Establishing, Measuring, and Achieving a Minimum Proficiency Standard with Point-of-Care Ultrasound Among Clinicians in an Air Medical Transport Program

Abstract

Objectives

One of the challenges in the implementation of point-of-care ultrasound in air medical transport is establishing a minimum proficiency standard and subsequently ensuring that all clinicians meet this standard. It is also challenging to objectively measure the effectiveness of hands-on ultrasound training. The aim of this study was to evaluate the level of proficiency among all clinicians in the program, measure the effectiveness of hands-on training, and to assess the feasibility of establishing and enforcing a minimum proficiency standard for all clinicians.

Methods

116 flight clinicians, all previously trained in point-of-care ultrasound, participated in a training session in which they were tasked with acquiring six diagnostic ultrasound views on live models. At the beginning of the session, their performance was evaluated by a trained observer and scored. Each view was given a score of 3 points if obtained proficiently with no guidance (minimum proficiency standard), 2 points if obtained with only slight prompting, and 1 point if obtained with significant guidance from the observer. The clinicians then participated in a guided training session and those who did not previously receive a perfect score of all threes, were reevaluated and scored again. Each clinician also completed a survey before and after the session in which they rated their confidence with their ability to obtain each view.

Results

The average score during the initial evaluation was 2.66 with 32 of the 116 clinicians (28%) obtaining a perfect score. The average score for those who were reevaluated at the conclusion of the training was 2.91 with 55 additional clinicians obtaining a perfect score. In the initial evaluation, 14 clinicians required significant guidance with one or more views. In the reevaluation this number fell to one. At the conclusion of the training, 75% of the clinicians were able to obtain all six diagnostic views with the desired minimum proficiency. In the initial confidence survey, when averaged across the six views, 1% of clinicians rated their confidence level as not at all, 5% as slightly, 20% as somewhat, 45% as fairly, and 28 % as completely. In the follow-up survey the results were 0% not at all, 0% slightly, 4% somewhat, 25% fairly, and 71% completely.

Conclusions

The baseline proficiency level in obtaining the diagnostic ultrasound views approved by our program was less than desirable. However, given the fact that a single training session resulted in the increase in number of clinicians who met the minimum standard from 28% to 75%, it is feasible to achieve a 100% compliance with this standard with additional training. Future research will focus on the amount and frequency of use and training required to maintain this proficiency once achieved. Another component of minimum proficiency not discussed here is the accuracy of interpretation of the diagnostic views, measured by a recurrent exam and quality assurance review process.