title: Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists.
abstract: OBJECTIVE
  Guidelines recommend teaching of lung ultrasound for critical care, though little information exists on how much training is required for independent practice, especially for non-physician trainees. We thus aimed to elucidate a threshold number of cases above which competency for independent practice may be attained for respiratory therapists (RTs).
  
  
  METHODS
  We conducted a prospective audit of lung ultrasound training between July 2014 and April 2015 in our 20-bed medical intensive care unit. Following theoretical instruction and self-learning, trainees acquired images from 12 lung zones under direct supervision and classified images into six patterns. Assistance during image acquisition and correct interpretation of ultrasound images were recorded.
  
  
  RESULTS
  Eleven ultrasound-naïve RTs scanned an average of 15 patients each (170 patients in total). Among supervisor-adjudicated lung ultrasound findings, 35.5% were abnormal. Blinded verification of the adjudicated findings was done for the first 92 patients (1104 images), with an agreement of 95.4%. As RTs scanned more patients, there was a significant decrease in the proportion of images requiring supervisor assistance (Cuzick's P < 0.001), and a significant increase in the proportion of correctly identified images (Cuzick's P = 0.008). After trainees performed at least ten scans, less than 2% of images required assistance with acquisition and less than 5% were wrongly interpreted.
  
  
  CONCLUSIONS
  Our training method allowed RTs to independently perform lung ultrasound after at least ten directly supervised scans. Given that RTs are likely to have less ultrasound knowledge and less clinical know-how compared to physicians, we believe that the same threshold number of scans may be also safely applied to the latter.
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore, 119228, Singapore. kay_choong_see@nuhs.edu.sg.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. kay_choong_see@nuhs.edu.sg.
authors.forename: K C
authors.initials: KC
authors.lastname: See
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore, 119228, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: V
authors.initials: V
authors.lastname: Ong
authors.affiliation: Respiratory Therapy, Inter-departmental Division of Critical Care, National University Health System, Singapore, Singapore.
authors.forename: S H
authors.initials: SH
authors.lastname: Wong
authors.affiliation: Respiratory Therapy, Inter-departmental Division of Critical Care, National University Health System, Singapore, Singapore.
authors.forename: R
authors.initials: R
authors.lastname: Leanda
authors.affiliation: Respiratory Therapy, Inter-departmental Division of Critical Care, National University Health System, Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.affiliation: Respiratory Therapy, Inter-departmental Division of Critical Care, National University Health System, Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Taculod
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore, 119228, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: J
authors.initials: J
authors.lastname: Phua
authors.affiliation: Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore, 119228, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: C M
authors.initials: CM
authors.lastname: Teoh
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D003479:Curriculum; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000592:standards; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011446:Prospective Studies; D012138:Respiratory Therapy / Q000193:education*; D014465:Ultrasonics / Q000193:education*; D014463:Ultrasonography
keywords: Curriculum; Education; Learning; Lung; Thorax; Ultrasonography