As previously mentioned, establishing, and maintaining a comprehensive point-of-care ultrasound curriculum demands significant time commitment and dedication from faculty members. Contrary to common belief, teaching POCUS entails more than simply finding an ultrasound machine and scanning a few patients; it requires a structured approach that covers the three essential components of POCUS: image acquisition, interpretation, and clinical integration. It is important to reinforce these concepts systematically and periodically to learners. Merely performing scans without a solid theoretical foundation creates ‘pseudo’ POCUS experts. Learners must understand the rationale behind each scan, how to locate the organ of interest, optimize images, troubleshoot as needed, interpret findings methodically, and integrate them into the clinical context. Due to logistical constraints and potential patient inconvenience, addressing all these aspects at the bedside for a group of learners is challenging.
Simulation offers an effective alternative for teaching these skills. Firstly, it allows for a comprehensive exploration of sonographic anatomy, aiding practitioners in recognizing normal structures and their appearances on ultrasound. Secondly, simulation provides a platform for honing image interpretation skills by exposing learners to diverse pathological images, thus refining their diagnostic abilities. Lastly, simulation facilitates the application of clinical knowledge in ultrasound practice by simulating realistic scenarios in a safe learning environment, fostering critical thinking and decision-making skills. In this brief post, I will outline some simulation methods utilized at our institution. It is important to note that I am not endorsing any specific product or company, and I have no financial conflicts of interest.
3D printed models: We use 3D printed cardiac models to illustrate various cardiac views and their corresponding slicing planes. This method is highly valued by our learners as it elucidates the rationale behind probe manipulation on the patient’s body. I personally print these models in my office using files borrowed from Georgetown University. Alternatively, some academic radiology departments have their own 3D printing facilities, where customized files, including models featuring abnormalities, can be designed upon request.
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We also use an augmented reality simulator to demonstrate cardiac views effectively. This innovative device allows users to interact with a fully immersive and accurate three-dimensional heart via a touch screen interface, enabling them to label structures and slice in any desired plane.
Our hands-on practice involves the use of Sonosim, a laptop-based software supplemented with a large online library of patient cases and a hand motion-sensing probe. This setup allows learners to familiarize themselves with probe positioning techniques for optimal image acquisition. During training sessions, the laptop is connected to an external display, and a medical manikin serves as a body for teaching probe manipulation techniques. In our study utilizing these simulation techniques, findings revealed that 70% of medical students expressed a preference for choosing a nephrology elective if POCUS training were integrated into the curriculum.
At one of our fellowship training sites, a high-fidelity simulator (Heartworks and Bodyworks eve) is available, capable of displaying real-time normal and abnormal images synchronized with probe movements. This simulator also offers illustrative animations to depict sonographic anatomy. While this equipment is not owned by the nephrology division, we organize periodic sessions to utilize it for teaching advanced POCUS techniques, such as Doppler echocardiography, and simulating abdominal pathologies. Additionally, it features a transesophageal probe, which we use to instruct fellows on cardiac anatomy. Transesophageal echocardiography (TEE) for nephrology fellows! Sounds ambitious, doesn’t it? But it’s not as daunting as it seems. In fact, TEE is technically simpler than transthoracic echocardiography once you understand transducer maneuvering. Since TEE offers a unique view of the heart from the esophagus, it helps to master the cardiac sonographic anatomy (really master!). Moreover, given that a considerable number of nephrology fellows are interested in critical care, TEE could be particularly beneficial for this subgroup.
In addition, we utilize a clinic room not in use for patient consultations to house the ultrasound machine, creating a stress-free environment for practicing image acquisition on volunteers (residents, fellows, and students). By experiencing the pressure of placing the probe on different areas of the body themselves during practice sessions, learners will develop mindfulness when scanning real patients.
We also leverage the medical school simulation lab to access human models for practice sessions. This facility also facilitates objective structured clinical examinations (OSCEs) to evaluate trainees’ proficiency in machine handling, patient interaction, and adherence to image acquisition protocols. Supplementary appendixes within our curriculum article contain OSCE forms tailored for various NephPOCUS applications.
I get that not every place will have all this stuff, depending on where they’re located or if they’re tied to a big med school or a community hospital. But here’s the thing: not all of it costs an arm and a leg, and POCUS faculty should discuss with the division leadership about getting whatever fits their budget. At the end of the day, it’s all about improving competency of the trainees and making sure our patients get the best care possible. I believe that doctors who don’t perform POCUS are better than those who receive insufficient training and overestimate their abilities.
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