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Credentialing in CED

Overview

Clinicians should be credentialed for their scope of ultrasound practice. ADHB and SSH aims to support the credentialing process with appropriate training, governance, equipment, dedicated IT and infrastructure.

For each ultrasound modality that practitioners wish to perform and interpret, they should have successfully completed a credentialing process and must continue to fulfill ongoing skills maintenance requirements.

It has been deemed reasonable by ACEM for clinicians to follow a similar structure in their advanced ultrasound training as detailed in the Australasian Society for Ultrasound Medicine (ASUM) Certificate in Clinician Performed Ultrasound (CCPU) or Diagnostic Diploma of Ultrasound (DDU) modules or equivalent. ACEM recognizes that the possession of these qualifications or equivalent should imply minimum competency in the relevant areas.

The credentialing and maintenance requirements and recommended pathway for ED trainees and specialists are outlined in the ACEM Policy on Credentialing for Emergency Medicine Ultrasonography (P733). The basic pathway to competency follows a structure of: theory and introductory phase, supervised practice, experience and exit assessment of competence.

The credentialing process requires candidates to:

  1. Complete an appropriate instructional educational program

  2. Perform and record a requisite number of supervised and logged emergency department ultrasounds

  3. Pass a summative assessment

  4. Once credentialed, meet ongoing maintenance requirements

Step 1 – Introductory courses

Courses should address the criteria described in the Credentialing Workbooks found below under Credentialing Resources.

Training courses accredited for the ASUM CCPU units also fit these criteria and can be found at https://www.asum.com.au/education/ccpu-course/ccpu-training-providers/. ASUM also provide minimum teaching requirements as part of their CCPU Syllabus documentation https://www.asum.com.au/education/ccpu-course/.

The Australasian College for Emergency Medicine (ACEM) Ultrasound Committee has designed online courses that provide the Theory requirements for Certification. Any individual can create an ACEM log in and access these courses here. The courses provided include:

  • Introduction to ED POCUS

  • Governance

  • Physics

  • AAA

  • EFAST

  • Thoracic/Lung

  • FELS (Focused Echo in Life Support) - 2 modules

  • Procedural Guidance - 4 modules

Step 2 – Logbook

For each Ultrasound modality a minimum number of ultrasound examinations are required to become credentialed (see Credentialing workbooks).

Patients must be informed that the ultrasound examination is being performed for credentialing purposes and verbal or written consent obtained.

Ultrasound examinations must be documented in an appropriately secure logbook. The entry should include: the clinical details, the date and type of ultrasound examination performed, the findings and the candidate’s interpretation of those findings. The findings and interpretation should subsequently be compared to other clinical data and a notation made as to whether the scan findings were accurate. Where the scan was not supervised there should be confirmatory evidence of the accuracy of the examination (via additional studies or clear clinical evidence). All logbook scans will be either directly proctored, or the images reviewed at a later date by one of the trainee’s supervisors.

We encourage you to perform as many of your logbook scans as possible with a credentialed clinician in order to gain feedback.

Step 3 – Assessments and Certification

For each modality, at least two directly supervised formative assessments must be completed prior to a final summative assessment. Assessment forms can be
found below in the Credentialing Resources section.

The final summative assessments and credentialing process must be overseen by a clinician who is themselves credentialed in that modality. They will observe the candidate performing the ultrasound examination and will not give any feedback during this examination. This may be undertaken simultaneously as a Direct Observations of Procedural Skill (DOPS) assessment for FACEM Trainees. The candidate must demonstrate the ability to:

  • acquire adequate ultrasound images of all the appropriate anatomical structures;

  • identify any relevant artefacts or pathology present during real time scanning and/or on recorded scans and/or hard copies of scans;

  • recognise an inadequate scan;

  • demonstrate an understanding of the indications and limitations of ultrasound examination for the condition in question;

  • demonstrate appropriate machine care, image labeling and documentation of their findings; and

  • integrate their findings into the overall clinical picture and generate appropriate treatment recommendations if appropriate.

Once the examination requirements are satisfied, the emergency medicine practitioner will be credentialed for the appropriate ultrasound module. The emergency medicine sonologist may then document the results of his/her ultrasound scans in the medical record and incorporate the results into clinical decisions. ACEM has a formal link with the Australasian Society for Ultrasound Medicine. ACEM accepts successful completion of the Certificate in Clinician Performed Ultrasound (CCPU) as appropriate demonstration of competence.

Historical experience

Those who have already completed equivalent requirements and who currently practice EFAST, AAA, Lung, FELS or Procedural Guidance should be considered competent in the relevant skill/s. These practitioners should meet relevant continuing professional development requirements.

For FACEMS who are practicing Focused Emergency Department ultrasound, but have never completed any form of credentialing process, it is recommended that the undergo a Summative assessment in each modality that they are practicing in. This should be overseen by the CLUS and/or other FACEMS with qualifications in that modality. If the practitioner does not pass the summative assessment, then they must repeat the process after an agreed period of ED POCUS re-training.

Step 4 – Maintenance

To maintain his/her credentials, the emergency medicine sonologist should undertake at least three hours of ultrasound training per year. This may include:

  • 1:1 training with a qualified Sonographer Educator in ED (SEED);

  • attending or presenting at an ultrasound webinar/workshop or conference;

  • teaching on an accredited course;

  • participation in ultrasound quality assurance and retrospective image review; and

  • reading Ultrasound journals or textbooks.

For each module that they are credentialed in, the emergency medicine sonologist must perform or supervise a minimum number of scans per two-year cycle (see Credentialing workbooks for numbers).

In cases where the sonologist is more experienced, the quality and consistency of their work should be able to be demonstrated. Sonographic examinations should consistently demonstrate reported pathology and minimum image sets and reports documented and recorded. These examinations should be open to independent scrutiny by a sonologist of similar qualification for the purposes of quality assurance. It is suggested that these, more advanced sonologists perform at least 50 focused ultrasound examinations per year.

In CED we have quarterly review meetings, to review scans in order to maintain credentialing. This is on top of the monthly audit of scans.

Credentialing resources