Peer-Learning Versus Physician-Led POCUS Training for Nurse Practitioners in Integrative Volume Status Assessment

Feasibility of a Peer-Learning Ultrasound Program to Enhance Nurse Practitioners' Competence in Integrative Volume Status Assessment

This study aims to develop and evaluate a peer-led training program specifically designed for Nurse Practitioners (NPs) to acquire Point-of-Care Ultrasound (POCUS) skills. POCUS, known for its non-invasive nature and real-time imaging capability, has been widely applied in clinical fluid status assessment and plays a pivotal role in enhancing diagnostic efficiency and quality of care. However, current POCUS training resources for NPs in Taiwan remain insufficient, limiting their clinical application and professional visibility. Using a quasi-experimental design, this study investigates the effectiveness of peer-led instruction in strengthening image interpretation, clinical reasoning, and self-efficacy among NPs. The ultimate goal is to establish an evidence-based, nursing-oriented POCUS education model to fill existing gaps in the training system and elevate the role of NPs in multidisciplinary care.

This quasi-experimental study aims to compare two instructional models-physician-led versus peer NP-led POCUS training-and their effects on learners' outcomes and clinical skill performance.

Methods:

Sixty NPs, either in practice or under training, will be recruited and non-randomly assigned to either the experimental group (peer-led instruction) or the control group (physician-led instruction), based on their course availability, simulating real-world clinical education allocation:

• Experimental group: Hands-on training led by NPs who have completed a structured POCUS curriculum and passed both teaching and practical assessments.
• Control group: Hands-on training delivered by specialist physicians.

To ensure the quality and standardization of instructional delivery and operational procedures, two groups of nurse practitioners received the training program in separate cohorts. The educational intervention was structured into two phases: the first phase consisted of a two-hour online course covering fundamental ultrasound theory, relevant anatomical structures, and key points in clinical application; the second phase was a four-hour in-person hands-on workshop focusing on clinical scanning techniques and image interpretation skills. The instructional content encompassed five core structures: (1) inferior vena cava (IVC) assessment, (2) pleural effusion detection, (3) ascites identification, (4) hydronephrosis evaluation, and (5) bladder volume estimation and urinary retention interpretation.

Participants completed a pre-test prior to the training, a first post-test immediately after the course, and a second post-test three months later. The assessment tools included: (1) a POCUS knowledge questionnaire, (2) a self-confidence scale, (3) an image interpretation assessment, and (4) an Objective Structured Clinical Examination (OSCE).

Inclusion Criteria:

Participants aged 18 years or older. Licensed nurse practitioners or nurse practitioner trainees currently enrolled in an accredited nurse practitioner training program.

Able to understand the study procedures and provide written informed consent. Able to participate in the complete training program and study assessments, including baseline, post-training, and 1-month follow-up assessments.

No prior formal POCUS training, or only limited basic exposure without systematic training experience.

Exclusion Criteria:

Participants who have previously completed a formal point-of-care ultrasound training program.

Participants who are unable to complete the full training program or study assessment procedures.

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