New BTS Training Opportunities in Thoracic Ultrasound

Thursday, March 30, 2023

We are pleased to welcome Dr Andrew Stanton and Dr Ian Forrest to Respiratory Futures to outline how the British Thoracic Society has re-engineered its support for training in thoracic ultrasound (TUS). Andrew and Ian are both respiratory consultants working in Newcastle. 

Why is training in TUS such an important area for the Society? 

BTS has a long history of supporting pleural disease and advocating for high quality training. More specifically, we are keen to ensure that those already working, and indeed those wishing to gain experience in TUS have access to high quality training and education.  

There have been great advances in TUS practice in recent years and we know that the majority of TUS is performed by respiratory teams. Training is most often led by respiratory professionals. 

It is important to recognise that TUS is now delivered by a wider range of healthcare professionals. BTS is a multi-professional organisation and therefore has a unique role in representing many of the professions involved in delivering this important aspect of patient care. 

BTS is also the home of the training standards document and pleural disease guideline. A new version of this guidance, plus a clinical statement for pleural procedures is due for public consultation this summer. 


Are there national standards for TUS training? What do people need to help them improve their skills?

In 2020, BTS published a training standard for thoracic ultrasound. 

This was a really important document as it set out, for the first time, a training structure for those wishing to train in this area, bringing with it greater clarity for both learners and educators. It clearly detailed the requirements for reaching agreed levels of initially supervised and ultimately independent practice in TUS. This involves largely exploiting learning opportunities in the clinical environment but with a foundation of theoretical and practical training.  

You can read more about the training standard in an article with Dr John Park, available here: 

An FAQ document is also available to support this publication. 


What should TUS training deliver?

There are two key elements to TUS training – theory and practical skills. We recognise that both those seeking and those delivering courses need clarity so that unnecessary variation can be minimised and there is a clear standard against which courses can be developed to ensure high quality education and training is delivered across the board. 

It is vital that learners gain an understanding of the underlying principles of TUS, in order to ensure safe practice and to support and ground learning of the practical aspects of the technique. We therefore advocate that this aspect is delivered before learners attend a practical course.  

There is a lot of ground to cover in TUS training and we know that there is huge benefit to hands on learning. We want to support our colleagues who are providing the practical element to allow them to focus in on giving learners hands-on experience with ultrasound scanning within a supportive learning environment. 


 Which members of the respiratory team are seeking training?

While it is most often respiratory trainees seeking training, we are mindful that other members of the respiratory team are seeking learning in this area. For example, specialist nurses, physician associates, advanced clinical practitioners, and physiotherapists. 

We believe that multi- and interprofessional learning is best delivered by a faculty which is representative of all those involved in TUS.  


How will BTS support TUS training?

BTS has a long history of providing training in thoracic ultrasound. The pandemic resulted in a necessary pause in our practical courses, but provision of training was already changing.  

We remain committed to supporting training in this area and have a clear framework in place to support both theoretical and practical education. 

This framework has been developed with help from an expert task and finish group, involving regional training programme directors, trainees and members of the BTS Education and Training Committee and Pleural Specialist advisory group. We are really grateful to all members of this group; regular meetings helped us to understand the various challenges and opportunities colleagues are facing. 


 What can people expect to support their understanding of the theory of TUS:

BTS will provide an online theory resource, developed by experts in TUS. This resource will be relevant to all those wishing to understand the theory needed to achieve Primary TUS operator status. More details are available here. 

We know that delegates find access to online resources helpful. The set of learning resources map to the agreed BTS learning objectives, which are available here.  

All delegates who book will have access to this online resource for 1 year. 

In a perfect world, people would be able to view the online content before they attend a practical course locally, but we understand this may not be possible for everyone. We hope making the resources available for 1 year will give people sufficient time to familiarise themselves will the general principles before their practical course as well as the chance to go back and review topics after any course as they assimilate their knowledge going forward. 


 Moving to practical courses, what is BTS’ role here?

High quality locally run courses are available across the country; a model that the Society feel is most appropriate and BTS no longer provides a practical course. 

We are keen to support training centres who offer practical courses and while we will not be offering an accreditation scheme, we have developed a set of minimum standards (see Appendix 2 here). 

These standards outline the steps to delivering a high-quality half day training course that will underpin the skills needed to achieve primary operator status. 

We have included course objectives as well as suggested content and format. This includes an indication of the role and number of patients and the need for a healthy volunteer.  

We have piloted these standards in face-to-face courses delivered in Newcastle and North Tees at the end of 2021. Hugely positive feedback from attendees confirmed that we were able to deliver the intended learning objectives with a varied patient cohort. 


 It is useful to see the 2 elements of training outlined. What sort of time commitment is involved?

We are keen that this model of learning does not over-burden those attending, or indeed those delivering training. 

For the theory, we anticipate that going through each of the pre-learning modules will take 20-30 minutes.  

Similarly, we know from our experience here in Newcastle running the practical course that the content detailed in our minimum standards document can be delivered very nicely in half a day. 


 How will this framework support non-BTS courses?

We recognise the value of locally delivered courses, and it is certainly not our intention to reduce the number of courses on offer, or stop providers delivering education.  

We will not accredit other practical courses, but we hope our minimum standards document will help to increase the number of high-quality courses on offer. 


How has this process involved partnership with the SAC/TPDs? 

Input to this process by TPDs from around the UK has been especially valuable and we want to make sure we stay connected to the experiences of those training. The SAC and local STCs and regional TPDs are key to ensuring delivery of these standards and by engaging with them in this process we feel we have a produced a framework that is deliverable and addresses the needs of trainees while respecting logistical challenges faced in providing practical training. We will build in regular review of our group’s output to ensure training remains up to date and aligns to all BTS publications.