Frank Norman joins the podcast today to discuss the Society of Physician Assistants in Clinical Ultrasound (SPACUS) and point of care ultrasound (POCUS) competency. The conversation also includes teasing out competency versus certification. Listening to this podcast is great for not only those who are new to ultrasound but also for those with experience and looking to help others interested in POCUS.
First, we need to make a quick apology for audio quality. It is not as good as we would have hoped but definitely worth listening for the content. SPACUS is about promoting ultrasound, especially POCUS. It also devotes to help with the credentialing and competency process. Another point for SPACUS is to introduce POCUS early in education, something we will discuss more in the next podcast.
POCUS is growing and is becoming more important in clinical practice not just in emergency medicine but across the board. Clinicians should like POCUS for its many benefits. This includes getting back to the patient's bedside and being able to show patients directly what their problem (or lack thereof) for better comprehension. It is alsobeneficial in environments where x-ray or CT may not always be available such as on thebattlefield. Some of these devices can actually beincredibly small.
In medicine, we are finding more uses for POCUS. We are finding more evidence for pneumonia or for other lung pathology. It can also help better detect fractures. This is in addition to already well known and demonstrated benefits such as the eFAST and RUSH exams. One commonly discussed (and previously reviewed) method is of bedside ultrasound prior to I&D of a potential abscess. Not all that is an abscess actually is one. Furthermore, another podcast we had discussed how dynamic ultrasound is beneficial such as with intubation.
There are many ways clinicians can learn ultrasound. Going to a basic or introductory course is often the first step to understand the basics. It is important to go to a live course at some point such as the one SEMPA hosts, but listening to FOAMed vodcasts such as the Ultrasound Podcast is also of great benefit when learning. If one is available use an expert (what we called "Yoda" or "guru") to help guide you through the process. There are also fellowships that exist which are essentially not different from the physician ones for PAs. One such example is the Ultrasound Leadership Academy (ULA) and they are available for distance learning of bedside ultrasound.
Once understanding the basics of POCUS, one of the most important things to do is getting through the experience phase. Essentially, most clinicians need to obtain 25-50 scans (of each type) to be considered "competent" in that exam. Especially for those in rural or remote settings, this is a challenging step if without someone to guide them. One trick is still getting whatever the "gold standard" or the most appropriate test for the patient is just after the bedside ultrasound. For example, a patient with traumatic injuries but stable can go to CT after the negative (or potentially positive eFAST) for confirmation. Take another example of a patient where the bedside ultrasound was for DVT. Have the ultrasound technician then do the same exam that is read by a radiologist. If something was found that would have been missed based on the bedside exam, learn from this and potentially do it again. Maybe a patient has a positive finding but did not do the bedside exam first. Discuss this with the patient and this can even be the time to attempt showing the patient that pathology on the bedside ultrasound. The key is to use whatever is appropriate while still gaining competency and experience.
Some may ask why certification is not better option than competency. ACEP supports competency and has used this in their guidelines. We just outlined competency above, but some may think certification may not be an issue. Keep in mind this would be something like ATLS or PALS where an outside group would decide what would make someone certified and then require repeat training on some form of a regular basis. This differs from competency since clinicians are demonstrating continued experience and use with time (like most other skills or procedures such as suturing, EKG reading, etcetera). Also, keep in mind that with the wide variety of fields clinicians work in using POCUS that testing would be difficult in certification. Those working in pain management or dermatology are using very different studies from another clinician working in orthopedics or obstetrics.
We will be back next week to discuss more about SPACUS and POCUS. Please let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook. Remember to look us up on Libsyn and on iTunes. If you have any questions you can also comment below, email at firstname.lastname@example.org, or send a message from the page. We hope to talk to everyone again soon. Until then, continue to provide total care everywhere.
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