Recommendations for Training Programs for Point-of-Care Ultrasound in the Chronic Pain Setting

Point-of-care ultrasound (POCUS) skills are essential for anesthesiologists and pain physicians; however, no guidance have been established for defining which core components are relevant for diagnosing and managing patients with chronic pain, nor are there requirements for documentation of competency for these physicians. To respond to these missing components, the American Society of Regional Anesthesia and Pain Medicine (ASRA) appointed a task force to formulate recommendations on training and education. This second part of the guidelines were published in the British Medical Journal.

The guidelines established objectives to achieving competency in the use of POCUS in the airway, lung, gastrointestinal tract, cardiac tissue, and sonogram for trauma. The minimum number of supervised POCUS sessions differs on type of ultrasound. The panel recommended a minimum of 20 sessions for some tissues and 150 supervised imaging sessions for others.

In general, all POCUS sessions follow the Indication, Acquisition, Interpretation, and Medical decision-making framework. This framework begins with theoretical knowledge of the relevant sonoanatomy combined with knowledge of the presentation of possible artifacts, requires the ability to accurately and efficiently acquire and interpret ultrasound images, and requires the ability to formulate appropriate clinical decisions and recommend treatments.

The expert panel asserted the training for the indications step should include didactic learning. Both image acquisition and interpretation should have large amounts of hands-on-training. The step of medical decision making should involve in-depth discussions of clinical cases with a mentor and fellow trainees.

In order to acquire the knowledge and expertise needed to incorporate POCUS into routine clinical practice, the authors of this review recommended the many ‘flipped classroom’ courses which have recently become available worldwide. In addition, several societies (International Anesthesia Research Society, American Society of Anesthesiologists, Society of Cardiovascular Anesthesiologists, and ASRA) host POCUS workshops in which interested clinicians may participate.

The authors highlighted potential barriers to the incorporation of adequate POCUS training programs or for its use in routine clinical practice. The most frequently cited difficultly has been access to appropriate machinery. Additional difficulties include no standardized curriculum in training programs or a lack of POCUS skilled faculty who can facilitate mentorship of trainees.

This review concluded by underscoring the importance of not only obtaining the knowledge needed to administer tissue-specific POCUS, but to maintain competency via life-long continuing educational programs. It is imperative that in addition to effort from individual physicians to seek out educational POCUS programs, societies and institutions need to develop and support standardized training such that POCUS may be widely available in the chronic pain setting.

Reference

Haskins S C, Bronshteyn Y, Perlas A, et al. American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part II: recommendations. Reg Anesth Pain Med. Published online February 24, 2021. doi:10.1136/rapm-2021-102561.