Is ultrasound training sustainable? A systematic review of competency retention in healthcare trainees

Despite Point-of-Care Ultrasound (PoCUS) emerging as an essential clinical skill, evidence regarding practitioners' knowledge retention and competence remains poorly synthesized. This systematic review sought to evaluate PoCUS competency retention patterns using the Indication, Acquisition, Interpretation, Medical decision-making (I-AIM) framework following various educational interventions and to identify factors influencing long-term skill retention among healthcare professional trainees.

The authors conducted a systematic review by searching PubMed, the Cochrane Library and Embase databases (1990-2024) for studies evaluating PoCUS educational interventions with objective competency measures and retention assessment. Data were analysed based on educational strategies, course duration and retention patterns across I-AIM domains.

Thirty-one studies met the inclusion criteria, comprising 1638 participants (38.6% medical students, 20.5% attending physicians). Most studies employed a single-group pretest-posttest design (54.8%) and demonstrated moderate-to-high methodological quality (Medical Education Research Study Quality Instrument median: 12.5, interquartile range [IQR]: 11.0 to 13.0). Within the I-AIM framework analysis, all domains of competency retention demonstrated a decline over a 1-12-month follow-up period. The Acquisition domain showed the most significant decline with median percentage changes of -11.8% (IQR: -16.5% to -6.4%), followed by Interpretation, Medical decision-making and Indication. Short-course programs (≤4 h) demonstrated greater competency decline (median: -11.8%, IQR: -16.9% to -4.4%) compared to long-course programs (median: -2.6%, IQR: -6.8% to 1.3%). Hands-on practice with high-fidelity simulation and clinical context integration were associated with superior retention outcomes across multiple domains.

Ultrasound competence retention showed variable decay patterns across I-AIM domains, with Acquisition skills showing the most pronounced deterioration, particularly following short-course programs. Comprehensive training programs integrating high-fidelity hands-on practice and clinical context may enhance PoCUS retention for healthcare providers.