One of the most persistent barriers to ultrasound education in clinical fellowship programs has nothing to do with technology or learner motivation. It comes down to something far more basic: faculty time.
A new study published by BMC Medical Education tackles this problem head-on, and the results offer a compelling case for how blended learning can reshape bedside ultrasound training in Pulmonary and Critical Care Medicine (PCCM) fellowship programs.
Bedside ultrasound is a core competency for PCCM fellows. The Accreditation Council for Graduate Medical Education (ACGME) requires it. Yet there is no established, standardized curriculum to guide how fellowship programs should actually teach it.
The barriers are well-documented. Scheduling conflicts, a limited number of trained faculty, and the sheer time commitment required to deliver in-person didactics all make it difficult to sustain consistent ultrasound education. As far back as 2010, more than 40% of PCCM program directors reported that a lack of trained faculty was a meaningful obstacle to ultrasound instruction. By 2020, nearly half of ICU chiefs at Veterans Affairs centers echoed the same concern.
The result is a training landscape that is inconsistent, hard to scale, and overly dependent on the availability of a small number of experts.
Researchers at Stony Brook University developed and evaluated a longitudinal, one-year blended learning curriculum for first-year PCCM fellows. The curriculum was structured around seven steps, covering everything from formal coursework and image portfolio development to deliberate practice sessions, clinically targeted scanning, and a final competency assessment.
The key innovation was in Step I, the initial formal training course. Rather than relying entirely on in-person didactics, the blended learning model incorporated asynchronous learning through the SonoSim platform, allowing fellows to complete modules on their own schedule before coming together for hands-on practice sessions with faculty.
Eleven first-year PCCM fellows completed the blended learning curriculum. Their outcomes were compared to those of fellows from prior years who had gone through a traditional, fully in-person version of the same curriculum.
The results were clear. Fellows in both groups showed significant improvements in both knowledge and hands-on skills immediately after completing the course, and those gains held up at the six-month mark.
On the written knowledge exam, median scores jumped from 24% before the course to 71% immediately after, with no meaningful drop at six months. Skills exam scores followed the same pattern, rising from 16% pre-course to 87% post-course, with retention remaining strong at the six-month follow-up.
Critically, there was no statistically significant difference in outcomes between the blended-learning group and the traditional-curriculum group. The blended approach performed just as well, but it required fewer than 15 faculty hours to deliver.
Learner feedback reinforced the numbers. All nine fellows who completed the course evaluation rated it as well-designed and engaging. They noted that the asynchronous modules were manageable in volume and that the combination of self-directed preparation and in-person scanning sessions gave the course structure and practical value.
The implications of this study extend well beyond Stony Brook. Fellowship programs across the country are grappling with the same faculty bandwidth problem, and the blended learning model offers a scalable path forward.
By shifting foundational didactic content to an asynchronous format, programs can reserve limited in-person faculty time for the sessions where it matters most: hands-on scanning, case-based discussion, and direct skill feedback. Fellows gain the flexibility to learn at their own pace, while programs gain a more sustainable training model that does not depend on an unlimited supply of expert faculty hours.
The study also reinforces something that the broader ultrasound education community has increasingly recognized: simulation-based, asynchronous learning is not a compromise. When implemented thoughtfully, it is a legitimate and effective way to build clinical competency.
It is worth noting that the SonoSim platform served as the foundation for the asynchronous learning component of this curriculum. Fellows completed interactive modules and virtual scanning simulations through SonoSim as part of Step I, building baseline knowledge and scanning familiarity before transitioning to supervised, in-person practice.
This type of structured, simulation-based preparation is exactly what SonoSim is designed to support. Whether a program is building out a new PCCM curriculum or looking for ways to reduce the faculty burden on an existing one, the combination of asynchronous learning and hands-on clinical practice represents a proven path to durable skill development.
If your program is looking to strengthen pulmonary and critical care ultrasound training, explore SonoSim's pulmonary ultrasound training resources to see how our platform can support your curriculum goals.
Reference: Kuperstein H, Gada K, Alam W, Ahmad S. A longitudinal blended learning curriculum for bedside ultrasound education in pulmonary and critical care fellowship. BMC Medical Education. 2025;25:123. https://doi.org/10.1186/s12909-024-06584-8