The course concluded with a capstone interactive group pathology identification examination reinforcing the material taught (See Appendix 1). The lead instructor was available during the practice sessions to supervise the instructors and assist residents or answer questions if the instructors were not able. The instructor was present at each practice station to answer questions, assist the residents in acquiring ideal images and facilitate discussion. Each practice station had a maximum of four residents. Each practice station had a live human model on an exam table, a volunteer instructor and an ultrasound machine. The learning objective for each practice session was to elevate the EM residentsвЂ™ competency in POCUS image acquisition.Дuring the practice sessions, residents were randomly assigned to a practice station. The learning objectives for each lecture were to elevate the EM residentsвЂ™ ultrasound knowledge and to have them identify ideal images including normal and pathologic findings for each scan.

The scans taught included cardiac, pulmonary, inferior vena cava, aorta and rapid ultrasound in shock and hypotension (RUSH). This four-hour course was taught using fifteen-minute lectures alternated with thirty-minute practice sessions. In addition, they were provided with attestations for their participation in trauma-specific CME and for the scholarly activity of teaching courses to residents outside of their institution. The instructors also received two hours of 1-A CME credit for the faculty development training and five hours of 1-A CME credit for teaching residents. They had the advantage of hearing the material twice and reinforcing what they learned by teaching others. They received two hours of close instruction along with supervision of their teaching by a POCUS expert. The instructors were incentivized with several benefits for attending this course. The three to five instructors for each session shared two live models and two ultrasound machines during the session. The instructor training consisted of limited lectures and supervised practice obtaining and interpreting images on live models. The instructors were trained on the morning of the course during a two-hour session. We specifically invited physicians with self-perceived low levels of POCUS competency who had a desire to elevate their own POCUS skills and their ability to teach POCUS. The volunteer instructors were attending physicians or senior residents from the EM residency programs within the consortium. To address these barriers, an innovative POCUS course was designed and delivered utilizing the 'train the trainer' model.ДЄn innovative element of this course was the cost-effective use of volunteer EM physicians as instructors for the course. In addition, geographic distances had presented barriers to resident participation in courses sponsored by their consortium held at a centralized site.

Many residency programs in the authorsвЂ™ health systems lacked faculty with advanced training to provide advanced POCUS training within their individual programs. 1,4,10,11 A newer model of instruction in GME that has shown promise has been вЂњtrain the trainerвЂќ 12,13 and вЂњco-learning,вЂќ 14,15 models that involve simultaneous faculty and resident training and вЂњpeer trainingвЂќ for senior-junior resident or faculty-faculty peers. 1,3,4 Some published studies on POCUS education and delivery models have shown positive learner outcomes however, several have also indicated variable improvement across learners. Most POCUS training workshops are one-half to two days in length and follow the traditional model of structured didactic sessions followed by hands-on training with human models or simulation units. 6 Several articles to date have suggested that POCUS competencies are not being regularly met in many EM residency program settings. 1вЂ“5 In 2000, POCUS residency training guidelines were released by the American College of Emergency Physicians (ACEP), including a recommendation that residents perform at least 150 procedures to establish minimal competency. Point-of-care ultrasound (POCUS) training is no longer considered a niche within Emergency Medicine (EM), but rather an expected component of Graduate Medical Education (GME) EM training programs.

The final station trainer