Point-of-Care Ultrasound Research: Unlocking the Secrets to Productivity and Partnership

Hamid Shokoohi, MD, MPH, FACEP
Harvard Medical School

The fast and furious clinical expansion and ever-growing advanced training have firmly pushed the point-of-care ultrasound (POCUS) research to the forefront of the academic program’s agenda. Identifying the need, the POCUS community has already experienced a surge in the number and quality of POCUS research projects. This growth is a testament to the potential impact that POCUS research can have on improving patient outcomes and transforming clinical practice. However, limited funding, audience, and partnership opportunities can hinder POCUS research progress. Therefore, it is imperative to implement strategies that can unlock the secrets to productivity and partnership among researchers in this field.

The POCUS research enterprise is a narrow field of research in academic medicine, and conducting research in this field comes with its own particular challenges mandating targeted planning. Limited funding can be a significant hurdle as a narrow ultrasound research field may attract less funding than broader research areas. Similarly important is the limited audience for POCUS research. Disseminating research findings can be challenging when the audience is relatively small, making it difficult to gain recognition and attract partners. For example, POCUS publications barely get attention from top-tier medical journals covering topics that apply to several specialties and a broad range of audiences in the medical community. Also, ultrasound publications receive relatively fewer citations and publicity, which may distract potential grants, funds, and partnerships.

Additionally, attracting collaborators with the necessary expertise is much more challenging while conducting research in a limited practice field. Successful partnership in this modern era of performing research is no longer a luxury but a must. A research project can only find its way to a practice-changing publication if it originates from a team with multi-disciplinary expertise.

Given these challenges, it is essential to identify the predictors of research productivity in POCUS research to develop strategies to overcome them. In this piece, I will briefly discuss the predictors of research productivity in ultrasound research, specifically on the three phases of research productivity metrics: input, productivity, and impact.

1- Input Metrics: In the input phase, factors such as topic stewardship, funding availability, team composition, and research design are critical predictors of research productivity.

Topic Stewardship: Prioritizing need-driven projects with clinical effectiveness has the potential to attract resources and funding. In POCUS research, there is often a lack of need-driven projects, with most projects being driven by curiosity and opportunity. To address this, resources should be allocated toward relevant projects identified as necessary to increase the chances of success. To ensure that POCUS research addresses real clinical needs, it is crucial to focus on need-driven projects that have the potential to impact patient outcomes and attract sufficient sponsorship. Projects that address high-priority clinical questions such as hypotension and shock, volume resuscitation, trauma, and patient safety procedures are more likely to attract funding and appeal to other institutions to build successful multi-institutional projects. These projects can help establish POCUS research as a vital component of emergency and critical care practice and demonstrate its potential to improve patient care.

Team Building: Building a successful research team in POCUS research requires a diverse and dynamic approach, with individuals recruited based on complementary skills. While building a team comprised of sonographers or isolated individuals with considerable expertise may be tempting, there may be more effective approaches. To build a successful POCUS research team, it is essential to design tasks that allow for autonomy, establish norms for working together, and match the team to specific research plans. Including people from other specialties, such as statisticians and digital media experts, can provide the team with a more comprehensive and diverse skill set. This can lead to more innovative and effective research outcomes. Collaboration is based on relationships rather than projects or organizations, and communication and trust are key to success. To establish a good culture of research, it is crucial to prioritize people over projects. This can help foster a sense of community and team sustainability, ultimately leading to better research outcomes.

Funding and Grants: Funding and grants are essential input metrics for research productivity in POCUS research. Unfortunately, most POCUS research projects are unfunded, which burdens academic clinicians who must devote extra time and effort to complete their projects. To address this, focusing on broader topics that matter to other specialties and prioritizing studies with patient-centered outcomes is essential. A well-designed study with a clear research question, methodology, and objectives, coupled with a competent research team, is more likely to attract funding and lead to successful research outcomes. Investing in rising POCUS stars, mentoring their faculty development, and supporting their research funding should be prioritized. For instance, linking junior faculty with NIH-funded and experienced faculty, offering them competitive internal grants, and establishing clinical scholar awards that secure buy-down time for junior ultrasound faculty with research interests and capabilities are effective approaches. In addition, entertaining candidacy and participation in committees and organizations in charge of scholarly funding and coordinating between ultrasound organizations and funding institutions are inevitable. By creating pathways for funding and grants, POCUS researchers can alleviate the financial burden on academic clinicians and attract resources for successful and high-quality research.

2- Productivity Metrics: In the productivity phase, effective communication, collaboration, and project management are vital in ensuring research productivity and publications.

Publications: One of the most critical metrics in research productivity is the number and quality of publications. Historically, POCUS articles have struggled to find their way into top-tier journals. This may be due to a relatively smaller audience, the type of studies needing more innovation and effectiveness, and the lower quality of projects. To improve the chances of publishing in top-tier journals, it is crucial to expand the scope of research to apply to a broader clinical application and a wider group of audiences. Selecting innovative topics with potential partnerships with other subspecialties and focusing on patient-centered outcomes can also increase the chances of publication in higher-level journals. Strategies for disseminating research findings are crucial in gaining the highest recognition and attracting partners. By reaching out to a broader audience, including medical professionals from various specialties and healthcare organizations, POCUS researchers can showcase the potential impact of their work and attract the attention and support needed to drive progress.

