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Quality Assurance and Improvement in Ultrasound Education

University of Minnesota
Minneapolis, MN

Program Director: Melissa King-Biggs MD
Type of Program: Pulmonary and Critical Care Medicine
Abstract Authors: Andrew Keenan, Petr Bachan and Melissa King-Biggs MD

As use of ultrasound (US) in critical care medicine (CCM) has expanded, there has been increased integration of US training into CCM programs. The Society of Critical Care Medicine (SCCM) and the American College of Chest Physicians (ACCP) provide guidelines regarding critical care ultrasound (CCUS) training, including recommendations for quality assurance and quality improvement (QA/QI) processes. Implementation of these processes can be complex given technical requirements, variable faculty level of ultrasound training, and the use of multiple training sites.

Our Pulmonary and Critical Care program is expanding our US curriculum into a longitudinal model that utilizes didactics, hands-on training, case reviews, and exam documentation. As part of a needs assessment, we found that a strong QA/ QI component for assessing image acquisition and interpretation would provide accountability and better document fellow skill level. Challenges we faced in developing this process included multiple training sites, and a high ratio of fellows to trained faculty. In our process, after a fellow performs an ultrasound examination, a de-identified exam is saved to a portable drive. Using non-traceable identifiers, the exam is logged into our education management suite (New Innovations, Inc.), and the video loops are uploaded to our academic center’s secure file sharing site (Google Drive). Experienced critical care faculty will review each US exam. The reviewing faculty can assess exam acquisition as well as interpretation, and provide direct feedback to the performing fellow. Requirements for the number and type of exams have been developed from society recommendations, and fellows will graduate with a log of these reviewed exams.

As part of our curriculum we will review US exam numbers, and adequacy of acquisition and interpretation based on fellow level. We have performed baseline assessments of US background knowledge, interpretation, and perceived skill level. These will be followed up by summative assessments at the end of the academic year, in addition to fellow evaluations of the new curriculum.

This QA/QI process provides accountability and documentation for our trainees as they transition out of fellowship. By utilizing resources commonly available to fellowship programs it limits the costs associated with dedicated US review and storage products, and works across multiple health systems. Additionally, by allowing remote exam review it leverages the skills of US trained faculty to provide more effective feedback. Our QA/QI process may serve as a model for other fellowship programs that are expanding their US curricula.

Last Reviewed: December 2016