Page 1 of 20 12/17 Australasian Society for Ultrasound in Medicine P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected]W www.asum.com.au ACN 001 679 161 ABN 64 001 679 161 Australian Society for Ultrasound in Medicine (ASUM) Certificate in Point of Care Ultrasound (ACPoCUS) Clinical Supervisor Handbook
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Page 1 of 20 12/17
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
Australian Society for Ultrasound in Medicine (ASUM)
Certificate in Point of Care Ultrasound (ACPoCUS)
Clinical Supervisor Handbook
Page 2 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
INTRODUCTION
Thank you for considering undertaking the role of Clinical Supervisor for a candidate for the
Australasian Society for Ultrasound in Medicine (ASUM) Certificate in Point of Care Ultrasound
(ACPoCUS). This is a vital and important role that can have a significant positive outcome on the
candidate's development of knowledge and skill in the practice of safe and clinically appropriate
point of care ultrasound (PoCUS).
Included in this section is the "Definition of an ACPoCUS Holder" for your information. You are
advised and encouraged to read this to understand the overall requirements and outcomes of the
ACPoCUS.
All candidates for the ACPoCUS must nominate a Primary Clinical Supervisor(s) before they
commence supervised clinical practice as a component of the ACPoCUS certification process.
All nominated Clinical Supervisors must complete a Nomination of Clinical Supervisor Form
available from the ASUM website (www.asum.com.au). It is the candidate's responsibility to submit
the form/s to the ACPoCUS Certification Board prior to the commencement of supervised practice
for the ACPoCUS. All nominated Clinical Supervisors must be approved by the ACPoCUS
Certification Board for the purposes of the ACPoCUS certification process.
Definition of an ACPoCUS holder
The overarching aim of the ASUM Certificate in Point of Care Ultrasound (ACPoCUS) process is to
certify, as competent, those practitioners performing focussed, point of care ultrasound procedures
as an adjunct to patient clinical management, within their specific scope of practice.
Capability Statements (CS)
The broad level knowledge, skill and abilities required of a practitioner awarded the ACPoCUS
includes, but is not limited to:
1. Use and care of ultrasound equipment including: underpinning theoretical knowledge of
relevant physics and instrumentation; ultrasound bioeffects and safety issues.
2. Understanding and demonstration of psychomotor and other skills involved in producing and
recognising an accurate and valid ultrasound examination and resultant data (the
“sonographic process”).
3. Detailed anatomy, physiology and pathology as related to the ultrasound examinations
relevant to the practitioner’s area of practice.
4. Accurate recognition and evaluation of sonographic appearances and information relevant to
the practitioner’s specific area of practice including: normal anatomy; normal variants;
artifacts; abnormalities.
5. Accurate critical analysis of information and ability to determine appropriate provisional
diagnosis/diagnoses as a result of the ultrasound examination and in conjunction with other
available clinical information as relevant.
6. Recognition of any limitations of the ultrasound examination and the effect of this on patient
clinical management.
7. Ability to critically analyse findings and determine the need for further information such as:
referral for more detailed ultrasound examination and diagnosis; other diagnostic tests;
further clinical information; follow-up examinations.
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Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
8. Understanding of, and the ability to apply, any professional, ethical and legal issues that may
be particularly relevant/unique to the ultrasound processes.
9. Understanding of, and commitment to, requirements for continuing professional
development, especially as related to the use of ultrasound in their clinical practice.
10. Ability to communicate with patients/clients and colleagues in a manner that is timely,
relevant and appropriate to the circumstances.
11. Ability to record ultrasound findings in the clinical record in a timely and accurate manner to
facilitate appropriate continuity of patient care.
Overview of the ACPoCUS process (refer to relevant curriculum document for detail)
SUPERVISION REQUIREMENTS
Primary Clinical Supervisor Requirements
All ACPoCUS candidates must have access to clinical supervision during their education and
training. Candidates must nominate a suitable “Primary Clinical Supervisor” or a combination of
suitable persons to act jointly as a “Primary Clinical Supervisory team” for the duration of their
candidature.
The requirements of the Primary Clinical Supervisor(s) for each specific area of practice are defined
in the relevant curriculum document which must be provided to potential supervisors by the
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
“competence” they require specific training in combination with deliberate practice. Beyond the
competence level with increasing levels of performance, to expert and master levels, much of the
increase in performance levels comes from deliberate practice.
