Poster1 - 06: A FORMAL CURRICULUM SIGNIFICANTLY IMPROVES CRITICAL CARE ULTRASOUND PERFORMANCE
Daniel J Haase, MD, RDMS, RDCS1, Margaret H Lauerman, MD1, Ashley R Menne, MD1, Syeda Fatima, RCS2, Cassandra Cardarelli, MD3, Renuka D Tripu, BS4, Stephanie L Kolb, BS4, Thomas M Scalea, MD1, Sarah B Murthi, MD1; 1R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 2R Adams Cowley Shock Trauma Center, 3Walter Reed National Military Medical Center, 4University of Maryland School of Medicine
Background: Critical care ultrasound (CCUS) use is common in surgical critical care (SCC). There is no required curriculum in general surgery residency or SCC fellowship.
Methods: All fellows in our SCC fellowship participate in a CCUS curriculum, which includes a one-day course, multiple didactic lectures, and a month-long rotation with a board-certified sonographer and CCUS faculty. CCUS skill was measured by CCUS faculty on human models before and after completion of the curriculum. Fellows also self-reported prior ultrasound experience and self-assessed intended future CCUS use. Specific CCUS exams included: focused assessment with sonography for trauma (FAST), lung ultrasound for pneumothorax detection (PTX), basic cardiac assessment (BCA) and advanced cardiac assessment (ACA), which included velocity-time integral (VTI), stroke volume and cardiac output (CO) measurements. Measurements were scored on a 5-point Likert scale, with greater than 3 considered competent or intended future use.
Results: Eighteen SCC fellows were included from 2013-2017. All fellows (17/17, 100%) planned to use FAST, PTX, and BCA in future practice and 16/17 (94.1%) ACA. Mean fellow CCUS skill improved after curriculum completion for FAST (3.78 ± 1.22 to 4.89 ± 0.47, p=0.004), PTX (2.78 ± 1.67 to 4.50 ± 1.10, p=0.002), BCA (1.86 ± 1.03 to 3.89 ± 1.14, p<0.001), and ACA (1.00 +/0.00 to 3.63 +/- 1.42, p=0.001). Percentages of competent fellows increased for FAST (44.4% to 94.4%), PTX (27.8% to 83.3%), BCA (5.6% to 67.7%) and ACA (0% to 67.7%). Post-curriculum competence with was not associated with increased prior CCUS experience (FAST [p=0.65], PTX [p=0.58], BCA [p=0.48], ACA [p=0.17]).
Discussion: Our formal CCUS curriculum significantly improved FAST, PTX, BCA and ACA performance, irrespective of previous CCUS exposure. SCC fellows intend to use CCUS in future practice, making a required CCUS curriculum essential.