P138: The Family Medicine Obstetrical Ultrasound (FaMOUS) course: a model for training office-based family physicians in first trimester point of care ultrasound

Abstract

Introduction / Innovation Concept: In Canada, family physicians (FPs) provide the majority of 1st trimester pregnancy care and are often first to evaluate complications, including threatened and spontaneous abortion and ectopic pregnancy. To receive a same day urgent US, most patients will be sent to the emergency department (ED). With increasing availability and affordability of point of care ultrasound (PoCUS), FPs are starting to use US in their offices, potentially diverting some ED visits for patients with reassuring US findings. To date, no formal certification process exists for FPs who wish to use PoCUS for 1st trimester indications. Methods: The objective of this educational initiative was to implement and evaluate a novel, 2-day didactic and hands-on certification process for FPs utilizing office-based PoCUS to identify intrauterine pregnancy and fetal cardiac activity. The FaMOUS course was modeled after the Canadian Emergency Ultrasound Society Emergency Department Echo (CEUS EDE) curriculum and adapted with permission for FPs. Curriculum, Tool, or Material: The curriculum consisted of a deliberate practice mastery model utilizing on-line materials, seminars and hands-on training. Prior to the 2-day course, FPs completed an e-learning module comprised of core competency material specific to obstetrical practice. Learners were required to score 100% on a post-module exam to participate in the 2-day course. Attendees participated in a 4-hour training session to learn US image generation and interpretation. This was followed by 10 hours of hands-on training with CEUS instructor supervision to complete the certification process (50 determinate scans). Thirteen FPs from 3 family practice units successfully completed the certification process. Cumulative knowledge and skill levels were assessed throughout the 2-day workshop through feedback from CEUS supervisors to confirm key concepts were learned. All 13 participants agreed to utilize PoCUS in their clinical assessments of patients with 1st trimester complaints using handheld PoCUS equipment provided to the sites. FPs will be surveyed at 3 month intervals for 12 months following the FaMOUS course to assess provider confidence, satisfaction and perceived impact on clinical decision-making. Conclusion: The FaMOUS certification course is a standardized curriculum by which FPs can learn PoCUS safely to improve quality and timeliness of care for patients experiencing 1st trimester complaints. If PoCUS is adopted by FPs, lengthy ED visits may be decreased for this patient population.