In the PoCUS context, education such the background theoretical knowledge specific to ultrasound
practice, development of psychomotor skills, and the integration of theoretical and practical
elements of practice can all be taught, to a large extent, outside the workplace environment.
The fundamental principle of competency/performance based education though is that
learners are only certified as competent in those skills that they demonstrate they can
perform independently and safely.
Frameworks have been developed to take into consideration the context of the clinical environment and the practitioner’s ability to adapt and perform competently in changing and challenging clinical contexts (ten Cate 2015). Ultimately the assessment of competence is directly linked to patient safety outcomes. The International Federation for Emergency Medicine Point of Care Ultrasound Curriculum (Atkinson et al, 2015) and Ilgen et al (2015) propose a similar concept called the “Global rating scale” to assess overall good clinical practice, in conjunction with assessments of specific competencies throughout a practitioner’s training and development. Assessment of clinical skills is used to determine if a practitioner has demonstrated competence at
a level where they are deemed safe to practise the activity/skill/procedure without supervision.
Competencies are directly mapped to the specific skills/tasks involved in the particular clinical
context and the relevant question to be answered is: “does this person have the requisite
competencies and attitude to carry out the task that is demanded” (without on-going
supervision). In areas such as PoCUS this involves integration of multiple competencies from
several domains (cognitive, psychomotor skills, interpretive skills, patient care and professional
communication).
The curriculum for an individual PoCUS area of practice (including Critical Care, Rheumatology, Emergency Medicine) expresses all the activities (core units) a competent practitioner, in the area of practice, is expected to be able to do. Being deemed at a level where on-going supervision is not required for all core units (the competence level), along with satisfactory results in other assessments, would lead to the award of the ACPoCUS in the defined scope of practice. Overall assessment based on multiple information sources is used to increase validity, reliability and consistency of final certification decision-making (Harrison, 2015).
Contact
If you require any further information on supervising a candidate for the ACPoCUS please contact:
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
References Atkinson, P., Bowra, J., Lambert, M., Lamprecht, H., Noble, V. & Jarman, B., 2015, International
Federation for Emergency Medicine point of care ultrasound curriculum, CJEM, 17(2), pp. 161-70 Boursicot, K., Etheridge, L., Setna, Z., Sturrock, A., Ker, J., Smee, S. & Sambandam, E., 2011,
Performance in assessment: consensus statement and recommendations from the Ottawa conference, Medical teacher, 33(5), pp. 370-83
Epstein, R.M. & Hundert, E.M., 2002, Defining and Assessing Professional Competence, JAMA,
287(2), pp. 226-35 Harrison, G., 2015, Ultrasound clinical progress monitoring: Who, where and how? Ultrasound,
23(4), pp. 197-203 Ilgen, J.S., Ma, I.W., Hatala, R. & Cook, D.A., 2015, A systematic review of validity evidence for
checklists versus global rating scales in simulation-based assessment, Medical education, 49(2), pp. 161-73
Khan, K. & Ramachandran, S., 2012, Conceptual framework for performance assessment:
competency, competence and performance in the context of assessments in healthcare--deciphering the terminology, Medical teacher, 34(11), pp. 920-8
ten Cate, O., Snell, L. & Carraccio, C., 2010, Medical competence: the interplay between individual
ability and the health care environment, Medical teacher, 32(8), pp. 669-75 ten Cate, O., Chen, H.C., Hoff, R.G., Peters, H., Bok, H. & van der Schaaf, M., 2015, Curriculum development for the workplace using Entrustable Professional Activities (EPAs): AMEE Guide No. 99, Medical teacher, 37(11), pp. 983-1002
APPENDIX 1 Supervisor nomination forms – To be developed and inserted.
Page 12 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
APPENDIX 2 Competence Assessment Forms
ASUM ACPoCUS Formative/Summative Competence Assessment Form
Note: This assessment tool MUST be used in conjunction with the ASUM Standards of Practice for the relevant area of practice, as published in the applicable ACPoCUS Curriculum, and the Competence Table provided at the end of this document. It is the Candidate’s responsibility to ensure the assessor has been provided with a copy of the relevant curriculum/Standards of Practice document/s along with this form.
