CCUS is currently used for managing many disease processes in critically ill patients and is considered part of standard patient management care in many instances. Better utilization of bedside ultrasound has also been associated with improved patient outcomes and decreased costs[10, 12, 13]. However, a formal curriculum has yet to be standardized for training ICU fellows. Therefore, a key issue is how to effectively promote high-quality CCUS training and make it accessible to every critical care physician. This study explored the impact of CCUS training methods implemented in our department. We found that (1) CCUS specialty training results in high trainee satisfaction; (2) after CCUS specialty training, trainees significantly improve their theoretical knowledge, interpretation of pathological images, and operational skills; (3) most CCUS examination components can be performed in a relatively short time, and trainees can perform independently and obtain adequate image quality and identify anatomy after training; and (4) the application of CCUS examination results has a certain degree of impact on clinical cases, with a substantial portion being secondary to new diagnoses or management changes.
The course content covered not only basic and theoretical ultrasound knowledge but also various common critical care issues. We included substantial components of transthoracic echocardiography and pulmonary, vascular, renal, and craniocerebral ultrasound examinations. This study introduced a new modality for ICU doctors from county hospitals nationwide to use CCUS to rapidly assess critical conditions, make differential diagnoses for unstable clinical situations, and guide subsequent treatment adjustments. CCUS research in the ICU has expanded greatly over the last 10 years. Most studies have focused on system-based ultrasound exams or certain protocols[14–17]. Our curriculum included many systems that can be checked anytime with a clinical problem; trainees can perform a full exam as time permits. Additionally, before clinical practice, participants interpreted and learned from pathological images, aiding clinical practice. Participants’ theoretical knowledge, pathological image interpretation, or basic technique performance significantly improved after training. In summary, this study confirmed that specialized CCUS training enables quick identification of clinical abnormalities, the acquisition of relevant ultrasound images, and accurate interpretations and analyses.
Simulation training has proven to be an effective method for CCUS education, significantly enhancing training effectiveness[18]. Previous studies also confirmed the efficacy of simulation training for transthoracic echocardiography application[13, 19]. Our study further corroborated the effectiveness of CCUS through models/simulations, strengthening training effects, and promoting the widespread application of bedside ultrasound. Traditional teaching relies mainly on instructor lectures, with students learning via textbooks and notes and then practicing on existing patients, which is a highly random process [20]. In contrast, simulation protects patient safety and rights, reducing hospital-acquired infection risk from repeated student practice. It also allows trainees to make mistakes, ensuring proficiency after multiple practice sessions. In our study, trainees practiced only on models and simulation systems, applying skills clinically postassessment passing. This rapidly improved performance and reduced adverse factors. Both course content and training methods, particularly models combining simulated ultrasound, garnered high satisfaction ratings.
Additionally, most prior studies have utilized short-term training for CCUS, typically lasting 1–2 days. This provides theoretical knowledge and preliminary performance skills[10, 21]. However, after theoretical courses and practical skills training, Killu[22] et al. reported that more than 3 months of reinforcement practice was needed for trainees to reach full confidence in operations. This is the first study reporting a 6-month training effect, providing sufficient practice and complete clinical performance training. This 6-month curriculum reinforced trainees’ theoretical knowledge, skills, and clinical integration, avoiding issues such as knowledge forgetting from lack of continuous ultrasound use post-training or ineffective skill correction from inadequate training.
Our results suggest that our specialized training curriculum has clinical utility, with 82.53% of ICU patients receiving CCUS. Manasia[14] et al. studied the applicability of echocardiography by intensivists after a 10-hour tutorial, finding a 94% success rate for performing exams and documenting limited exams, which led to management changes in 37% of cases. Previous studies[23] have reported that perioperative bedside ultrasound often detects new cardiopulmonary pathologies, similar to the findings of this study. Cardiopulmonary ultrasound assessment was most commonly used and impacted subsequent clinical decision-making. Other CCUS methods, including renal, vascular, and craniocerebral ultrasound, are also widely used and can benefit ICU patients. This suggests that after complete training, all CCUS content can benefit ICU doctors.
The limitation of this study is that it is a single-center study in a single ICU, and there may be biases in the interpretation and treatment of patients' clinical conditions. Our results are not comparable to the gold standard for various diseases, but we will seek advice from bedside ultrasound experts as we implement them. At the same time, our curriculum is incomplete and needs much revision and improvement work in the future.