King’s Partnership Point of care ultrasound training Curriculum
This is our local training structure for a suggested approach to how to learn point of care ultrasound (POCUS). This programme is not accredited by any outside bodies, but certificates will be provided after completing of each level.
It is divided up broadly in three areas of the body: Thoracic, Cardiac and Abdominal. Within each region there will an introductory lecture and a suggested number of observed scans. However, this number of scans is a guide only, certificates will be provided after attendance of lectures, completion of logbook AND ongoing assessment of competency.
It is designed to be modular and flexible. For example, if a candidate feels one region or type of scan will be useful for there practice then they can proceed only with that particular indication (for example a surgical training only undertaking the Abdominal module or medical residents not learning scans only relevant to trauma).
Modules
Thoracic (lung)
Cardiac (Echocardiography)
Abdominal
Description of levels
Level 1; Able to undertake scan of each area, identify basic pathology. Approximately 10 scans.
Level 2; Identify more complex pathology in each area. Approximately 30 scans.
Level 3 would be masters/educators and undertake more technically difficult scans, this would vary based on area of practice. 50-100 scans suggested.
Level one
Thoracic
Can identify pneumothorax, effusions, A-lines, B-lines.
Can identify landmarks for pleural drainage (if undertaken this)
Abdominal
Identify ascites or free fluid in case of trauma.
Can identify both kidneys.
Identify liver, spleen, and bladder.
Estimate bladder volume using automatic function.
Cardiac
Perform subxiphoid, parasternal long and short axis views and 4 chamber view.
Identify pericardial effusion.
Make gross estimation of cardiac contractility.
Level two
Suggested 30 scans.
Can perform all scans suggested at level one but in addition.
Level two candidates should be able to choose which scans to undertake and combine different scans together as per the patients’ presentations.
They should also have knowledge of standardised protocols (eFAST, RUSH, FASH)
Thoracic
Can identify pneumothorax, effusions, A-lines, B-lines.
Can identify landmarks for pleural drainage (if undertake this)
Identify pneumonia, abscess.
Abdominal
Identify largest pocket of ascites for drainage and suggest unsafe volume.
Can identify both grade 3 and above hydronephrosis.
Identify large and small bowel obstruction.
Basic early pregnancy findings (e.g. free fluid in suspect ectopic pregnancy)
Cardiac
Roughly estimated LV fraction (poor, moderate, good)
Identify right ventricle strain/dilation.
Identify IVC and implications of this finding regards to fluid balance.
Perform two-point compression DVT scan.
Soft tissue and musculoskeletal (optional level two)
Identify signs of peripheral oedema/cellulitis
Identify an abscess.
Perform ultrasound assisted/guided knee aspiration.
Level 3
Suggested 50-100 per region.
Level 3 practitioners will be confident enough in the level 2 curriculum to teach this content and demonstrate good teaching abilities to their peers. They are also able to demonstrate advantages and limitations of POCUS.
In addition, they can undertake more complex scanning when indicated, such as listed below. However, the exact nature of their advance scanning will be adapted to the field in which they work.
Thoracic
Identify features consistent with TB.
Identify rib fractures.
Understand and perform the Blue protocol.
Abdominal
Identify grade 1 and 2 hydronephrosis.
Biliary; identify calculi, signs of cholecystitis and obstruction.
Perform manual estimation of bladder size.
Identify and measure kidneys, spleen, and liver.
Look for signs of appendicitis.
Cardiac
Make a quantitative estimate of LV function.
Identify valvular dysfunction.
Regional wall motion abnormalities
Look for indirect signs of aortic dissection.
Ultrasound guided pericardiocentesis
Soft tissue and musculoskeletal (Optional Level three)
Identify fractures and dislocations.
Undertake ultrasound guided peripheral nerve blocks.
Identify muscle/tendon tears.
Use ultrasound to assist difficult lumbar punctures.
Other areas for potential use (To learn as directed)
Ocular ultrasound
Advance pregnancy ultrasound
Detailed early pregnancy findings
Regional nerve blocks