Camilla Aakjær Andersen

Point-of-care ultrasound (POCUS) has increasingly become an integral diagnostic tool in general practice and family medicine (GP/FM) [1,2]. POCUS use in primary care has the potential to improve di...

This document was initiated by the Safety Committee (ECMUS) of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) and prepared together with the Executive Board. It gives directions as to how to perform live ultrasound demonstrations at courses, meetings, and conferences with respect to the patients and models including informed consent.

English Frontline physicians working in primary care increasingly use diagnostic ultrasound examinations and simple ultrasound-guided procedures as part of their daily practice. Primary care is organized in many ways across Europe and as a result, primary care physicians have different qualifications in terms of using and integrating point-of-care ultrasound in patient care. To ensure high quality and standardized practice across Europe, this position paper of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) describes training recommendations and a generic core curriculum for frontline physicians working in primary care. The core curriculum was developed through a Delphi process and includes basic ultrasound examinations corresponding to the EFSUMB competence level 1 for medical ultrasound practice. The training recommendations are intended to build a common foundation while national adjustments must be made to ensure relevance in the clinical setting and patient population. German In der Primärversorgung tätige Ärzte setzen zunehmend diagnostische Ultraschalluntersuchungen und einfache ultraschallgesteuerte Verfahren als Teil ihrer täglichen Routine ein. Die Primärversorgung ist in Europa sehr unterschiedlich organisiert, sodass die Qualifikationen der Ärzte, die Point-of-Care-Ultraschall in der primären Patientenversorgung einsetzen und integrieren, sehr unterschiedlich sind. Mit dem Ziel, eine hohe Qualität und standardisierte Ausübungspraxis in ganz Europa zu gewährleisten, stellt dieses Positionspapier der European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Ausbildungsempfehlungen und ein PoCUS Basis-Curriculum für in der Primärversorgung tätige Ärzte vor. Das Basis-Curriculum wurde im Rahmen eines Delphi-Verfahrens entwickelt und umfasst grundlegende Ultraschalluntersuchungen, die dem EFSUMB-Kompetenzniveau 1 für die medizinische Ultraschallpraxis entsprechen. Die Ausbildungsempfehlungen sollen eine gemeinsame Grundlage schaffen, wobei durch nationale Anpassungen die Relevanz für das konkrete klinische Umfeld und die betreuten Patientengruppen sichergestellt werden muss.

As an imaging modality, ultrasound relies on user skill and demands the integration of anatomical understanding, image acquisition techniques, and clinical knowledge. Proficiency in performing Point-of-Care Ultrasound (POCUS) examinations is a gradual process necessitating ongoing practice and exposure. Office-based general practitioners (GPs) encounter distinctive educational challenges when striving to acquire and sustain scanning competences. Therefore, traditional short workshops and training programs are not well suited for GPs. This hybrid effectiveness-implementation study aimed to explore whether a novel educational program, specifically tailored to meet the learning needs of office-based GPs, could lead to scanning competence by the program's conclusion and if this competence can be sustained post-course. GPs working in office-based general practice in Denmark were invited to participate in a three-months ultrasound educational program. To assess its effectiveness, participants underwent scanning competence evaluation by external experts at the end of the training program and again three months later. The experts assessed the participants twice using the objective structured assessment of ultrasounds skills (OSAUS) standardized evaluation tool. This evaluation covered seven items: ‘indication for the examination’, ‘applied knowledge of ultrasound equipment’, ‘image optimization’, ‘systematic examination’, ‘interpretation of images’, ‘documentation of the examination’, and ‘medical decision-making’. To evaluate implementation of the educational program, data were collected on the participants’ completion of the program’s educational elements and their use of POCUS following the program. The 18 participating GPs were found to have scanning competence scores after completing the educational program, ranging from 68.9% to 82.3% of the maximum score, depending on the POCUS application. At follow-up, their scores had significantly increased for all POCUS applications, ranging from 80.9% to 92.6% of the maximum score. While completion of the educational elements varied between participants, all implemented POCUS in their daily practice during the educational program. This study emphasizes that a customized training program, considering the learning challenges faced by office-based GPs, can result in scanning proficiency that continues to develop in the months following the training. Clinical trials registration ID NCT05274581.

