Skip to main content

Main menu

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Past issues
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Thoracic ultrasound competence for ultrasound-guided pleural procedures

David J. McCracken, Christian B. Laursen, Graham Barker, Fergus V. Gleeson, Kathy M. Cullen, Najib M. Rahman
European Respiratory Review 2019 28: 190090; DOI: 10.1183/16000617.0090-2019
David J. McCracken
1Oxford Centre for Respiratory Medicine, Oxford, UK
2Centre for Medical Education, Queen's University Belfast, Belfast, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: david.mccracken@ouh.nhs.uk
Christian B. Laursen
3Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Christian B. Laursen
Graham Barker
4Nuffield Dept of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fergus V. Gleeson
5Dept of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kathy M. Cullen
2Centre for Medical Education, Queen's University Belfast, Belfast, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Najib M. Rahman
1Oxford Centre for Respiratory Medicine, Oxford, UK
6Oxford NIHR Biomedical Research Centre, Oxford, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

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

      MethodDomainType of useLimitationsStrengths
      Written exercises
      Multiple-choice questions in either single-best-answer or extended matching formatKnowledge, ability to solve problemsSummative assessments within courses or clerkships; national in-service, licensing, and certification examinationsDifficult to write, especially in certain content areas; can result in cueing; can seem artificial and removed from real situationsCan assess many content areas in relatively little time, have high reliability, can be graded by computer
      Key-feature and script-concordance questionsClinical reasoning, problem-solving ability, ability to apply knowledgeNational licensing and certification examinationsNot yet proven to transfer to real-life situations that require clinical reasoningAssess clinical problem-solving ability, avoid cueing, can be graded by computer
      Short-answer questionsAbility to interpret diagnostic tests, problem-solving ability, clinical reasoning skillsSummative and formative assessments in courses and clerkshipsReliability dependent on training of gradersAvoid cueing, assess interpretation and problem-solving ability
      Structured essaysSynthesis of information, interpretation of medical literaturePreclinical courses, limited use in clerkshipsTime-consuming to grade, must work to establish interrater reliability, long testing time required to encompass a variety of domainsAvoid cueing, use higher order cognitive processes
      Assessments by supervising clinicians
      Global ratings with comments at end of rotationClinical skills, communication, teamwork, presentation skills, organisation, work habitsGlobal summative and sometimes formative assessments in clinical rotationsOften based on second-hand reports and case presentations rather than on direct observation, subjectiveUse 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 skillsLimited use in clerkships and residencies, a few board-certification examinationsSelective rather than habitual behaviors observed, relatively time-consumingFeedback provided by credible experts
      Oral examinationsKnowledge, clinical reasoningLimited use in clerkships and comprehensive medical school assessments, some board-certification examinationsSubjective, sex and race bias has been reported, time-consuming, require training of examiners, summative assessments need two or more examinersFeedback provided by credible experts
      Clinical simulations
      Standardised patients and objective structured clinical examinationsSome clinical skills, interpersonal behaviour, communication skillsFormative and summative assessments in courses, clerkships. Medical schools, national licensure examinations, board certification in CanadaTiming and setting may seem artificial, require suspension of disbelief, checklists may penalise examinees who use shortcuts, expensiveTailored to educational goals; reliable, consistent case presentation and ratings; can be observed by faculty or standardised patients; realistic
      Incognito standardised patientsActual practice habitsPrimarily used in research; some courses, clerkships, and residencies use for formative feedbackRequires prior consent, logistically challenging, expensiveVery realistic, most accurate way of assessing clinician's behavior
      High-technology simulationsProcedural skills, teamwork, simulated clinical dilemmasFormative and some summative assessmentTiming and setting may seem artificial, require suspension of disbelief, checklists may penalise examinees who use shortcuts, expensiveTailored to educational goals, can be observed by faculty, often realistic and credible
      Multisource (“360-degree”) assessments
      Peer assessmentsProfessional demeanour, work habits, interpersonal behaviour, teamworkFormative feedback in courses and comprehensive medical school assessments, formative assessment for board recertificationConfidentiality, anonymity, and trainee buy-in essentialRatings encompass habitual behaviours, credible source, correlates with future academic and clinical performance
      Patient assessmentsAbility to gain patients’ trust; patient satisfaction, communication skillsFormative and summative, board recertification, use by insurers to determine bonusesProvide global impressions rather than analysis of specific behaviours, ratings generally high with little variabilityCredible source of assessment
      Self-assessmentsKnowledge, skills, attitudes, beliefs, behavioursFormativeDo not accurately describe actual behaviour unless training and feedback providedFoster reflection and development of learning plans
      PortfoliosAll aspects of competence, especially appropriate for practice-based learning and improvement and systems-based practiceFormative and summative uses across curriculum and with-in clerkships and residency programmes, used by some U.K. medical schools and specialty boardsLearner selects best case material, time-consuming to prepare and reviewDisplay 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.

