Recognition of AFC-diploma in Acute Care POCUS

Recognition of an Area of Focused Competence (AFC-diploma) in Acute Care Pont of Care Ultrasonography (Acute Care POCUS)

An opportunity for increased collaboration and communication

In a 1988 editorial entitled “Ultrasound: The stethoscope of the future”, published in Radiology, Roy Filly described ultrasound (US) as the “visual stethoscope of the 21st century.” He considered that in the future, the US unit would become a portable instrument that, like the stethoscope, would be available for bedside diagnosis.

US technology has since experienced an evolution in speed, power and miniaturization. Thanks to ongoing miniaturization, US hardware now includes viewing screens that can fit into the palm of a hand, contributing to its proliferation. The use of US beyond its traditional role within the radiology department has been termed “point of care” ultrasound.

In June 2013, the CAR published a Position Statement on the Use of Point of Care Ultrasound. The CAR Point of Care Ultrasound working group, chaired by Dr. David Vickar, defined Point of Care Ultrasound (POCUS) as an ultrasound examination provided and performed by the primary care physician (or their designate) of the patient, usually as an adjunct to the physical examination, to identify the presence or absence of a limited number of specific findings. The CAR POCUS position statement considers POCUS as a different examination than a comprehensive or limited sonographic evaluation of a patient performed in a dedicated imaging facility or department in a consultative process between the physician providing primary or specialty care for the patient and the consulting imaging specialist. It explains that POCUS can, at times, be invaluable at the point of care to clarify uncertain findings of the physical exam, identify important conditions in the context of acute care of the unwell patient, or provide image guidance that improves the success and safety of many procedures in the acute care setting, particularly when time saving for diagnosis or treatment is absolutely critical.

The CAR POCUS position statement further explains that “there is no question of the value of sonographic evaluation in medical imaging, if used appropriately by properly trained healthcare professionals.” However, as more physicians choose to use this valuable modality in their daily practice, concerns rise regarding their ability to appropriately utilize this modality in a manner that is objective, standardized, and of the utmost quality on a continuing basis. Nurse practitioners and other healthcare providers may also be involved in the practice of point of care ultrasound and therefore should also be included in the discussion points of this position statement. Utilization of new equipment for tasks for which practitioners may not have received adequate training and supervision could result in less than favorable diagnostic and management outcomes of their patients.

Dr. Edward A. Lyons OC, Professor of Radiology, Obstetrics & Gynecology and Anatomy at the University of Manitoba, cautions, “Ultrasound may look easy to do and interpret, but it is actually the most difficult of all imaging. This is something that most non-radiologists fail to appreciate.” Dr. Lyons further states that “robust standardized training in POCUS is required and those undergoing training must be objectively tested.”

Over the past decade, there has been a growing number of training programs for POCUS offered across Canada by various providers. The Royal College AFC Diploma program will promote the standardization of training with carefully planned education, assessment and continuing professional development expectations of the diplomates. Dr. David Vickar, radiologist and Past President of the CAR, explains, “The AFC program will recognize that POCUS is not a final diagnostic study and will encourage collaboration and consultation with diagnostic imaging specialists.” Dr. Vickar agrees with the Royal College’s statement that the field of POCUS in Canada can only stand to benefit from Canadian-oriented standards for training, and certification of the academic leaders responsible for POCUS advancement. Although the AFC Diploma program is not mandatory for practitioners who perform POCUS exams, it is a solid foundation upon which academic institutions and regulatory authorities can build expectations for the highest standard of practice for those utilizing this modality.

The CAR had a representative involved in the application process for an Acute Care AFC POCUS Program at the invitation of the Acute Care Physicians. In similar fashion, there will be a radiologist on the Royal College’s working group mandated to develop the discipline-specific documents. The CAR continues to collaborate with governments, health professionals and technology leaders to promote the highest standards of diagnostic imaging. The CAR will monitor the evolution of this area of practice and training programs with the goal to ensure that POCUS is performed to the highest standards to promote patient safety and ensure the continued status of radiologists and the recognized specialists as the ultimate resource in the field of ultrasonography and diagnostic imaging.


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