The use of point-of-care ultrasound (POCUS) in general practice increases, but little is known about potential unintended findings and harms to patients. Information regarding such unwanted effects may be obtained by evaluating the medical records of patients who have been scanned by their general practitioner. To identify and characterize re-consultations related to POCUS use in general practice, potential misdiagnosis, overdiagnosis, and incidental findings, and to compare potentially troublesome cases to GPs' scanning competence and type of ultrasound device. Professors in general practice with extensive experience in both research and quality assurance in general practice did a blinded review of prospectively collected routine electronic medical record data combined with cross-sectional data collected in relation to POCUS examinations. Twenty general practitioners collected data on 564 patients examined with POCUS in primary care. International standards for the classification of adverse events and incidental findings were used. First, research assistants identified all re-consultations described in the medical records that were related to the primary health complaint at the index consultation. Second, these re-consultations were classified by the medical experts in terms of seriousness and relation to the POCUS examination performed at the index consultation. In addition, the experts identified possible misdiagnosis, possible overdiagnosis, and incidental findings. Finally, identified cases were discussed in terms of appropriateness and described narratively. Medical records of 564 patients were reviewed. A low risk of possible misdiagnosis (5.3%), potential overdiagnosis (0.7%), and incidental findings (0.7%) were found. Eleven POCUS-related re-consultations were identified and described. POCUS scanning performed by general practitioners was generally safe, but it can result in unnecessary examinations and potential harm in a few cases. Certain areas, e.g. pelvic scans that included the ovaries, may especially be prone to misdiagnosis. NCT03375333.

Point-of-care ultrasound (PoCUS) has found its way into primary care in some, but not all, European countries. A prerequisite for achieving Europe-wide comparable diagnostic reliability of PoCUS performed by primary care physicians is high-quality training that is limited to relevant, frequently encountered PoCUS applications that are easy to learn and master. A European Federation of Societies for Ultrasound in Medicine (EFSUMB) task force performed a brainstorming exercise to identify all possible ultrasound examinations that could be performed in primary care. A 3-stage Delphi process was launched. The Delphi panelists were 95 primary care physicians from 28 European countries with more than 2 years of experience using and teaching ultrasound. Solely focusing on the complexity of performing PoCUS, the panelists reduced the brainstorming list in a stepwise manner to a basic core curriculum intended for primary care frontline physicians including 40 diagnostic PoCUS examinations within 13 different anatomical areas and no ultrasound-guided procedures. A 75% cut-off was used for agreement. Despite the great heterogeneity of the Delphi panel representing different views and contexts from across Europe, kappa statistics showed substantial or moderate agreement across Delphi rounds 2 and 3 for 85% of the 40 diagnostic PoCUS applications. The results of this study offer guidance for EFSUMB to establish training recommendations for a basic core curriculum that can be adapted to the needs of different regions of Europe and thus create a basis for PoCUS to become a reliable diagnostic tool in primary care across Europe, based on common quality standards.

To evaluate general practitioners' (GPs') ability to perform focused lung ultrasound (FLUS) following a training program and assess FLUS feasibility in general practice. Also, to describe FLUS findings and evaluate GPs' ability to interpret these in adults with acute lower respiratory tract infection (LRTI) when pneumonia is suspected and assess GPs' perception of FLUS impact. Nine GPs, using point-of-care ultrasound, completed a FLUS training program. Adults (≥ 18 years) with acute cough (< 28 days) and at least one other symptom of acute LRTI, where the GP suspected pneumonia, were subsequently included. All patients received FLUS. The GPs reported FLUS findings, feasibility, and perception of FLUS impact. Recorded FLUS videos from all patients were reviewed by two specialists (Specialist Reference). The specialists assessed FLUS image quality. Agreements between the GPs and the Specialist Reference on FLUS findings were used to evaluate GPs' ability to interpret FLUS. Of 91 patients included, FLUS image quality was acceptable or higher in 84 patients (92.4%). FLUS proved feasible with only two scans not completed. The GPs reported FLUS pathological findings in 51.7% of patients in 78% agreement with the Specialist Reference and Cohen's kappa 0.56. Focal B-lines represented the most frequent pathological findings. The GPs perceived that FLUS impacted change in tentative diagnosis and/or plans for treatment and/or visitation in 29 (32.0%) of patients. After the training, the GPs performed FLUS well. Interpretation of FLUS pathology presence was of moderate agreement. The GPs perceived that FLUS had impact on patient management. ClinicalTrials.gov NCT04711031.

The use of point-of-care ultrasonography in primary care is increasing. Primary care physicians are introduced to ultrasonography at short workshops with little guidance for implementation of the technology in clinical routines and medical decision-making. This article introduces a framework for longitudinal ultrasound education tailored for office-based general practice, building on the best available evidence and established teaching principles. The framework includes three teaching seminars over three months, a curriculum of 10 ultrasound applications, an online learning platform providing educational support before, during, and after the teaching seminars and continuous support and feedback from allocated mentors. The framework aims to reduce primary care physicians' absence from the clinic, scaffold the learning process to build a solid and sustainable foundation of knowledge, and support implementation and appropriate use of the technology in the unselected patient population in primary care setting. Evaluation of the framework demonstrated high satisfaction with the educational elements among both participants and teachers.