In 2014, Nibras F. Bughrara, MD, FASA, FCCM, joined Albany Medical Center (AMC) in Albany, New York, USA, after completing a critical care medicine fellowship and perioperative echocardiography training at Johns Hopkins School of Medicine. At the time, he was the only intensivist at AMC using point-of-care ultrasound (POCUS).
Dr. Bughrara wanted to start a POCUS training program, but he knew it would be a massive undertaking to create a curriculum himself. Then he took SCCM’s Advanced Critical Care Ultrasound: Adult course and had an idea: What if he could use the SCCM course lectures—already created, approved, and successful—and combine them with interactive training to teach trainees on site at AMC?
Photo courtesy of Nibras F. Bughrara.
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He received permission from SCCM to do just that and began teaching the four-day course to anesthesia residents and critical care fellows. Dr. Bughrara presents eight hours of video in the mornings, pausing to discuss cases and to ensure the trainees understand the concepts. In the afternoons, they practice ultrasound techniques on actual ICU patients.
“Instead of wasting time trying to reinvent the wheel, we utilize state-of-the-art SCCM educational materials. The course is prepared by the best in the field and contains pathologic findings from patients from all over. The course faculty are intensivists from a variety of backgrounds, including surgeon intensivists, cardiologist intensivists, pulmonologists, emergency medicine physicians, and anesthesiologists,” said Dr. Bughrara, director of the Anesthesia Critical Care Division at AMC and associate professor of anesthesiology and surgery at Albany Medical College.
A study of the program tested residents and fellows before, immediately after, and six months after the course and showed that they retained the knowledge. Dr. Bughrara began expanding the course’s reach. “I took that experience, and I started implementing it in other institutions,” he said. Now, more than 10 institutions across the United States are using the SCCM course in the same fashion.
“We showed that you can take the SCCM ultrasound course and structure interactive skills training around it, implement it, and it’s successful,” he said. The course standardizes training and reduces faculty requirements. Instead of inviting four faculty to give lectures, hospitals need only one trained faculty member to moderate the recorded presentations. “This is an excellent course. We can implement it in hospitals and expand our reach, and we have a lot of use for it,” he said.
At AMC, the program has become the source for all critical care ultrasound training. Now, course participants include residents from anesthesiology, internal medicine, surgery, and neurology; and fellows from cardiac surgery, cardiac anesthesiology, pulmonary, and nephrology. Dr. Bughrara is conducting another study examining retention over one year at 10 institutions.
SCCM recently approved Dr. Bughrara’s proposal to create an introductory POCUS course for cardiac arrest and sepsis that relies on only one view, thus expanding the reach of POCUS. Dr. Bughrara proposed the program after first trying it out at AMC. “When we started training our fellows in ultrasound, it was clear that they would be able to pick it up during the one year of fellowship, but training critical care ultrasound with multiple views to our faculty was very challenging,” he explained. Faculty did not have time for a long course and could not get enough interactive training. So Dr. Bughrara developed a new introductory protocol teaching only one view and studied the results.
“We compared the qualitative echocardiographic information obtained through the subcostal window with focused transthoracic echocardiography and found an excellent correlation,” he explained. “Teaching a simplified, one-view protocol reduced the barrier to entry for most users while enabling quick identification of actionable pathologies that are amenable to life-saving interventions. Based on that, we started training our attending physicians and, over the years, we reached out to train many more physicians, nurse practitioners, and physician assistants.”
Dr. Bughrara continues to receive requests to implement the SCCM Critical Care Ultrasound course, including from international medical centers. “This model brought SCCM expertise into the institutions. We’re going to enroll a lot more hospitals into the program.” The course format means that hospitals worldwide do not have to fly their trainees and physicians somewhere to take part in high-quality training, he said. And the course requires only one trained faculty member. “This has made it possible to democratize using critical care ultrasound,” Dr. Bughrara said.
