Critical Care Ultrasound for Critical Care Medicine Faculty, Fellows and Nurse Practitioners: A Needs Assessment Approach to Develop a Standardized Inter-Professional Curriculum
CCCF ePoster library. Buchanan B. Nov 7, 2018; 233381; 24 Disclosure(s): I have received research grant support from the Department of Critical Care Medicine "Run for our Lives" campaign. The Department of Critical Care Medicine at the University of Alberta has received an unrestricted educational grant from SonoSite.
Brian Buchanan
Brian Buchanan
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Abstract
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Introduction: Critical care ultrasound (CCUS) is a potent and versatile adjunct to care of the acutely ill patient. CCUS is defined by the following: exams are focused; performance and real-time interpretation are by the treating practitioner; and is specific to the context of critical care medicine (CCM). For CCUS to maximize its potential, we believe it needs a curriculum that receives wide input, broad acceptance, and be deliberate and informed. Despite a “call-for-action” from several North American organizations,1,2 published surveys suggest many institutions have no deliberate strategy, no formalized curriculum, and insufficient engagement of front-line stakeholders.3,4

 

Objective: To develop a formal inter-professional standardized CCUS curriculum using a needs assessment methodology.

 

Methods: We used a mixed-methods needs assessment approach to systematically address potential gaps in CCUS training for various CCM practitioners: faculty, fellows, nurse practitioners. A combination of literature review and expert opinion informed the development of semi-structured focus groups. Audio transcripts were analyzed using the constant comparative method in order to achieve content saturation. Subsequent qualitative data were then used to develop a 19-item survey; with mostly Likert-based

anchored rating scales. Next, we emailed the survey to all clinical stakeholders in the Edmonton clinical zone. Descriptive statistics were used to characterize survey responses.

 

Results: We performed three focus groups with 19 CCM practitioners in order to achieve content saturation. We identified the following major themes: perceived benefits, existing learning limitations, key priorities, perceived risks, qualities of effective instruction, ensuring long-term success/retention and achieving competency. Sub-themes were coded by comment frequency and by the number of respondents. We identified the following common sub-themes of practice that might positively impact training, by order of comment frequency: access to learning modules (n=11), archiving with dedicated personalized feedback (11), awareness of limitations (9), hands-on training in critically ill patients (9) with ICU-related clinical problems (6). We also identified limitations to learning CCUS: insufficient access to skilled bedside mentorship (12); inadequate longitudinal training (8). Fifty percent (35/70) of eligible participants completed the survey (20 faculty, 4 fellows, 11 nurse practitioners). Participants stated they would “probably” or “definitely” attend bi-monthly (~2-3 hour: 22/35, 62.8%) or 3-4 high-intensity (5-10 hour: 23/35, 51%) scheduled training sessions. Eighty percent (28/35) agreed that portfolio development was necessary for independent performance. 26/35 (74.2%) were willing to complete CCUS exam reports to enable feedback, but five individuals (5/35, 14.2%) noted concerns about “time constraints”. Participants stated that competency assessment would be “probably” or “definitely” needed in the form of 1:1 proctored assessment of cognitive/technical skill (28/35, 80%), formal portfolio review (27/35, 77%) and multiple choice-based exam (27/35, 77%). Further survey data established curricular scope and content.

 

Conclusion: Our needs assessment approach has informed the development of a formal inter-professional CCUS curriculum. Focus groups and survey methodology helped to engage clinical personnel and provide insight on key aspects of curriculum development.

 


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