Giving back to babies, point of care ultrasound in paediatrics

The problem addressed was the deficiency in training the paediatric residents in point of care ultrasound (POCUS), which has led to underutilization of POCUS in the paediatric population who are amongst the most vulnerable to harmful ionising radiation from X-rays and CT scans performed as diagnostic modalities.

A multicentre national needs assessment of 12 US paediatric residency programmes identified lack of trained instructors to be the largest barrier to teaching (POCUS) in the paediatric residency programmes.

This highlights an area where improvement is needed to ensure that paediatric residents receive adequate education and hands on experience with POCUS techniques.

Paediatric residents, novice in ultrasound skills, asynchronously completed online modules and quizzes on select paediatric relevant applications, which included extended focused assessment with sonography in trauma, soft tissue, renal/bladder, cardiac and anatomical landmarks for lumbar puncture and vascular access. Using handheld devices with teleguidance capabilities, real-time tele-teaching sessions were then proctored by a remote POCUS-trained paediatric emergency medicine faculty member. Residents used a tablet connected to the ultrasound probe that was positioned on a tripod with anatomy of interest in view of the rear camera. This gave the instructor a view of ultrasound images, probe positioning and anatomical site in real-time.

The instructor provided feedback via audio visual communication and remote control of aspects of the ultrasound probe including gain, depth, mode and image annotation.

The barrier of lack of trained instructors was solved by utilising virtual means of teaching POCUS to paediatric residents. The residents demonstrated improvement in captured image quality and technique through independent practice after the end of training period. The residents were able to pass on their training to other learner in the programme creating a sustainable training system.

The virtual teaching model transcends geographic barriers, enabling education in POCUS even in institution without their own paediatric ultrasound faculty.

This is an educational practice model that can be adopted more broadly to support education of POCUS in paediatric residents, thereby improving care for populations at high risk from ionising radiation.

Overall, the use of innovative technology and virtual training methods proved effective in overcoming challenges associated with traditional POCUS training for paediatric residents.

No conflict of interest to disclose.