      PreviousNext
      Back to top
      View this article with LENS
      Vol 28 Issue 154 Table of Contents
      European Respiratory Review: 28 (154)
      • Table of Contents
      • Index by author
      Email

      Thank you for your interest in spreading the word on European Respiratory Society .

      NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

      Enter multiple addresses on separate lines or separate them with commas.
      Thoracic ultrasound competence for ultrasound-guided pleural procedures
      (Your Name) has sent you a message from European Respiratory Society
      (Your Name) thought you would like to see the European Respiratory Society web site.
      CAPTCHA
      This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
      Print
      Citation Tools
      Thoracic ultrasound competence for ultrasound-guided pleural procedures
      David J. McCracken, Christian B. Laursen, Graham Barker, Fergus V. Gleeson, Kathy M. Cullen, Najib M. Rahman
      European Respiratory Review Dec 2019, 28 (154) 190090; DOI: 10.1183/16000617.0090-2019

      Citation Manager Formats

      • BibTeX
      • Bookends
      • EasyBib
      • EndNote (tagged)
      • EndNote 8 (xml)
      • Medlars
      • Mendeley
      • Papers
      • RefWorks Tagged
      • Ref Manager
      • RIS
      • Zotero

      Share
      Thoracic ultrasound competence for ultrasound-guided pleural procedures
      David J. McCracken, Christian B. Laursen, Graham Barker, Fergus V. Gleeson, Kathy M. Cullen, Najib M. Rahman
      European Respiratory Review Dec 2019, 28 (154) 190090; DOI: 10.1183/16000617.0090-2019
      del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
      Full Text (PDF)

      Jump To

      • Article
        • Abstract
        • Abstract
        • Epidemiology and relevance
        • Role of ultrasound for pleural procedures
        • Training and curriculum requirements
        • Current training standards
        • Competence
        • Alternatives to current UK practice in TUS
        • Conclusions
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
      • PDF

      Subjects

      • Lung imaging
      • Tweet Widget
      • Facebook Like
      • Google Plus One

      More in this TOC Section

      • Efficacy and safety of gefapixant for chronic cough
      • Phenotype overlap in the natural history of asthma
      • Furin as a therapeutic target in CF airways disease
      Show more Reviews

      Related Articles

      Navigate

      • Home
      • Current issue
      • Archive

      About the ERR

      • Journal information
      • Editorial board
      • Press
      • Permissions and reprints
      • Advertising
      • Sponsorship

      The European Respiratory Society

      • Society home
      • myERS
      • Privacy policy
      • Accessibility

      ERS publications

      • European Respiratory Journal
      • ERJ Open Research
      • European Respiratory Review
      • Breathe
      • ERS books online
      • ERS Bookshop

      Help

      • Feedback

      For authors

      • Instructions for authors
      • Publication ethics and malpractice
      • Submit a manuscript

      For readers

      • Alerts
      • Subjects
      • RSS

      Subscriptions

      • Accessing the ERS publications

      Contact us

      European Respiratory Society
      442 Glossop Road
      Sheffield S10 2PX
      United Kingdom
      Tel: +44 114 2672860
      Email: journals@ersnet.org

      ISSN

      Print ISSN: 0905-9180
      Online ISSN: 1600-0617

      Copyright © 2023 by the European Respiratory Society