Table 2 Key considerations regarding education and competency
Educational elements | Potential educational mechanisms and assessment of competency | Relevance to scope of practice |
|---|---|---|
1. Critical understanding of how an ultrasound image is generated. Includes  • Fundamental physics as applied to ultrasound  • Artefacts and how to manage/interpret them | Face to face teaching and/or provision of online/pre-reading material Multiple choice questions/coursework around imaging scenario(s) | As core underpinning principles, PoCUS users require an awareness of the limitations of the modality and how to interpret the sonographic representation of tissues |
2. Image optimisation. Includes:  • The function of ultrasound machine settings (relating back to fundamental physics principles)  • ‘Knobology’ and application of image optimisations strategies in practical scenarios | Include provision of online/pre-reading material. However, hands on teaching is essential—for example, using phantoms, simulators, healthy subjects Overlap with 1. However hands on assessment is essential and could be integrated with objective structured clinical examination (OSCE) format | Image optimisation techniques are essential for high quality imaging practice and allows for adaptation to different ultrasound machines and clinical scenarios |
3. Safety and professional considerations. Includes:  • Thermal and non-thermal effects; ALARA (As Low As Reasonably Achievable) principles  • Infection prevention and control  • Use of evidence based protocols; taking and labelling of standardised views  • Reporting terminology  • Secure storage of images and their integration into the electronic patient record of the wider care pathway  • Awareness of benefits and limitations of ultrasound imaging and awareness of role of other imaging modalities  • Indications for performing a scan; includes informed patient consent | Include provision of online/pre-reading material, although practical teaching is essential Overlap with 1 and 2. Hands on assessment is essential and could be integrated with OSCE format | Safety considerations that are generic in ultrasound imaging and specific to respiratory system scanning Standardised image taking, recording and reporting allow for consistency with other ultrasound imagers As professionals without a pre-existing foundation in imaging, awareness of the indications for, and the role of imaging modalities is essential |
4. Imaging of ‘normal’ anatomy. Includes  • Ability to use standardised protocols, recognise normal anatomical variation and adapt imaging based upon factors such as high levels of adipose tissue, poor patient positioning or poorly imaging tissues | Include provision of online/pre-reading material. However, hands on teaching is essential—using simulators and more importantly healthy subjects. Requires a range of ‘normal’ presentations Overlap with 1 and 2. However hands on assessment is essential and could be integrated with OSCE format | Awareness of the range of ‘normal’ presentations provides a reference for identifying deviations from normal Provides an opportunity to familiarise self with strategies for addressing sub-optimal imaging prior to moving onto imaging ‘non-normal’ |
5. Imaging of ‘non-normal’ anatomy. Includes  • Awareness of the range of sonographic presentations associated with different pathologies/clinical scenarios. Where applicable, how to perform a differential sonographic diagnosis  • How to adapt imaging based upon factors, such as high BMI, poor patient positioning or poorly imaging tissues  • Clinical relevance (or otherwise) of sonographic findings, including false + ve/–ve | Include provision of online/pre-reading material. However, hands on teaching is essential—using simulators and more importantly patients. Requires a range of different pathologies/clinical presentations Essential requirements include availability of suitably qualified and experienced mentor, access to an appropriate patient mix and directly supervised scanning Overlap with 1 and 2. However hands on assessment is essential. Directly supervised assessment of scanning patients is the recommended assessment approach along with logbook of scans undertaken and critical reflection upon subsequent clinical decision making | Awareness of the range of pathological / clinical presentations, including spectrum of severity. Ability to adapt imaging practice to address sub-optimal imaging An awareness of how to interpret the imaging findings, implement them into clinical decision making/treatment—and communicate them to the other care pathway members (as appropriate) |