Thoracic ultrasound experiences among respiratory specialty trainees in the UK

There were some interesting points raised by Sivakumar et al in their article on thoracic ultrasound experience among respiratory trainees in the UK.¹ The difficulties with supervision and competent senior clinicians is one which is also seen among acute internal medicine trainees wishing to gain experience in point of care ultrasound (POCUS),² and requires much work to overcome. It is reassuring that progress is being made within respiratory medicine.

The fact that a number of trainees claim confidence in diagnosing pulmonary oedema and pneumothorax with ultrasound is interesting, since neither of these pathologies are covered within the Royal College of Radiologists (RCR) curriculum.³ Indeed, I am not aware either of a training curriculum that sits within respiratory medicine which covers the use of bedside ultrasound for respiratory failure, as opposed to pleural disease which has traditionally been the mainstay of thoracic ultrasound. To my knowledge, the focused acute medicine ultrasound (FAMUS) curriculum⁴ is the only training programme for physicians within the UK which covers the use of POCUS in patients with conditions like pneumothorax and pulmonary oedema.

I agree with the sentiment that the current RCR curricular do not entirely fulfil the requirements of respiratory medicine trainees, since they do not cover the use of thoracic ultrasound for respiratory failure. There is increasing evidence for the utility of POCUS for aiding diagnoses of pneumothorax, pulmonary oedema, pneumonia, asthma/COPD and pulmonary embolism,⁵ and this should surely form part of a future respiratory medicine ultrasound curriculum. This seems imperative to me given that respiratory medicine (and indeed acute internal medicine) care for the majority of medical patients with acute respiratory failure.

A revision of the current respiratory medicine ultrasound curriculum to include a respiratory failure component would require a significant undertaking from training committees to support both trainees to achieve those competencies, and trainers to deliver them. However, given this is a largely untapped use of POCUS with significant scope to improve diagnostic accuracy,⁵ it is a logical extension of the current use of ultrasound within respiratory medicine.

Conflict of interest

The author is a member of the FAMUS working group.