Training leaders in point of care ultrasound in Peru

Remote, tele-ultrasound education for emergency medicine physicians to improve bedside diagnosis and treatment and develop 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 become leaders in point-of-care ultrasound (POCUS). POCUS enables physicians to make critical diagnosis and treatment decisions at the bedside; however, there is 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, and 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 allowed healthcare professionals to interact remotely and dynamically in a wide range of applications, from teleconsultations, secure messaging and tele-ultrasound to interactive telesurgical assistance and remote procedure supervision.

As part of the program, each fellow was required to complete 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 the 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, seven 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.

An interesting project outcome, several case reports were published on pathology 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 quickly developing into educational leaders capable of facilitating curricular change and integrating 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 – first in Mexico and later in Costa Rica.