Point-of-Care Ultrasound • POCUS

Challenges Abound for POCUS Learners

The challenges to learning and teaching ultrasound at the bedside are well-known and well-documented. Throughout medicine, practitioners know that point-of-care ultrasound can greatly speed up and increase the accuracy with which patients are diagnosed and treated.

However, learning and teaching POC ultrasound requires overcoming a lot of critical factors. You have to be able to overcome a lack of machines, a lack of ultrasound experts available at the right moment, a need for the right patients at the right time with the right pathology, the ability to create standardization of learning and repetition for learners... the list goes on.

There is no better way to learn POCUS than having a qualified instructor take a learner with baseline ultrasound knowledge through a diligent ultrasound exam that helps inform medical decision-making. However, in reality, the lack of standardized access to pathology, qualified instructors, teaching moments, and access to ultrasound machines all combine to create massive obstacles to widespread POCUS competency. Combine with the lack of foundational ultrasound knowledge in learners, performance tracking, assessment, and feedback mechanisms and the barriers become a seemingly unsolvable puzzle.

Mastering point-of-care ultrasound (POCUS) can be an intimidating endeavor. This cutting-edge imaging method has gained popularity in clinical settings due to its numerous advantages over traditional methods. It is a non-invasive, portable solution that offers real-time imaging, allowing clinicians to interpret and quickly translate findings to patient care. However, there are several obstacles that care providers encounter when learning to perform ultrasound at the bedside in clinical practice.

One of the primary challenges lies in the variable & inconsistent exposure to patient pathology. Unlike radiologists who analyze countless scans daily, clinicians using POCUS may only come across a few cases each week. This scarcity can make it challenging to learn to acquire ultrasound images, identify abnormalities and develop a comprehensive understanding of what constitutes "normal" in ultrasound readings.

Consistently correct interpretation of ultrasound images also proves to be a formidable challenge. The intricate nature of anatomy and the lack of standardized protocols contribute to the difficulty in reliably interpreting ultrasound images. Distinguishing between normal and abnormal structures can be particularly challenging, especially when dealing with critically-ill patients. And, understanding how to use and/or overcome imaging artifacts, such as shadowing or reverberation, is a critical skill that adds to the complexity of ultrasound acquisition & interpretation.

Point-of-care ultrasound skill acquisition is also often compromised by the limited availability of ultrasound experts to provide feedback. The learning curve for ultrasound can be steep and protracted, and it may take some time before a novice is proficient enough to perform scans without supervision.

Finally, learning & teaching POCUS can be challenging because of time constraints that limit "teaching moments". Characterized by having an ultrasound machine, a patient with pathology, a learner, a qualified instructor, and the ability to engage in deliberate practice, teaching moments are rare. These teaching moments are critical and need to be repeated multiple times, and applied to each new ultrasound application a learner wishes to master.