In order to become competent in critical care ultrasonography (CCUS), the intensivist must access effective training, as competence is the goal of training. This chapter summarizes some aspects of training in CCUS that may be useful to two distinct groups: the frontline clinician who has decided to develop competence in CCUS and the faculty who are responsible for providing training to their colleagues.
Individual intensivists who seek training face different challenges depending on their function within the medical hierarchy. Physicians in training, such as residents or fellows, are in a good position, as they have the time and assignment to acquire a wide variety of skills intrinsic to critical care medicine, one of which includes CCUS. Only if there are no capable faculty available to provide them with training will they have difficulty in achieving this goal. Unfortunately, this is still the case in many fellowship training programs both in North America and Europe and will only be remedied in coming years by faculty development aided by the establishment of requirements for provision of training in CCUS at the fellowship level.
The attending level intensivist faces the challenge of obtaining training in CCUS while balancing the demands of the workplace, family life, and economic pressures. Some attending level intensivists come from an adverse training environment. They may work in a geographically isolated hospital surrounded by unfriendly colleagues from other specialties who are not interested in helping a co-worker develop a new skill. Others may be more fortunate and work in a hospital where knowledgeable radiology and cardiology colleagues are interested in providing local expertise for supervision of training.
There are several approaches that are effective when considering training. If a resident or fellow is in a program that provides formal training in CCUS, competence is achieved as a normal part of critical care training. If the program is not able to provide this, the fellow is in the same position as the attending who seeks training following their fellowship years. This group frequently develops competence using an “on the job” approach. In this case, the clinician works in a friendly training environment where they are supported by an informal network of colleagues.
Training in CCUS requires skills in image acquisition, image interpretation, and mastery of the cognitive elements of the field. Mastery of image acquisition is a key skill required for CCUS, as the frontline intensivist personally performs all parts of the ultrasound examination. Training in image acquisition requires partnering with a skilled ultrasonographer in combination with regular deliberate practice, initially on normal models followed by the scanning of patients. For “on the job” training, the learner may seek the help of highly skilled ultrasound technicians who, particularly in the United States, perform much of cardiology and radiology image acquisition. Widespread use of ultrasound technicians is common in the United States, while in Europe it is common for the physician ...