Point-of-care ultrasound for general practitioners: a systematic needs assessment

Thomas Løkkegaard, Tobias Todsen, Leizl Joy Nayahangan, Camilla Aakjaer Andersen, Martin Bach Jensen, Lars Konge, Thomas Løkkegaard, Tobias Todsen, Leizl Joy Nayahangan, Camilla Aakjaer Andersen, Martin Bach Jensen, Lars Konge

Abstract

Objective: The aim of the study was to achieve consensus among a group of ultrasound proficient general practitioners (GPs) from Denmark, Norway, Sweden and Finland on which ultrasound scanning modalities and ultrasound-guided procedures are essential to GPs in their daily work for the purpose of including them in a basic ultrasound curriculum.Design: The Delphi methodology was used to obtain consensus.Subjects: Sixty Scandinavian GPs with more than two years of point-of-care ultrasound (POCUS) experience were invited to join the Delphi expert panel.Main outcome measures: In the first Delphi round each member of the panel was asked to produce a list of scanning modalities and procedures which they found relevant to include in a basic ultrasound curriculum. In Delphi round two, these suggestions were presented to the entire panel who assessed whether they found them essential in their daily work. Items not reaching consensus in round two, were presented to the panel in a third and final round. Items reaching more than 67% agreement were included.Results: Forty-five GPs were included in the study and 41 GPs completed all rounds. Agreement was obtained on 30 scanning modalities and procedures primarily within the musculoskeletal (8), abdominal (5), obstetric (5) and soft tissue (3) diagnostic areas. Four ultrasound-guided procedures were also agreed upon.Conclusion: A prioritized list of 30 scanning modalities and procedures was agreed upon by a group of ultrasound proficient GPs. This list could serve as a guideline when planning future POCUS educational activities for GPs.Key pointsPoint-of-care ultrasound (POCUS) is increasingly being used by general practitioners (GPs), but little is known about which ultrasound applications are most used.We performed a systematic needs assessment among a group of ultrasound proficient GPs using the Delphi methodology for the purpose of establishing a basic POCUS curriculum.The process resulted in a prioritized list of 30 scanning modalities and ultrasound guided procedures.Our study provides the basis for an evidence-based basic POCUS curriculum for GPs.

Keywords: Delphi study; Point-of-care testing; curriculum; general practice; primary care; ultrasonography.

Figures

Figure 1.
Figure 1.
Study flow. Items: scanning modalities and procedures. N:number of panelists in the study.

References

    1. Mengel-Jorgensen T, Jensen MB. Variation in the use of point-of-care ultrasound in general practice in various European countries. Results of a survey among experts. Eur J Gen Pract. 2016;22:274–277.
    1. Hall JW, Holman H, Bornemann P, et al. . Point of care ultrasound in family medicine residency programs: a CERA study. Fam Med. 2015;47:706–711.
    1. Galusko V, Khanji MY, Bodger O, et al. . Hand-held ultrasound scanners in medical education: a systematic review. J Cardiovasc Ultrasound. 2017;25:75–83.
    1. Dietrich CF, Goudie A, Chiorean L, et al. . Point of care ultrasound: a WFUMB position paper. Ultrasound Med Biol. 2017;43:49–58.
    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–757.
    1. Todsen T, Melchiors J, Charabi B, et al. . Competency-based assessment in surgeon-performed head and neck ultrasonography: a validity study. Laryngoscope. 2018;128:1346–1352.
    1. Tolsgaard MG, Todsen T, Sorensen JL, et al. . International multispecialty consensus on how to evaluate ultrasound competence: a Delphi consensus survey. PLoS One. 2013;8:e57687.
    1. Andersen CA, Holden S, Vela J, et al. . Point-of-care ultrasound in general practice: a systematic review. Ann Fam Med. 2019;17:61–69.
    1. American Academy of Family Physicians . Recommended curriculum guidelines for family medicine residents: point of care ultrasound. AAFP Reprint No 290D. 2016 Dec [cited 2018 Mar 1]. Available from:
    1. Bornemann P. Assessment of a novel point-of-care ultrasound curriculum's effect on competency measures in family medicine graduate medical education. J Ultrasound Med. 2017;36:1205–1211.
    1. Lee JB, Tse C, Keown T, et al. . Evaluation of a point of care ultrasound curriculum for Indonesian physicians taught by first-year medical students. World J Emerg Med. 2017;8:281–286.
    1. Wong F, Franco Z, Phelan MB, et al. . Development of a pilot family medicine hand-carried ultrasound course. WMJ. 2013;112:257–261.
    1. Flick D. Bedside ultrasound education in primary care. J Ultrasound Med. 2016;35:1369–1371.
    1. Todsen T, Tolsgaard MG, Olsen BH, et al. . Reliable and valid assessment of point-of-care ultrasonography. Ann Surg. 2015;261:309–315.
    1. Lindgaard K, Riisgaard L. Validation of ultrasound examinations performed by general practitioners. Scand J Prim Health Care. 2017;35:256–261.
    1. Mjolstad OC, Snare SR, Folkvord L, et al. . Assessment of left ventricular function by GPs using pocket-sized ultrasound. Fam Pract. 2012;29:534–540.
    1. Mumoli N, Vitale J, Giorgi-Pierfranceschi M, et al. . General practitioner-performed compression ultrasonography for diagnosis of deep vein thrombosis of the leg: a multicenter, prospective cohort study. Ann Fam Med. 2017;15:535–539.
    1. Keeney S, Hasson F, McKenna H. The Delphi technique in nursing and health research. 1st ed. Oxford: Wiley-Blackwell; 2011.
    1. Nayahangan LJ, Stefanidis D, Kern DE, et al. . How to identify and prioritize procedures suitable for simulation-based training: experiences from general needs assessments using a modified Delphi method and a needs assessment formula. Med Teach. 2018;40:676–683.
    1. de Villiers MR, de Villiers PJ, Kent AP. The Delphi technique in health sciences education research. Med Teach. 2005;27:639–643.
    1. Skulmoski GJ, Hartmann FT, Krahn J. The Delphi method in graduate research. Int J Inf Educ Technol. 2007;6:1–21.
    1. Lyttkens CH, Christiansen T, Häkkinen U, et al. . The core of the Nordic health care system is not empty. Nordic J Health Eco. 2016;4:7.
    1. Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2017;69:e27–e54.
    1. European Core Curriculum for Emergency Medicine . 2017. [cited 2019 Mar 1]. Available from:
    1. Moth G, Olesen F, Vedsted P. Reasons for encounter and disease patterns in Danish primary care: changes over 16 years. Scand J Prim Health Care. 2012;30:70–75.
    1. Zamorano JL, Moreno R, Alburquerque C. Echocardiography performed by physicians outside of echo-labs – is it possible? Eur Heart J. 2002;23:908–909.
    1. Evangelista A, Galuppo V, Mendez J, et al. . Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation. Heart. 2016;102:376–382.
    1. Chamsi-Pasha MA, Sengupta PP, Zoghbi WA. Handheld echocardiography: current state and future perspectives. Circulation. 2017;136:2178–2188.
    1. Bornemann P, Johnson J, Tiglao S, et al. . Assessment of primary care physicians' use of a pocket ultrasound device to measure left ventricular mass in patients with hypertension. J Am Board Fam Med. 2015;28:706–712.
    1. Chavez MA, Naithani N, Gilman RH, et al. . Agreement between the World Health Organization algorithm and lung consolidation identified using point-of-care ultrasound for the diagnosis of childhood pneumonia by general practitioners. Lung. 2015;193:531–538.

Source: PubMed

3
Prenumerera