Commentary

A case for mandatory ultrasound training for rural general practitioners: a commentary

AUTHORS

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Annie C Arnold1
BMedSci, MD Student *

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Richard Fleet2
MD, PhD, CCFP (EM), Professor

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David Lim3
MD, PhD, Director of Academic Program

AFFILIATIONS

1 College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia

2 Familly and Emergency Medicine, Université Laval, 050 Avenue de la Médecine, Quebec G1V0A6, Canada

3 School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia

ACCEPTED: 20 May 2021


early abstract:

Context: Point-of-care ultrasound is a rapidly evolving technology which enables rapid diagnostic imaging to be performed at the patients’ bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients’ lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant example application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five.
Issues: Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling, and quality assurance programs prevent physicians from feeling confident utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use.
Lessons: Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance.