Emergency medicine society of South Africa guidelines for the training and credentialing in emergency point-of-care ultrasound

Abstract

Background: The Emergency Medicine Society of South Africa (EMSSA) has provided training and credentialing in emergency point-of-care ultrasound (ePoCUS) since 2008. Since the use of ePoCUS has changed in the last decade and educational methods have evolved, it has become necessary to update and modify our guidelines, which are reported here. This document contains the full and detailed updated guidelines in five parts: Part 1: EMSSA emergency point-of-care ultrasound training. Part 2: Credentialing in emergency point-of-care ultrasound. Part 3: Curriculum for core emergency point-of-care ultrasound training. Part 4: Curriculum for advanced emergency point-of-care ultrasound training. Part 5: Quality management in emergency point-of-care ultrasound. The executive summary will highlight the important changes from the previous guidelines. The rationale for these changes will be expounded in the individual sections of the document. The main difference between this ePoCUS guideline and other international policies is that there is a greater focus on credentialing in the South African (SA) guidelines while international guidelines focus more on the details of ePoCUS training. As patient safety is paramount, we believe that competency is crucial, and the outcomes of specific training focuses can be variable. We acknowledge the lack of good-quality evidence regarding specific training pathways or mechanisms that are required to produce a competent ePoCUS user. While we have made recommendations based on the best available evidence, this evidence does not take individual users' differences into account. Since competency is the endpoint, we have focused on a process that will ensure that we evaluate candidates comprehensively to establish this competency. It is necessary to concede that there is limited evidence to show that any competency examination accurately predicts safe and effective ePoCUS users in real-world circumstances. Nonetheless, we feel that this is the best interpretation of the current evidence and the most effective system currently available. Three key concepts were considered in the formulation of these guidelines: 1. What types of ePoCUS scans are needed by clinicians practising in the Emergency Department (ED) based on the types of emergency patient presentations that are most prevalent and/or have the greatest threat to life? 2. What types of scans are needed in the training process from an educational perspective to allow for the development of appropriate ultrasound skills? 3. What is the most appropriate evidence-based method of credentialing users?