Execution of the NephroPOCUS curriculum
POCUS program runs smoothly when there are at least 2 (or more) key faculty who can dedicate significant amount of their time to the program development. Depending on the number of fellows, it is reasonable for the POCUS program director to negotiate for 10-20% FTE of non-clinical time for the administration of the program.
The key faculty should also be prepared to spend adequate time to enhance their skills and POCUS-related knowledge by attending workshops, online courses and/or shadowing physicians from other POCUS-performing specialties (unless they have completed a 1-year formal POCUS fellowship). Shadowing sonographers is also a good idea to improve the image acquisition technique. You can also invite experts from other institutions to visit and conduct an informal workshop using your ultrasound machine(s) – works better than just bringing them for a talk.
When making decisions about purchasing equipment, Keep in mind that POCUS skills evolve over time. A basic US machine with one transducer and limited options might appear good initially from monetary perspective but limits growth potential of the program.
Have a clear idea of what sonographic applications you are going to teach and determine milestones to be evaluated. For example, in our program, we follow the trainees’ progress as below at the end of every 6 months.
Having a designated place to practice on volunteers helps. It could be the medical school simulation lab or a clinic room or simply a work room where you can use a foldable massage bed (as below).
Have the fellows log their scans into the fellowship management system that you use such as the New Innovations.
Establish ways to provide feedback to the trainees – both by direct observation and retrospective image review. Here are the sample evaluation forms that we use.
There is no nephrology-specific guideline at present for the required number of scans each trainee has to perform to gain competency. In our experience, we believe 40 scans per sonographic application is a reasonable goal. Most hospitals follow ACEP guidelines to grant privileges, so we make sure our fellows perform at least 25 ‘documented & reviewed’ scans per application. However, competency is not just about the number and continued practice is the key to gain confidence.