Putting precise boundaries to the content is essential because of the vast number of medical fields with the potential to benefit from US. It also reduces the significant risk of students dispersing their energies at the expense of targeting essential learning. The website’s basic content was defined using the ACCP-SRLF consensus recommendations. However, that content only includes the educational components which are most useful to critical care medicine for minimal, basic and advanced focused ultrasonography. The ACCP-SRLF panel defined the specific skills required for each part.
The learning objectives have been structured into elements of knowledge corresponding to explicit, targeted questions to which the student will have to reply. For example in the basic heart component:
• “Is there any significant pericardial effusion?”
• “Is there any left ventricular systolic dysfunction?”
• “Is there any right ventricular dysfunction or overload?”
• “Are there any signs of hypovolemia or preload dependence?”
Mastering the basic skills provides the student with access to new diagnostic strategies such as the Rapid Ultrasound for Shock and Hypotension (RUSH) examination or the Bedside Lung Ultrasound in Emergency (BLUE) protocol.
The training process
Training takes place in four phases:
• acquisition of theoretical knowledge;
• acquisition of basic practical knowledge: workshops with healthy models, simulators and mannequins;
• intensive learning on a simulator: simulation centre;
• learning at the bedside: patients in real-world clinical contexts
Acquisition of theoretical knowledge
The training modules are permanently available on our internet server and are thus at the disposal of physicians in training, 24 hours a day, so that they can study according to their individual time schedules.
There are six components:
• technical,
• cardiac,
• pulmonary,
• abdominal,
• vascular and protocols.
Learning progress is continuously monitored via a series of multiple-choice questions which are constantly being improved and updated. This efficiently eases time constraints on learning and combines effective monitoring; it ensures that every student can participate fully in all the e-learning modules. A second verification of the student’s knowledge of basic CCUS will be carried out by their instructors during practical sessions.
With the goal of standardizing and aligning teaching content, regularly updated, online, printable pocket guides are available for use as reference documents.
Acquisition of practical knowledge
This phase takes place in regionally centralized sessions which enable us not only to provide instructors who master the learning objectives. These sessions bring together groups of 3 to 4 participants, with an instructor and healthy models, as well as an ultrasound simulator.
• The first part - 30 minutes long - is dedicated to knowledge about and getting used to the equipment (machine utilization and maintenance, adjusting basic settings, transducer manipulation).
• The second part is dedicated to a cardiac examination comprising five 45-minute sessions during which students are taught the classic US views (the parasternal long and short axis views, the apical 4 and 5 chamber views, the subcostal 4 chamber view and the inferior vena cava view). A 3-D heart is available as a model and on a simulator so as to give a better spatial appreciation of the organ’s anatomy and how to orient the transducer. At the end of part two, the student will be exposed to normal anatomy on the simulator in order to revise the views taught and verify their mastery of the basic competencies.
• Part three, divided into 50 minute sessions, looks a general US (lungs, abdomen and blood vessels):
- session on the lungs (pleural line, diaphragm)
- session on the abdomen (abdominal organs and recesses)
- session on blood vessels (the anatomy of cervical and leg veins, US-guided jugular cannulation on a mannequin).This phase of training is monitored using a scored test of image acquisition on volunteers and by the investigation of clinical scenarios on the simulator. The phase itself is also evaluated by the participants using a standard form.
Acquisition of practical skills
Once students have acquired the theoretical and practical basics, they can carry out examinations at the patient’s bedside, initially under direct supervision and subsequently, after the instructor’s agreement, under indirect supervision or remotely using telemedicine. Success in this last phase requires both highly-qualified, very accessible instructors and very active student participation. It is the student’s responsibility to carry out the number of examinations necessary for certification, under appropriate supervision, and to maintain adequate associated documentation in the form of a logbook validated by their supervisors.
Conclusion
Although teaching is traditionally centred on the teacher, we propose a concept of participative training which involves the student significantly in the learning process (flipped classroom). In this context, the teacher is considered to be a learning facilitator. Learner-centred rather than teacher-centred training enables better comprehension and the chance to immediately apply the cognitive and psychomotor skills required for US. This concept also proposes a change in paradigm as we move from a time-based training model to a model with continuous competency-based monitoring.
Publications
Tagan D, Bendjelid K, Beaulieu Y, Broccard A, Christen G, Fishman D, Ribordy V. L’échocardiographie par l’urgentiste et l’intensiviste. Rev Med Suisse 2009; 5: 1620-2.
Giraud R, Siegenthaler N, Tagan D, Bendjelid K. Evaluation des compétences requises pour la pratique de l’échocardiographie aux soins intensifs. Rev Med Suisse 2009; 5: 2518-2521.
Giraud R, Siegenthaler N, Tagan D, Bendjelid K. Evaluation des compétences pour la pratique de l’échocardiographie à un niveau avancé aux soins intensifs. Revue Médicale Suisse. Rev Med Suisse 2011; 7: 413-6.
Tagan D, Beaulieu Y. Implémentation de l'ultrasonographie ciblée dans une unité de soins critiques. Praxis 2014; 103: 705-709.
Tagan D, Fumeaux T et Beaulieu Y. Un concept novateur de formation en échographie ciblée pour l’intensiviste utilisant l’e-learning et la simulation. Rev Med Suisse 2015 ; 11 : 785-6.