Objective and Structured Assessment of Lung Ultrasound Competence A Multispecialty Delphi Consensus and Construct Validity Study

Rationale: Point-of-care lung ultrasound imaging has substantial diagnostic value and is widely used in respiratory, emergency, and critical care medicine. Like other ultrasound examinations, lung ultrasound is operator dependent. The current recommendations for competence in lung ultrasound set a fixed number of ultrasound procedures to be performed without considering different learning rates. Recommendations do not consider different uses of lung ultrasound across specialties. Objectives: To create a reliable, valid, and feasible instrument to assess lung ultrasound competence that includes the diverse use of lung ultrasound among medical specialties. Methods: A Delphi consensus survey was undertaken with participation of 11 experts from four different specialties to design an objective and structured assessment ultrasound tool. The construct validity of the assessment tool was examined by scoring 23 ultrasound operators of different competence levels. Examination time was measured and skill level rated by experienced observers using the assessment tool. Interrater agreement was examined by two observers in nine lung ultrasound examinations. Results: Consensus was obtained within three Delphi rounds. Five elements were excluded. Two new elements were proposed, and one gained consensus. Two elements were rephrased. We found that the lung ultrasound competence evaluation tool could differentiate between levels of competence (P < 0.001). Examination time differed significantly between experts and intermediate operators (P = 0.005), but not between novices and intermediate operators (P = 0.06). The assessment tool had good interrater agreement (Pearson's r= 0.85; P < 0.005). Conclusions: This assessment tool provides a relevant, valid, and feasible method for evaluation of operator competence in point-of-care lung ultrasound across multiple specialties. This allows for a more individualized assessment of competence than current recommendations.