Introduction and Basic Principles

Introduction

Welcome to Pocus Basics!

Pocus Basics is created by our instructor Tofan Taeri and was originally intended as pre course material for ultrasound courses and is now developed as an open source teaching hub for POCUS learning.

The material consist of 10 modules, where modules 1-6 are the main modules and the protocols that the students are expected to practice before hands-on ultrasound courses. Pocus Basics consists of the following ten modules:

• M0: Introduction & Basic Principles
• M1: Fundamentals
• M2: E-FAST
• M3: Abdominal Ultrasound
• M4: Lung Ultrasound
• M5: Cardiac Ultrasound
• M6: Vascular Ultrasound
• M7: Musculoskeletal Ultrasound
• M8: Ultrasound Practices in Clinic
• M9: Ultrasound Beyond This Course

1. Principle 1 — Legacy & Transparency

I decided to create the course material in english and make it completely available online for two main reasons. Firstly, there is a rich legacy of online POCUS material made available by physicians in the medical community (in the tradition of FOAMed: Free Open Access Medical Education) that we have learned from, practiced, and taught over the years in our own clinic. Also, a lot of the material available elsewhere online is frequently borrowed from and referred to in this course. Creating everything from scratch for this course would just not be feasible at this time within our current budget and timeframe. Our aim is, over time, to be able to add original content, such as original videos, to the course material.

Secondly, making the course material available online in English, and not in Swedish, also means anyone speaking English can (theoretically) give feedback, use the material, and adjust it to their own course as they see fit (letting us join and contribute to the FOAMed tradition). English as the main language for the course material gives the course global transparency. As English is the dominant scientific and medical language of the world, and as Swedes in general have excellent language skills in English, it seemed to me as the obvious choice since I wanted to make what we teach open for scrutiny to the (global) medical community.

2. Principle 2 – The Limits of Bedside Ultrasound

Bedside ultrasound is just another tool in the clinician’s toolbox, similar to other adjuncts such as labs, x-ray/CT, and the stethoscope. It has its own limits and requires, like other adjuncts, a learned skill set for adequate interpretation. It is, however, perhaps unlike the other adjuncts mentioned, more user dependent and requires a higher level of proficiency from the practitioner for correct assessments. Understanding this basic premise and the limits of one’s own ability is one of the most important lessons to keep in mind for the beginning practitioner who is just starting to learn bedside ultrasound.

We are of the firm belief that bedside ultrasound is a great tool for every clinician and that it should be practiced widely by anyone who has access to proper equipment. However, we make a distinction between practicing bedside ultrasound and the ability to make clinical judgements based on the images retrieved. There is to this date no specific certificate or consensus in Sweden on what bedside ultrasound constitutes or what is required before clinicians are able to make judgments and write their assessment in journal records. As long as the clinician is honest with the patient and the clinic when it comes to their ability (or lack thereof), we believe in-clinic practice with ultrasound should be encouraged as it is the only way for each clinician to improve proficiency.

Ideally any clinical practice done with bedside ultrasound should be supervised and reviewed by more skilled practitioners, and each clinic should have their own terms and regulations when it comes to when and what clinicians can assess and journal. However, since that is, for the time being, far from the case in most clinics/hospitals outside the main cities in Sweden, we believe in the case-to-case use of bedside ultrasound, where each clinician is trusted to apply good judgement and where it is done in continuous dialogue and development with the home clinic/hospital.

3. Principle 3 — Evidence Based Learning & Practice

There is, as mentioned, no national consensus or certification in Sweden at present moment for practitioners of bedside ultrasound. Among the questions that need answering when it comes to teaching and implementing a (future) national curriculum are:

• How many exams is needed before the practitioner becomes adequately sufficient for each protocol?
• How many of the exams need to be pathological?
• How do we evaluate bedside ultrasound skills?
• How do we best teach Point Of Care Ultrasound?

Optimal training required for proficiency in bedside ultrasound is unknown. Participants in an introductory POCUS course seem to have significant improvement in knowledge up to at least six months after, and incorporating supervised hands-on ultrasound by more experienced practitioners into the curriculum seems to yield even higher knowledge retention [*,*,*]. However there is scarce data on the optimal amount of supervised hands-on training or the optimal number of performed exams needed to achieve proficiency.

One of our goals with this course is to gather data, follow up the trainees, and create the tools needed for evaluating bedside ultrasound, when it comes to teaching and practicing bedside ultrasound in the clinic.

4. Course Summary

The main part of the mandatory study material for this course are video clips, shamelessly, copy-pasted from YouTube and Vimeo (se list below for the total video time). The course includes one day for studies before the 5-day on-site hands-on practice. The students are expected to learn the material by watching the videos, reading the text, and doing the quizzes before the course starts. The reasoning behind heavenly relying on the video format is due to how important understanding the visual images in bedside ultrasound are, and no other study medium provides a better learning and image bank than instructive video clips of normal and pathological bedside ultrasound exams.

Total video Length:

• M1 – Fundamentals: 53 min
• M2 – E-FAST & Abdominal: 85 min
• M3 – Lung: 42 min
• M4 – Cardiac: 40 min
• M5 – Vascular: 48 min
• M6 – Musculoskeletal: 20 min (but NOT mandatory!)
• Total video time: 268 min (ca 4,5 hours)

5. References

• Matthews et al. ‘Skill retention with ultrasound curricula’. 2020.
• Noble et al. ‘Assessment of knowledge retention and the value of proctored ultrasound exams after the introduction of an emergency ultrasound curriculum’. 2007.
• Yamada et al. ‘Skills acquisition for novice learners after a point-of-care ultrasound course: does clinical rank matter?’ 2018.