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Training leaders in point of care ultrasound in Peru

   

Remote, tele-ultrasound education of emergency medicine physicians to improve bedside diagnosis and treatment and become local educational leaders who multiply impact

    About

     

    This project with the non-profit Ondas de Latinoamérica improved emergency care in Latin America by training emergency medicine physicians to be leaders in point-of-care ultrasound (POCUS). POCUS enables physicians to make critical diagnosis and treatment decisions at the bedside; however, there was limited access to this technology in Peru due to lack of education and training.

     

    The project focused on training physician leaders in POCUS by implementing a novel multi-pronged approach using tele-ultrasound to provide ongoing remote education and support, in addition to traditional hands-on education. By employing a “train-the-trainers” model, the impact is exponentially increased since all trainees work at large public hospitals with residency training sites.

     

    Partners

    How

     

    Ondas de Latinoamérica selected 11 emergency medicine physicians from both urban and rural sites for a one-year POCUS fellowship training program. The training started with a two week “boot-camp” in Peru to introduce the types of POCUS exams and focus on hand-on scanning. Following the “boot-camp” the Fellows had access to online lectures and remote tele-ultrasound education. The program included weekly question-and-answer sessions, scheduled journal club meetings, scheduled and unscheduled live consultation sessions through the tele-ultrasound platform.

     

    Telehealth solution


    The remote tele-ultrasound education and consultation was enabled by the Philips Lumify portable ultrasound solution, in combination with the Reacts collaborative platform. This allows healthcare professionals to interact remotely and dynamically in a wide range of applications, from teleconsultations, secure messaging, tele-ultrasound, to interactive tele surgical assistance and remote procedure supervision.

    As part of the program each Fellow was required to complete either a quality improvement project, educational project or research project. This led to various conference contributions, scientic publications and other knowledge generating activities as spin-off of the project.

    Results

     

    To date, 11 emergency medicine physicians from both urban and rural sites have completed the one-year POCUS fellowship training program.

    The train-the-trainer model has proven to be an effective means of reaching a wider audience of emergency medicine physicians as evidenced by the accomplishments of our graduates. The graduates have established POCUS training rotations at two sites in Lima for emergency medicine residents to learn firsthand how to apply POCUS applications within their clinical practice. To date, 7 resident physicians from multiple sites throughout Peru have participated in the rotation and further sessions are planned, also inviting emergency residents from other countries in Latin America.

    As an interesting spin-off of the project, several case reports were published on pathology that is rarely described in the developed world where most of the medical literature tends to come from.

    Learnings and next steps

     

    The objective of training ultrasound leaders by leveraging tele-ultrasound is proving to work. The program graduates are developing fast to become educational leaders for facilitating curricular change and integration of POCUS within graduate medical education in Peru and Latin America. Several graduates have also assumed further leadership roles within the public healthcare system or have become the directors of their emergency medicine departments.

    In Peru, the learnings can be put into practice fast, because an installed base of ultrasound equipment is already present. In 2015, a decree by the Ministry of Health required all emergency departments treating critically ill patients to have availability to an ultrasound system. However, due to the lack of training programs and qualified faculty a large percentage of the systems remain unused.

    Responding to the Covid-19 pandemic, the graduates could immediately utilize their knowledge to improve patient care. They developed and implemented a triage protocol using point of care ultrasound, which helped alleviate testing shortages in the early stage of the pandemic.

    Ondas de Latinoamérica is currently in the process of training an additional seven fellows from Peru. Based on the successful approach, the NGO is also expanding its model to other countries in Latin America. At first in Mexico, later in Costa Rica.

    Status

    Concluded

    When

    2019 - 2021

    Where

    Peru

    Care to collaborate, or want to learn more about this project?  
    Do not hesitate to contact us.

    In line with Sustainable Development Goal 17 (partnerships for the goals), we believe we can make a real difference in providing access to quality healthcare if we work together.

    Project report

    Resources

    [1] Research publication: A Dreyfuss et al, A Novel Approach to Point-of-Care Ultrasound in Low-Resource Settings. Western Journal of Emergency Medicine, 2020.

    [2] Video explaining Ondas de Latinoamerica’s story

    [3] Research publication: AC Rider et al, Image to Fit the Clinical Picture: Point-of-care Ultrasound Assessment of Ebstein's Anomaly in Peru. Clin Pract Cases Emerg Med. 2020.
    [4] Research publication: Alexandra Hill et al, Point-of-care Ultrasound Diagnosis of Pulmonary Hydatid Cyst Disease Causing Shock: A Case Report. Clinical Practice and Cases in Emergency Medicine 2021

    Relevant links

    Partner websites

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