All righty. Thank you so much for joining us this morning. The focus of my talk is going to be on really how we train our physician, as well as APP colleagues for point-of-care ultrasound. I have no disclosures to make. So starting with the APP team, in 2011, we created APP primarily Nurse Practitioner Critical Care Fellowship. It was very early on in this curriculum that we realized that point-of-care ultrasound was very integral in their training to be successful. So wherever critical care area, they ended up after fellowship. So it was very early on in this course that we integrated point-of-care ultrasound into it. And this is kind of how it looks for us. The fellows that we have each year get didactic content starting in the beginning of fellowship. And this is continued on with multidisciplinary lectures throughout the nine months of their fellowship of different various ultrasound lectures and topics. They have a specific rotation that they are with an ultrasonographer for at least a week to two weeks doing all the scans with that subject matter expert and practicing interpretation of it. We do bi-monthly ultrasound rounds with them. So every other Thursday, we'll go with the fellows and one-on-one. One of the faculty as well as the fellows will go around and do ultrasound rounds. So whatever critical care unit we're in, doing one-on-one time with them. So this is a great dedicated time that we can give them that one-on-one support that they need. And then certainly, they are encouraged to integrate critical care in all of their experiences that they have from a clinical standpoint. They all rotate through, it's a nine-month fellowship, but they rotate through five different intensive care units. And so they're encouraged throughout that time to really integrate what we've, the faculty has taught them into those clinical scenarios. It is the goal throughout fellowship for them to complete and log at least 50 exams of the TTEs, FAST, VESSEL, and LUNG images. So they're pretty proficient by the end of this fellowship. And just a little bit more about our fellowship. So again, it started in 2011. We are on our 14th cohort. We've successfully graduated 22 NPs, and our rate of retention is about 87%. So these now have become very kind of more experienced clinicians that are staffing our ICUs. So this point-of-care ultrasound training that they received very early on, they are now the ones precepting and teaching. So in regards to our fellows, we ask them to complete a self-survey that is given to them at the beginning of fellowship, midway through fellowship, and then at the end of fellowship. And this is a self-assessment score that they complete, rating their confidence from very little confidence that they would need somebody there to assist them with to feeling pretty confident and self-sufficient in it. And you can see their kind of progresses very nicely in their confidence level. Something that we're seeing both in our EPP trainees as well as some of the other trainees that definitely throughout the years post-pandemic, we're seeing even less confidence that they really haven't received much in training, in graduate training. And so by the time they get to us, you can see that their kind of pre-scores here are lower than previous years. But with kind of this intervention, we're able to get them confident by the end of fellowship. So though we would love to have all of our new graduate EPPs that are going into our critical care areas complete fellowship, that's not possible. So we quickly realized the need to be able to provide a condensed form of didactic training, including point-of-care ultrasound for all new hire EPPs that were coming into the institution. So we created a EPP critical care boot camp. This ranges throughout the years. We started it in 2017 from anywhere from five days to three days. It's a whole bunch of didactic content that the participants received, including content on point-of-care ultrasound. We then couple that with one-on-one hands-on skills lab time with a live model for them to be able to practice those didactics. Kind of important is that those point-of-care philosophies that we teach them are then integrated into simulation that we complete with them, as well as some of the other didactic topics. You know, if I give a PE lecture, I'm incorporating some of those didactic ultrasound components into it. So it's sprinkled throughout this process. In regards to how many we've trained, it was late 2017, early 2018 that we began integrating point-of-care ultrasound into this boot camp training. We have trained over 147 participants. There was a time due to the pandemic that some of those were virtually. So certainly they missed out on the hands-on component, but received the didactic component. And so this is, again, a self-assessment score that we provided the trainees that went through our boot camp, again, looking at their self-confidence scores. So really kind of the major questions we were asking is, are you able to attain those images of cardiac, ultrasound, and lung? And then are you able to incorporate those images that you received or were able to process and make a clinical decision because of that? And you can see kind of their scores progress nicely from pre- to post-training and really kind of became much more confident. And so I think the important thing to kind of focus on here is it proves that they are more proficient and that confidence that they're gaining from this training, I think, has been shown anecdotally from us that it really is motivating to take back to the critical care units that they're getting. And they certainly can, you know, this is just an entry-level training for the point of care, but it really kind of sparks their interest in it that they continue to grow their knowledge base. And then focusing a little bit more on our other trainees, so these are physician fellows that were part of a retrospective review that we did from 2016 to 2018. These include fellows that are both surgical critical care as well as medical fellows. And so the way that they are educated is by Dr. Haase and colleagues. They receive a day-long point of care ultrasound training class at the beginning of their fellowship class. They receive several multidisciplinary POCUS lectures throughout their fellowship. They also go through an ultrasound rotation and then continue to have some instruction during their rotations. These fellows took a knowledge test and skill set before and after their program, their fellowship program. And again, this was graded on a scale of how much intervention was required to help them get these images and obtain these images. So on a scale of one to five. And so the results of this, again, self kind of grading how much assistance they needed. They were able to capture 42 critical care fellows during this time. And their post score tests increased significantly by 96%. And their knowledge retention by 47 compared to those pre-test scores. So definitely a significant amount of knowledge retention throughout this training process. Some things to consider with point of care ultrasound training, whether it's through APPs or our physician colleagues. So we just started a software program at University of Maryland where we're much more easily able to capture these images. So I think this is going to be extremely beneficial for educational. We went to the point, we completely de-identified the scans and would have the fellows kind of record on their phones. So not ideal for interpretation. With this software program, we're now able to capture those images when they're out in their clinical rotations. And then kind of during those didactic periods, go and one-on-one review with them for interpretation. So I think that's going to be huge for our educational benefits. The other thing to consider is this is great. This plants seeds. It gives them the foundational knowledge of point of care. But we certainly need to have ongoing education for these people to prove their competency and proficiencies as time goes on. Something that we are working with right now is regards to what makes you proficient in this. Is it just the amount of scans? Do you need to perform some form of formal education? Or do you need to be credentialed throughout the hospital institution? So those are all things that we're working out right now, as I would imagine many programs are who are incorporating more point of care ultrasound. Certainly with competency and certification, as we do more and more exams, we are interested in being able to reimburse for this. And that's all part of the process that we're going through right now to figure out that. And then I think the one thing that certainly none of this is possible if we don't have kind of protected time to be able to teach. So luckily, our institution, we've had a lot of buy-in and recognition of how important this is for our critical care learners. So we've had some protected time that allows us to really provide for excellent education, which without that would not be possible. All right. Thank you so much for your attention. Thank you.

point-of-care ultrasound

Advanced Practice Providers

critical care training

ultrasound proficiency

credentialing