Background: Ultrasonography is a safe, non-invasive bedside tool used by providers to obtain real-time, dynamic images to support diagnostic guidance, therapeutic decisions, and procedural success. Point-of-care ultrasonography (POCUS) has demonstrated improved outcomes in states of critical illness such as trauma or shock and enhanced the command and accuracy of procedural skills. Despite these important measures, formalized training in POCUS is sparse in pediatrics. Insufficient faculty training, high fellow turnover, and equipment availability have been identified as barriers to ultrasound training. Current programs exist among multiple specialties, but the lack of standardized training contributes to the variable acquisition of ultrasound knowledge and skills. Retention of skills further relies on practice with ultrasound examinations and expert-led feedback in image acquisition and interpretation; however, the process to achieve this is vague. We created and implemented a POCUS curriculum for pediatrics to determine the effect of independent practice on ultrasound knowledge and skills retention.
Methods: This prospective cohort study trained fellows from pediatric critical care, neonatology, and pediatric emergency care with an initial standardized 2-day course on the basics of ultrasound (physics, vascular, thoracic, abdominal, cardiovascular exams), with pre- and post-testing to determine knowledge acquisition. Lecture-based learning focused on factual knowledge and interactive skills stations with standardized patients harmonized psychomotor practice to ultrasound skills acquisition. Independent learner-led practice of ultrasound scanning was performed over the subsequent 3 months. At a 3-month follow-up refresher course, a case-based lecture in thoracic ultrasound was administered to boost medical knowledge and skills. Pre- and post-testing were performed.
Results: During the initial course, the mean pre-test score on thoracic ultrasound was 46% (SD 15), and the mean post-test score was 81% (SD 9), with an improvement of 35% (p = 0.0001). Learners performed independent practice of ultrasound scans. The mean number ultrasound scans per learner was 17.2 (SD 10). Expert feedback was provided. At a 3-month follow-up, refresher training on thoracic ultrasound with clinical cases was provided. The pre-test mean was 46% (SD 15), and the post-test mean was 72% (SD 19), with an improvement after thoracic ultrasound refresher training of 26% (p = 0.0005). Medical knowledge decay was statistically significant with a decrease in mean score from 81% to 46% (p = 0.0001). A statistically significant correlation (rho = –0.651, p = 0.009) existed between the number of scans completed and decay of medical knowledge with independent-led ultrasound scanning.
Conclusions: This study demonstrates that a standardized POCUS curriculum can provide medical knowledge acquisition in ultrasound; however, medical knowledge retention notably decays over time. Though refresher courses have been shown to mitigate skill or memory decay, independent practice of ultrasound scanning did not improve knowledge retention and is not an effective method of skills practice. The next phase of this study will be to evaluate the effect of supervised ultrasound scanning on medical knowledge retention and refresher training.