Tables
- TABLE 1
Minimum training requirements for the practice of medical ultrasound in Europe
Level 1: practice at this level would usually require the following abilities To perform common examinations safely and accurately To recognise and differentiate normal anatomy and pathology To diagnose common abnormalities within certain organ systems To recognise when referral for a second opinion is indicated Level 2: practice at this level would usually require the following abilities To accept and manage referrals from Level 1 practitioners To recognise and correctly diagnose almost all pathology within the relevant organ system To perform basic, non-complex ultrasound-guided invasive procedures To teach ultrasound to trainees and to Level 1 practitioners To conduct some research in ultrasound Level 3: this is an advanced level of practice, which involves the following abilities To accept tertiary referrals from Level 1 and 2 practitioners To perform specialised ultrasound examinations To perform advanced ultrasound-guided invasive procedures To conduct substantial research in ultrasound To teach ultrasound at all levels To be aware of and to pursue developments in ultrasound Reproduced with permission from [27].
- TABLE 2
Commonly used methods of assessment
Method Domain Type of use Limitations Strengths Written exercises Multiple-choice questions in either single-best-answer or extended matching format Knowledge, ability to solve problems Summative assessments within courses or clerkships; national in-service, licensing, and certification examinations Difficult to write, especially in certain content areas; can result in cueing; can seem artificial and removed from real situations Can assess many content areas in relatively little time, have high reliability, can be graded by computer Key-feature and script-concordance questions Clinical reasoning, problem-solving ability, ability to apply knowledge National licensing and certification examinations Not yet proven to transfer to real-life situations that require clinical reasoning Assess clinical problem-solving ability, avoid cueing, can be graded by computer Short-answer questions Ability to interpret diagnostic tests, problem-solving ability, clinical reasoning skills Summative and formative assessments in courses and clerkships Reliability dependent on training of graders Avoid cueing, assess interpretation and problem-solving ability Structured essays Synthesis of information, interpretation of medical literature Preclinical courses, limited use in clerkships Time-consuming to grade, must work to establish interrater reliability, long testing time required to encompass a variety of domains Avoid cueing, use higher order cognitive processes Assessments by supervising clinicians Global ratings with comments at end of rotation Clinical skills, communication, teamwork, presentation skills, organisation, work habits Global summative and sometimes formative assessments in clinical rotations Often based on second-hand reports and case presentations rather than on direct observation, subjective Use of multiple independent raters can overcome some variability due to subjectivity Structured direct observation with checklists for ratings (e.g. mini-clinical-evaluation exercise or video review) Communication skills, clinical skills Limited use in clerkships and residencies, a few board-certification examinations Selective rather than habitual behaviors observed, relatively time-consuming Feedback provided by credible experts Oral examinations Knowledge, clinical reasoning Limited use in clerkships and comprehensive medical school assessments, some board-certification examinations Subjective, sex and race bias has been reported, time-consuming, require training of examiners, summative assessments need two or more examiners Feedback provided by credible experts Clinical simulations Standardised patients and objective structured clinical examinations Some clinical skills, interpersonal behaviour, communication skills Formative and summative assessments in courses, clerkships. Medical schools, national licensure examinations, board certification in Canada Timing and setting may seem artificial, require suspension of disbelief, checklists may penalise examinees who use shortcuts, expensive Tailored to educational goals; reliable, consistent case presentation and ratings; can be observed by faculty or standardised patients; realistic Incognito standardised patients Actual practice habits Primarily used in research; some courses, clerkships, and residencies use for formative feedback Requires prior consent, logistically challenging, expensive Very realistic, most accurate way of assessing clinician's behavior High-technology simulations Procedural skills, teamwork, simulated clinical dilemmas Formative and some summative assessment Timing and setting may seem artificial, require suspension of disbelief, checklists may penalise examinees who use shortcuts, expensive Tailored to educational goals, can be observed by faculty, often realistic and credible Multisource (“360-degree”) assessments Peer assessments Professional demeanour, work habits, interpersonal behaviour, teamwork Formative feedback in courses and comprehensive medical school assessments, formative assessment for board recertification Confidentiality, anonymity, and trainee buy-in essential Ratings encompass habitual behaviours, credible source, correlates with future academic and clinical performance Patient assessments Ability to gain patients’ trust; patient satisfaction, communication skills Formative and summative, board recertification, use by insurers to determine bonuses Provide global impressions rather than analysis of specific behaviours, ratings generally high with little variability Credible source of assessment Self-assessments Knowledge, skills, attitudes, beliefs, behaviours Formative Do not accurately describe actual behaviour unless training and feedback provided Foster reflection and development of learning plans Portfolios All aspects of competence, especially appropriate for practice-based learning and improvement and systems-based practice Formative and summative uses across curriculum and with-in clerkships and residency programmes, used by some U.K. medical schools and specialty boards Learner selects best case material, time-consuming to prepare and review Display projects for review, foster reflection and development of learning plans - TABLE 3
Thoracic ultrasound (TUS) competency levels
Emergency-level TUS operator Completed an introductory TUS session and has a basic understanding of ultrasound machines and examinations
Logbook of five normal TUS and live large pleural effusions of >5 cm depth
Satisfactory summative DOPS to identify thoracic and abdominal cavity structures (diaphragm, lung, heart, rib, liver, spleen and kidney)
Satisfactory summative DOPS to identify a large pleural effusion >5 cm depth and to guide intervention
Basic-level TUS operator Completed a structured TUS course and has a basic understanding of ultrasound physics, modes of ultrasound, anatomy of thoracic cavity and simulated experience
Ability to identify small pleural effusions and complex/septated pleural effusions
Ability to identify gross malignant pleural nodularity; for example, diaphragmatic nodularity
Ability to identify consolidated and atelectatic lung
Ability to assess lung sliding
2x satisfactory summative DOPS in a “challenging USS case”. Examples of this include: small pleural effusion on CXR, consolidation versus collapse versus effusion on CXR and loculated effusion on CXR/CT
Logbook of procedures including >60 ultrasound procedures including normal scans, pleural effusions and identification of sites for intervention
The logbook should include minimum of 10 thoracic ultrasounds of small effusions <5 cm, complex/septated effusions, pleural nodularity or consolidated/atelectatic lung
Intermediate-level TUS operator Minimum of 2 years' experience as a basic-level TUS operator
Ability to detect A-lines and B-lines in lung ultrasound
Ability to identify and assess pleural thickening
Ability to assess diaphragm function on ultrasound
Ability to perform real-time pleural aspiration and chest drain insertion when required
Ability to use ultrasound help guide site for indwelling pleural catheter insertion (scanning patients in lateral decubitus position)
Annual review and appraisal of practice including standardised outcome measures
Advanced-level TUS operator Advanced TUS practitioners who performs minimum of 100 TUS per year
Ability to perform real-time image-guided pleural biopsy
Ability to use M-Mode, colour and Doppler in appropriate setting
Annual review and appraisal of practice including standardised outcome measures
CXR: chest radiograph; CT: computed tomography; DOPS: direct observation of procedural skills.
