Establishing point of care ultrasound in undergraduate medical education and postgraduate paediatric critical care medicine

Abstract

Point-of-care ultrasound (POCUS) is a rapidly evolving bedside imaging modality that enhances clinical decision-making, facilitates procedural guidance, and improves patient safety. This thesis explores the establishment of POCUS in both undergraduate medical education and postgraduate paediatric critical care, outlining its pedagogical and clinical integration.

In the undergraduate medical curriculum, early exposure to POCUS aids students in developing anatomical and physiological understanding, hand-eye coordination, and image interpretation skills. The research presented evaluates the effectiveness of ultrasound as a teaching and assessment tool, comparing it to traditional methods such as cadaveric prosections. The findings highlight the benefits of POCUS in enhancing anatomical comprehension and clinical application.

In postgraduate paediatric critical care, the thesis demonstrates the utility of POCUS in acute paediatric medicine, particularly in respiratory and cardiovascular assessment. Evidence is provided on the incorporation of POCUS into paediatric resuscitation guidelines and its role in the management of paediatric shock, respiratory failure, and procedural safety. Additionally, the research details the development of the Children’s Acute Ultrasound (CACTUS) course, a national paediatric POCUS curriculum designed to standardize training, accreditation, and governance.

Challenges to implementation, including training barriers, governance issues, and the need for faculty development, are also explored. The research contributes to policy and practice by providing a structured pathway for POCUS integration at multiple levels of medical education.

This body of work establishes a foundation for future research in paediatric POCUS, advocating for continued curriculum development, assessment standardisation, and widespread adoption of ultrasound in medical education and paediatric critical care.

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Parts of this work have been published as:-
• Griksaitis MJ, Sawdon MA, Finn GM. Ultrasound and Cadaveric Prosections as Methods for Teaching Cardiac Anatomy: A Comparative Study. Anat Sci Educ Jan 2012; 5:20-26
• Finn GM, Sawdon MA, Griksaitis MJ. The additive effect of teaching undergraduate cardiac anatomy using cadavers and ultrasound echocardiography. Eur J Anat Sept 2012;16(3):199-205
• Griksaitis MJ, Scott MP, Finn GM. Twelve tips for teaching with ultrasound in the undergraduate curriculum. Med Teach Jan 2014;36(1):19-24
• Griksaitis MJ, Scott MP, Finn GM. Comment on letter by Nicholls et al.--Ultrasound: a hands-on and kinaesthetic approach to anatomy education. Med Teach. 2014 Jul;36(7):644.
• Potter SK, Griksaitis MJ. The role of point of care ultrasound in pediatric acute respiratory distress syndrome: emerging evidence for its use. Ann Transl Med. 2019 Oct;7(19):507
• Edelman J, Taylor H, Goss AM, Tisovszky N, Sun KM, O'Toole S, Herriotts K, Inglis E, Johnson C, Penfold S, Bull J, Shires P, Towers A, Griksaitis MJ. Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study. Arch Dis Child. 2024 Mar 19;109(4):287-291.
• Walden A, Smallwood N, Dachsel M, Miller A, Stephens J, Griksaitis M. Thoracic ultrasound: it's not all about the pleura. BMJ Open Respir Res. 2018 Oct 1;5(1):e000354.
• Ord HL, Griksaitis MJ. Fifteen-minute consultation: Using point of care ultrasound to assess children with respiratory failure. Arch Dis Child Educ Pract Ed. 2019 Feb;104(1):2-10.
• Hardwick JA, Griksaitis MJ. Fifteen-minute consultation: Point of care ultrasound in the management of paediatric shock. Arch Dis Child Educ Pract Ed. 2021 Jun;106(3):136-141.
• Job S, Griksaitis MJ, Singh Y (Editors: Singh Y, Tissot C, Fraga MV, Conlon T) Chapter 17: Role of Point of Care Ultrasound in Transport Setting for Evaluating Infants & Children with Shock (within Point of Care Ultrasound for the Neonatal & Pediatric Intensivist: A Practical Guide on the Use of POCUS) Sept 2023; 1st Ed. Springer, ISBN 9783031265372
• Griksaitis MJ, Zoica B. (Editor: Stephanie Smith) Appendix I: Point of Care Ultrasound in Paediatric Resuscitation. Within Advanced Paediatric Life Support (APLS) 7th Ed. Aug 2023, Wiley Blackwell Publishers, ISBN 9781119716136
• Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P; Children’s ACuTe UltraSound (CACTUS) group. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child. 2024 Jun 19;109(7):543-549.
• Morea CG, Beaves C, Shires P, Hargadon-Lowe A, Ross O, Griksaitis MJ. Current provision of point of care ultrasound in UK paediatric critical care: an online survey. Arch Dis Child. 2025 Feb [E-pub ahead of print 10.1136/archdischild-2024-327934]

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