The Design and Evaluation of the Comprehensive Hospitalist Assessment and Mentorship with Portfolios (CHAMP) Ultrasound Program
BACKGROUND: Literature supports the use of point-of-care ultrasound performed by the treating hospitalist in the diagnosis of common diseases. There is no consensus on the training paradigm or the evaluation of skill retention for hospitalists.
OBJECTIVE: To evaluate the effectiveness of a comprehensive bedside ultrasound training program with postcourse competency assessments for hospitalists.
DESIGN: A retrospective report of a training program with 53 hospitalists. The program consisted of online modules, a 3-day in-person course, portfolios, 1-day refresher training, monthly scanning, and assessments. Hospitalists were rated by using similar pre- and postcourse competency assessments and self-rating parameters during the 3-day and refresher courses.
SETTING: A large tertiary-care center.
RESULTS: Skills increased after the 3-day course from a median preassessment score of 15% correct (interquartile range [IQR] 10%-25%) to a median postassessment score of 90% (IQR 80%-95%; P < .0001). At the time of the refresher course, the median precourse skills score had decreased to 65% correct (IQR 35%-90%), which improved to 100% postcourse (IQR 85%-100%; P < .0001). Skills scores decreased significantly less between the post 3-day course assessment and pre 1-day refresher course for hospitalists who completed portfolios (mean decrease 13.6% correct; P < .0001) and/or monthly scanning sessions (mean decrease 7.3% correct; P < .0001) compared with hospitalists who did not complete these items.
CONCLUSIONS: A comprehensive longitudinal ultrasound training program including competency assessments improved ultrasound acquisition skills with hospitalists. Skill retention remained high in those who completed portfolios and/or monthly scanning sessions along with a 1-day in-person refresher course.
© 2018 Society of Hospital Medicine
Point-of-care ultrasound (POCUS) is a valuable tool to assist in the diagnosis and treatment of many common diseases.1-11 Its use has increased in clinical settings over the years, primarily because of more portable, economical, high-quality devices and training availability.12 POCUS improves procedural success and guides the diagnostic management of hospitalized patients.2,9-12 Literature details the training of medical students,13,14 residents,15-21 and providers in emergency medicine22 and critical care,23,24 as well as focused cardiac training with hospitalists.25-27 However, no literature exists describing a comprehensive longitudinal training program for hospitalists or skills retention.
This document details the hospital medicine department’s ultrasound training program from Regions Hospital, part of HealthPartners in Saint Paul, Minnesota, a large tertiary care medical center. We describe the development and effectiveness of the Comprehensive Hospitalist Assessment and Mentorship with Portfolios (CHAMP) Ultrasound Program. This approach is intended to support the development of POCUS training programs at other organizations.
The aim of the program was to build a comprehensive bedside ultrasound training paradigm for hospitalists. The primary objective of the study was to assess the program’s effect on skills over time. Secondary objectives were confidence ratings in the use of ultrasound and with various patient care realms (volume management, quality of physical exam, and ability to narrow the differential diagnosis). We hypothesized there would be higher retention of ultrasound skills in those who completed portfolios and/or monthly scanning sessions as well as increased confidence through all secondary outcome measures (see below).
MATERIALS AND METHODS
This was a retrospective descriptive report of hospitalists who entered the CHAMP Ultrasound Program. Study participants were providers from the 454-bed Regions Hospital in Saint Paul, Minnesota. The study was deemed exempt by the HealthPartners Institutional Review Board. Three discrete 3-day courses and two 1-day in-person courses held at the Regions Hospital Simulation Center (Saint Paul, Minnesota) were studied.
Program Description
In 2014, a working group was developed in the hospital medicine department to support the hospital-wide POCUS committee with a charter to provide standardized training for providers to complete credentialing.28 The goal of the hospital medicine ultrasound program was to establish the use of ultrasound by credentialed hospitalists into well-defined applications integrated into the practice of hospital medicine. Two providers were selected to lead the efforts and completed additional training through the American College of Chest Physicians (CHEST) Certificate of Completion Program.29 An overall director was designated with the responsibilities delineated in supplementary Appendix 1. This director provided leadership on group practice, protocols, and equipment, creating the organizational framework for success with the training program. The hospital medicine training program had a 3-day in-person component built off the CHEST Critical Care Ultrasonography Program.24 The curriculum was adapted from the American College of Chest Physicians/Société de Réanimation de Langue Française Statement on Competence in Critical Care Ultrasonography.30 See Table 1 for the components of the training program.
Online Modules
3-Day In-Person Course with Assessments
The 3-day course provided 6 hours of didactics, 8 hours of image interpretation, and 9 hours of hands-on instruction (supplementary Appendix 4). Hospitalists first attended a large group didactic, followed by divided groups in image interpretation and hands-on scanning.24
