ESRA and USabcd POCUS e-learning

The members of ESRA Europe have been granted exclusive access to the USabcd online interactive e-learning resource of point-of-care ultrasound (POCUS) on the ESRA website since 2018. The range of POCUS topics is: Cardiac, lung, airway, gastric, central and peripheral vascular access, and nerve blocks. In addition, courses are also offered about emergency ultrasound, FAST, basic ultrasound physics, as well as a dedicated course for medical students.
The concept of the POCUS e-learning resource is to provide theoretical knowledge in order to prepare for hands-on focused training workshops. The goal is acquisition of competency and high-performance practical skills standing on a solid base of theory. The virtue of online e-learning compared to traditional lectures and class room teaching is that it can be studied anywhere and anytime (Figure 1).
The design of the e-learning site is very structured aiming at maximizing ‘knowledge retention’ complying with a proven model: (1) Introduce the topic (2) Teach it (3) Test it. All figures, animations and videos comply with this structure. Each video is short and focused one a single message (Video 1).

«In the present times of pandemic hardship, the virtue of online e-learning is becoming even more prominent.»

We used to run annual Scandinavian 3-day POCUS meetings based on lectures and hands-on training workshops at Aarhus University Hospital, Denmark from 2006 to 2009. It was costly, time consuming and demanded a lot of on-site man power. The participants and their hospital managements spent a lot of time and money on traveling, hotels, and registration fees. When we evaluated the ‘knowledge retention’ of the participants, it became clear to us that the true benefit of on-site lectures and practical hands-on training is typically very limited – unless the participants are well prepared theoretically before arrival to the venue. We learned that on-site hands-on teaching is slowed down and becomes inefficient unless the participants share a pre-course common understanding of the topic and knows the terminology. Those lessons learned ignited our online, interactive e-learning site USabcd – ‘Ultrasound of the Airway, Breathing, Circulation & Dolor’. The first version of the USabcd e-learning site went online in 2009.

In non-pandemic times, the virtue of e-learning is that it facilitates maximum cost-effectiveness and quality of hands-on training. By eliminating on-site lectures and theory classes, the costly on-site time can be reduced or more time can be dedicated to focused hands-on training. It saves on-site hours and workshop expenses for instructors and models. It reduces time away from the hospital and travel expenses. Online e-learning facilitates that hands-on training can focus on learning practical skills as everybody already shares a common reference of knowledge and terminology.
An additional benefit for an academic society such as ESRA is that a successful shared resource of e-learning can help promote a standardised terminology and a mutual understanding of basic concepts.

In the present times of pandemic hardship, the virtue of online e-learning is becoming even more prominent. It has the potential to become a powerful resource for each and every department of anaesthesiology that the ESRA members are affiliated to – all over Europe and the rest of the world. The opportunity to join international meetings, courses and congresses is practically non-existent and will most likely be very limited for a long time to come. This means that the e-learning accessible on the ESRA website becomes an important resource for enthusiastic ESRA members who are typically the point-of-care ultrasound (POCUS) experts of their department and the natural born in-hospital POCUS course instructors. The ESRA member can use the ESRA/USabcd e-learning to prepare small groups of peers for covid-compliant sessions of hands-on training on models in the department. The benefits are obvious. Even the most enthusiastic POCUS expert who truly wants to teach her peers in her own department of anaesthesiology often does not have the time or motivation to prepare high-quality power point presentations of all the relevant and important theory that is mandated for efficient outcome of practical hands-on training. In addition, such presentations are typically run in a class room format during working hours. Allocating time for this is not necessarily feasible or easy or well-received by the management of the department.
The e-learning theory prepares the colleagues theoretically for the practical skills training. Less time is needed to reach the learning goals of hands-on training. The e-learning promotes a shared terminology, a shared language and fruitful academic discussion. It also minimizes bias and misunderstandings.

Figure 1. Ideal training program.
An ideal training program involves e-learning based presentation of theory as it can be implemented anywhere and anytime

The local in-hospital ESRA affiliated course instructor can take advantage of the course management resource on the USabcd website. This resource allows dynamic monitoring of the e-learning progress of the ‘students’ in the department. It means the instructor is offered the opportunity to demand and control that the colleagues only get access to the in-hospital hands-on training of POCUS, if they have appropriately completed the relevant e-learning course.
We would like to emphasize that this learning model based on the combination of online interactive e-learning and hands-on training in small groups in-hospital requires that an enthusiast and expert of POCUS is employed in the local department of anaesthesiology – the beacon of POCUS in the department. That would typically be an ESRA member.

On-line e-learning has many advantages over traditional on-site learning (lectures, classroom teaching). It allows progress that is tailor-made for the individual student. It can be repeated as required and it is independent of time and place. It can be accessed on different devices (mobile phone, computer, tablet). In the case that the student needs an intermission, the e-learning can be re-accessed where the student stopped. The interactivity using tests and quizzes makes the learning more fun and efficient. The digital, interactive format especially suits the digitally native younger colleagues and strengthens their motivation for learning POCUS. It offers different ways to grasp difficult theoretical concepts – text, images, videos, animations, voice-over, quizzes and tests. This promotes faster and easier understanding.
A limitation of many e-learning systems is the lack of access to an expert supervisor during the online e-learning based training. This is probably not a critical problem, when the course instructor is employed in the same department as the course participants. In the case that the course instructor wants to communicate online with the in-hospital POCUS course participants and grant them access to submit questions along their e-learning course that is also a built-in option in the USabcd course management tool.

We encourage all ESRA members who want to teach POCUS hands-on training to their peers in their own hospital to take advantage of the complimentary USabcd POCUS e-learning resource.
To access the USabcd as an ESRA member: click here

Video 1. An example of a short video demonstrating how to scan the right pleura.