This chapter presents some important issues related to training and competence in critical care ultrasonography. The field is likely to undergo rapid growth in the next few years. Intensivists should be aware of some of the challenges they will face in achieving competence in bedside ultrasonography and the potential solutions to those challenges. This chapter will present a discussion of some of the issues related to training in critical care ultrasonography and will describe a more concrete and prescriptive approach to the issue of training, developed and implemented for our own trainees, which serves as a model for ensuring that the knowledge and skills can be applied to the care of the patient. Table 4.1 provides a list of common terms that are important to the discussion of training.
Table 4.1. Common Terms Important in Discussing Training |Favorite Table|Download (.pdf)
Table 4.1. Common Terms Important in Discussing Training
• Competence refers to the implicit, internalized knowledge of critical care ultrasonography that enables intensivists to use the technique for the clinical benefit of their patient; this requires the skill, knowledge, and capacity to be proficient in the field.
• At the most basic level, any definition of competence is based on a standard developed by an authoritative group.
• In the United States, major national professional societies have traditionally been involved with the definition of competence. In addition, the American Board of Medical Specialties and the Accreditation Commission for Graduate Medical Education have been responsible for defining competence that is relevant to postgraduate medical education including critical care fellowship training.
• Certification is defined as the process by which competence is formally recognized by an external agency.
• In the United States, there is presently no accepted process for certification in critical care ultrasonography. A formal definition of competence is clearly a necessary prerequisite to developing criteria, standards, and a training process leading to certification.
• Credentialing is defined as the method whereby an individual hospital or other specific entity grants a clinician permission to practice based on an assessment of legitimacy of training, knowledge, and skills.
• Credentialing is a local, hospital-based issue that is related to competence and certification insofar as the hospital may require competence and certification (if available) before granting credentials (or privileges) to perform critical care ultrasonography.
• Training refers to the process by which the intensivist develops the knowledge, skills, and competence in critical care ultrasonography.
• Training of the intensivist encompasses hands-on image acquisition, immediate bedside image interpretation, and the cognitive ability to apply the results at the bedside of the critically ill patient.
Critical care ultrasonography is a relatively new application of a well-established technology. In the United States, there is not yet a means for the intensivist to become formally certified in the field, and the relevant professional societies have not yet developed a clear ...