Date of assessment: __________________________________
Assessment type: □ Formative (feedback & teaching given during assessment for education) □ Summative (prompting allowed but teaching not given during assessment) Number of assessment for this area of practice (please circle): Formative 1 2 3 4 Summative 1 2 3 4 Number of cases for this area of practice recorded in clinical record log at time of assessment (to be sighted by assessor). Please circle: 0 10 20 30 40+
Competent Minor prompting
Significant prompting
Not yet competent
Patient care and communication (suitable to clinical context)
Example cues:
Patient prepared, positioned correctly
Adequate explanation to patient, consent obtained
Correct entry of patient details
Due regard to patient care and comfort at all times
Effective and appropriate communication
1 If the assessor is the candidate’s approved Clinical Supervisor write “approved supervisor”. If the assessor is another
eligible person (as defined in the curriculum, please indicate qualifications here).
Page 13 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
Competent Minor prompting
Significant prompting
Not yet competent
Checked clinical indications and other relevant information
Understood implications of clinical history/indications
Preparation of equipment
Example cues:
Lights dimmed if possible
Selected appropriate probe
Changed probe as needed
Selected appropriate presets
Image acquisition
Example cues
Recognised and described relevant anatomy
Acquired complete image/data set as required by applicable Standards of Practice
Performed accurate measurements as required by Standards of Practice
Understood rationale for, and implications of, measurements
Labelled and stored images appropriately as required by Standards of Practice
Image optimisation
Example cues:
Manipulated equipment controls appropriately to ensure accuracy of information
Identified and explained image artifacts and tried to eliminate if needed
Image interpretation
Example cues:
Identified and adequately documented abnormalities, anomalies and variants applicable to PoCUS context and the applicable Standards of Practice
Discussed findings and interpretation of findings accurately
Page 14 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
Competent Minor prompting
Significant prompting
Not yet competent
Clinical integration
Example cues:
Documented examination and findings adequately in patient’s clinical record
Accurately determined if clinical question (the focus of the examination) had been answered in the positive, negative or was equivocal.
Described and analysed implications of examination findings on patient clinical management
Identified and analysed limitations of examination and the implications for patient clinical management
Post examination
Example cues:
Cleaned probe and relevant equipment adequately
Stored ultrasound machine and probes safely and correctly
COMMENTS Feedback of particularly effective/satisfactory performance:________________________________
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
Page 17 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
ASUM ACPoCUS FINAL (Holistic) Summative Competence Assessment Form Note: This assessment tool MUST be used in conjunction with the ASUM Standards of Practice for the relevant area of practice, as published in the applicable ACPoCUS Curriculum, and the Competence Table provided at the end of this document. It is the Candidate’s responsibility to ensure the assessor has been provided with a copy of the relevant curriculum/Standards of Practice document/s along with this form.
Area of practice (for example AAA, EFAST, ELS, Rheumatology etc): _________________
Date of assessment: __________________________________
Assessor’s note: Please rate the candidate’s overall performance in the area of focussed/point of care ultrasound in the relevant area of practice. The assessment is to rate the candidate’s performance across the core clinical areas of the area of practice as defined in the relevant curriculum (for example for Emergency Medicine the core areas are AAA, EFAST and ELS).
Competent Minor prompting required
Significant prompting required
Not yet competent
Patient care and communication (suitable to clinical context)
Example cues:
Effective and appropriate communication demonstrated at all times
Due regard to patient care and comfort at all times
Understands implications of clinical history/indications on PoCUS examination
Image acquisition skill, including correct use of equipment
Example cues
Knows relevant sonographic anatomy
Acquires complete image/data sets as required by applicable Standards of Practice
Performs accurate measurements as required by Standards of Practice
2 If the assessor is the candidate’s approved Clinical Supervisor write “approved supervisor”. If the assessor is another
eligible person (as defined in the curriculum, please indicate qualifications here).
Page 18 of 20
Australasian Society for Ultrasound in Medicine
P (61 2) 9438 2078 F (61 2) 9438 3686 E [email protected] W www.asum.com.au
ACN 001 679 161 ABN 64 001 679 161
Competent Minor prompting required
Significant prompting required
Not yet competent
Understands rationale for, and implications of, measurements
Manipulates equipment controls correctly
Understands implications of image artifacts
Image interpretation ability
Example cues:
Identifies and adequately documents abnormalities, anomalies and variants applicable to PoCUS context and the applicable Standards of Practice
Discusses interpretation of findings accurately
Clinical integration ability
Example cues:
Documents examination and findings adequately in patient’s clinical record
Accurately determines if clinical question (the focus of the examination) has been answered in the positive, negative or was equivocal.
Describes and analyses implications of examination findings on patient clinical management
Identifies and analyses limitations of examination and the implications for patient clinical management
Demonstrable understanding of role and limitations of PoCUS in the specific scope of practice