Collaboration and Partnership: Successful collaboration is critical in conducting POCUS research. Studies with multi-disciplinary expertise involvement have the potential to be translated into practice-changing publications. By forming partnerships with experts from various fields, we can ensure that our work is comprehensive and has a meaningful impact on patient care. Building sustainable partnerships with other POCUS researchers in other institutions nationally and worldwide can lead to more productive research. One way to facilitate collaborative research is to openly share previous grants, papers, and IRB applications through a central repository. This can help streamline the research process and guide multi-institutional projects. Transparent discussions on roles and responsibilities and focusing on high-impact study questions can also help ensure successful collaborations. Expanding the teams to share mental teamwork, providing infrastructure for better communication and coordination, and promoting knowledge dissemination in other formats than publications can highly encourage productivity. Recognizing that competition in publishing and credits can hinder productivity is also essential. Collaborative and inclusive environments can help improve productivity by fostering a sense of teamwork and encouraging knowledge sharing.

Keeping Your Team Around: Another predictor of productivity is the success of keeping the team together. When team members feel valued and essential to the project, they are more likely to stay engaged and committed to the research. Strategies for successful authorship, including ethical and transparent authorship practices, early discussion of authorship, and setting expectations, can expand authorship opportunities and encourage the team to stay together. The longer the team stays together, the greater the potential for exponential research productivity. Effective team communication strategies, clear roles and responsibilities, and regular progress updates can help streamline research processes, reduce errors, and prevent project delays. By setting clear expectations and providing regular feedback, team members can stay engaged and motivated throughout the research process. It is also essential to prioritize team culture and morale. Providing opportunities for team members to socialize and bond outside of research can help foster a sense of community and teamwork. This can lead to greater collaboration and better outcomes.

3- Impact Metrics:

Factors affecting the impact of research findings on clinical practice and their adoption in medical guidelines are critical predictors of research success, and POCUS research is no exception. Factors such as publication quality, dissemination strategies, and impact assessment are fundamental in attracting funding, collaborations, and partnerships, leading to further research productivity.

Despite the critical impact of POCUS in clinical practice, there is still a need to present evidence of its effectiveness more convincingly. One criticism of POCUS publications is the need for more effective patient-centered outcomes.¹ To address this, investigators should prioritize developing high-quality projects that present the impact of POCUS that directly or indirectly affect clinical outcomes. Aside from that, highlighting significant developments that may use POCUS in improving clinical practice, such as time to diagnosis, reducing uncertainty, reducing further imaging and length of stay, and streamlining testing pathways, are also essential.² Supporting translational POCUS research and relevant metanalysis and systematic reviews can emphasize the impact metrics and improve integration in the clinical practice.

To improve the standard of practice and ensure that POCUS is included in guidelines, it is crucial to prioritize investigations that integrate previous research and develop high-quality projects that demonstrate the impact of POCUS. One clear example is the use of POCUS in cardiac arrest. The landmark multi-institutional studies on cardiac arrest found their way to high-tier journals.^3,4 However, they still need to support the investigation, especially from other subspecialties, to help integrate with the updated ACLS protocols.

Defining the standard of care can promote the highest level of clinical research: integration and clinical impact assessments. In many other applications, a body of scientists should come together, as we have seen in lung ultrasound in COVID, and develop guidelines and protocols based on scientific evidence. This opens more windows to patient-outcome-based studies with more potential for grants and funding. Translational knowledge is essential and can help disseminate projects, develop needs and awareness, and make POCUS integration in clinical practice easier.

In summary, we acknowledge the significant contributions of related organizations and leaders in the POCUS research field, who have guided and encouraged successful research despite the challenges. It is important to note that POCUS research holds tremendous promise and offers exciting opportunities to transform healthcare. With the right resources, collaborations, and partnerships, POCUS researchers can continue to make significant strides in the field and improve patient outcomes. We remain hopeful and inspired by the potential impact of POCUS research, and we look forward to this field's continued growth and success.

References:

1. Bernstein E, Wang TY. Point-of-care ultrasonography: Visually satisfying medicine or evidence-based medicine? JAMA Intern Med. 2021;181(12):1558-9.
2. Shokoohi H, Liteplo AS, Ma IWY. Point-of-care ultrasonography: clearly more than a pretty picture. JAMA Intern Med. 2022;182(5):567.
3. Gaspari R, Weekes A, Adhikari S, et al. Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest. Resuscitation. 2016;109:33-39.
4. Gaspari R, Weekes A, Adhikari S, et al. Comparison of outcomes between pulseless electrical activity by electrocardiography and pulseless myocardial activity by echocardiography in out-of-hospital cardiac arrest; secondary analysis from a large, prospective study. Resuscitation. 2021;169:167-72