results of a Critical Care Ultrasound Program for Fellows Using Cloud-Based Image Review Software

Abstract

PURPOSE: Training in General Critical Care Ultrasound (GCCUS) skills is increasingly provided during Pulmonary/Critical Care (PCCM) fellowship despite reports of multiple teaching barriers. Studies demonstrate competence in aspects of GCCUS shortly after focused training interventions, but no intra or post-fellowship skill assessments have been done. We describe the implementation of an ultrasound program (USP) to facilitate the teaching and assessment of GCCUS skills during fellowship. METHODS: A multi-component USP for first year fellows was devised as follows: 1) Required attendance at a 3-day intensive, hands-on course at start of fellowship; 2) Mandated saving of protocolized image sets with immediate interpretation using a structured GCCUS report form; 3) Use of software to allow wireless uploading of studies to a centralized database (Qpath™, Telexy Healthcare); 4) Daily over-reading and feedback on uploaded studies by an attending trained in GCCUS; and 5) Monthly conferences to review problem areas, illustrative cases, and deliver focused lectures. Fellow interpretations of Basic Critical Care Echocardiography (BCE) and Lung Ultrasound (LUS) exams were compared to the attending interpretation using kappa analysis. RESULTS: 4 first year fellows participated in the USP. From training month 4 through 8, 53 BCE studies were over-read. 88% of fellow interpreted left ventricular function (kappa.69, p