A number of point-of-care ultrasound (POCUS) accreditation schemes have been developed to encourage and facilitate the training of critical care clinicians in these skills. The Focused Intensive Care Echocardiography (FICE) accreditation scheme provides a recognised structure of training, reporting and accreditation in echocardiography. The Core Ultrasound Skills in Intensive Care (CUSIC) accreditation has also been introduced and provides competency assessments for lung, abdominal and vascular ultrasound.
These schemes require a minimum number of scans with critique and feedback from a qualified mentor. The trainee’s initial scans must be directly supervised by their mentor until basic competencies are met. Subsequent scans can be undertaken without direct supervision but these must be stored for review with the mentor. Current practice generally involves a trainee accumulating several scans then identifying a mutually available time slot to review these with their mentor.
Barriers to this process can include the absence of a trained mentor at a trainee’s location, lack of shared time slots during the working day and trainees rotating to different sites whilst undergoing accreditation. These logistical issues can make accreditation challenging to achieve in the specified timeframe.
We developed a cloud-based spreadsheet whereby a trainee can enter the details required by the FICE and / or CUSIC schemes for each of their scans. The scans themselves were anonymised and uploaded to an online DICOM file sharing service. Subsequently each scan was made available via hyperlink from the relevant patient’s spreadsheet page. The trainee’s spreadsheet allowed for questions and comments to be posed to the mentor.
The mentor was then able to view the trainee’s scans and analysis at their leisure from anywhere with an internet connection using an inbuilt web-based DICOM viewer.
The mentor could then answer any questions and pose further questions if needed via the shared spreadsheet.
This method also provides the facility of “face-to-face” discussions over video-conferencing software whilst ultrasound clips are being viewed simultaneously by trainee and mentor. This provides the potential for real-time education without geographic constraints.
The spreadsheet could also be shared with others so provides an easy route for mentors to seek second opinions or encourage shared learning amongst their peers or with other trainees.
Attention was given to security and confidentiality issues throughout this process and all patient-identifiable was removed from all files prior to use. This project was undertaken with the input of our Trust’s Caldicott guardian ensuring confidentiality requirements were adhered to.
The spreadsheet and file upload proved easy to use. The shared form required the same information as the FICE and CUSIC paper forms and therefore did not require any more time or effort to complete. The scans were not embedded in each patient form but rather were linked. For this reason the scans and analysis had to be viewed in separate windows which hindered usability and flow to some degree. The spreadsheet worked well in terms of sharing and editing but the user interface could have been improved in terms of aesthetics.
The user interface remains embryonic and attempts are being made to streamline the process in terms of upload and review.
We believe that the use of secure cloud software and video-conferencing technology can improve access to ultrasound training opportunities and improve trainee and mentor experience. The platform and user interface will continue to be improved and could soon be available to be trialled on a larger scale.