Learning Pediatric Point-of-Care Ultrasound: How Many Cases Does Mastery of Image Interpretation Take?

Area of Science:

• Pediatric Emergency Medicine
• Medical Education
• Diagnostic Imaging

Background:

• Point-of-care ultrasound (POCUS) is increasingly vital in pediatric emergency care.
• Standardized training and assessment are crucial for ensuring physician competency in POCUS interpretation.
• Understanding case volume and difficulty is key to developing effective POCUS curricula.

Purpose of the Study:

• To determine the number of cases needed to reach a performance benchmark in interpreting pediatric POCUS images across various applications.
• To identify specific POCUS applications and imaging findings that pose the greatest diagnostic challenges for physicians.
• To inform the development of future POCUS credentialing guidelines and educational interventions.

Main Methods:

• Pediatric emergency physicians completed web-based POCUS courses with deliberate practice.
• Participants aimed for a 90% combined score in accuracy, sensitivity, and specificity for image interpretation.
• Case interpretation difficulty was scored to identify diagnostic challenges.

Main Results:

• A median of 87-128 cases were required to achieve the performance benchmark, with cardiac applications needing the most cases (median 128).
• Interpreting foreign bodies in soft tissue POCUS was more challenging than other findings.
• Assessing cardiac function and abnormal ventricles, and identifying absent lung sliding, were more difficult than other lung POCUS findings.

Conclusions:

• Significant variation exists in the number of cases required to achieve POCUS proficiency.
• Cardiac and lung POCUS applications, along with specific findings like foreign bodies, present greater diagnostic hurdles.
• These findings can guide the creation of more targeted and effective POCUS training programs and credentialing standards.