Perception, Challenges, and Barriers of Point-of-Care Lung Ultrasound Among Respiratory Therapist in the United States

BackgroundPoint-of-care lung ultrasound (POCLUS) has gained significant interest within the respiratory therapy profession.Research QuestionDoes participating in an online on-demand POCLUS didactic course affect the willingness to use or promote POCLUS among respiratory therapists (RTs)? What are the critical barriers to the implementation of POCLUS? What are the perceptions of RTs about the use of POCLUS?Study Design and MethodsThis study used a pre-educational vs posteducational interventional design and received approval from the institutional review board. Participants were recruited via social media channels. The inclusion criteria required participants to be licensed registered RTs actively engaged in bedside practice within the United States. After signing the informed consent form, participants completed an online survey, underwent the online course, and participated in a 2-week follow-up survey.ResultsA total of 70 participants with a mean ± SD age of 38.8 ± 9.0 years participated in the study. Most participants were female (n = 50 [71.4%]) and had been practicing as RTs for > 1 year (n = 65 [92.9%]). Most participants (87.1% [n = 61]) had observed POCLUS being performed on a patient and were curious to use it after the course; 97.1% (n = 68) believed that POCLUS should be incorporated into the clinical assessment. Additionally, 91.4% (n = 64) of the participants discussed the POCLUS elements with fellow RTs and 90% (n = 63) reported an increased willingness to use this skill. The top barriers to performing POCLUS were the lack of a formal curriculum and limited device availability. Interestingly, financial incentives did not emerge as a significant barrier.InterpretationOur findings show that RTs display strong willingness and interest in integrating POCLUS into their daily clinical assessments. The inclusion of POCLUS in the curriculum was found to be the primary barrier, whereas surprisingly, financial incentives were not reported as a significant barrier. Point-of-care lung ultrasound (POCLUS) has gained significant interest within the respiratory therapy profession. Does participating in an online on-demand POCLUS didactic course affect the willingness to use or promote POCLUS among respiratory therapists (RTs)? What are the critical barriers to the implementation of POCLUS? What are the perceptions of RTs about the use of POCLUS? This study used a pre-educational vs posteducational interventional design and received approval from the institutional review board. Participants were recruited via social media channels. The inclusion criteria required participants to be licensed registered RTs actively engaged in bedside practice within the United States. After signing the informed consent form, participants completed an online survey, underwent the online course, and participated in a 2-week follow-up survey. A total of 70 participants with a mean ± SD age of 38.8 ± 9.0 years participated in the study. Most participants were female (n = 50 [71.4%]) and had been practicing as RTs for > 1 year (n = 65 [92.9%]). Most participants (87.1% [n = 61]) had observed POCLUS being performed on a patient and were curious to use it after the course; 97.1% (n = 68) believed that POCLUS should be incorporated into the clinical assessment. Additionally, 91.4% (n = 64) of the participants discussed the POCLUS elements with fellow RTs and 90% (n = 63) reported an increased willingness to use this skill. The top barriers to performing POCLUS were the lack of a formal curriculum and limited device availability. Interestingly, financial incentives did not emerge as a significant barrier. Our findings show that RTs display strong willingness and interest in integrating POCLUS into their daily clinical assessments. The inclusion of POCLUS in the curriculum was found to be the primary barrier, whereas surprisingly, financial incentives were not reported as a significant barrier. The art and skill of auscultation are essential elements of clinical practice used by clinicians across various medical settings. The stethoscope remains an efficient, cost-effective, and noninvasive universal tool, particularly for respiratory therapists (RTs). However, a 2020 meta-analysis by Arts et al1Arts L. Lim E.H.T. van de Ven P.M. Heunks L. Tuinman P.R. The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis.Sci Rep. 2020; 10: 7347Crossref Scopus (41) Google Scholar evaluated the diagnostic accuracy of auscultation in patients with pulmonary pathologic features and reported a sensitivity of 37% and specificity of 89%. These findings highlight the limitations of using lung auscultation with a stethoscope as a diagnostic tool. With the advancement of technology and the availability of specific imaging tools, obtaining a clear and comprehensive view of the lungs at the bedside using point-of-care devices can aid in improving patient assessment and, eventually, diagnosis. Ultrasound is a point-of-care advanced imaging method that can be used for lung imaging and assessment at the bedside. Various studies have reported the effectiveness of using point-of-care lung ultrasound (POCLUS) at the bedside for clinicians in multiple contexts.2Li N. Zhu Y. Zeng J. Clinical value of pulmonary congestion detection by lung ultrasound in patients with chronic heart failure.Clin Cardiol. 2021; 44: 1488-1496Crossref Scopus (5) Google Scholar, 3Mojoli F. Bouhemad B. Mongodi S. Lichtenstein D. Lung ultrasound for critically ill patients.Am J Respir Crit Care Med. 2019; 199: 701-714Crossref PubMed Scopus (267) Google Scholar, 4Yassa M. Birol P. Mutlu A.M. Tekin A.B. Sandal K. Tug N. Lung ultrasound can influence the clinical treatment of pregnant women with COVID-19.J Ultrasound Med. 2021; 40: 191-203Crossref Scopus (27) Google Scholar, 5Blans M.J. Bousie E. van der Hoeven J.G. Bosch F.H. A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy.Ultrasound J. 2021; 13: 29Crossref PubMed Scopus (6) Google Scholar, 6Bouhemad B. Dransart-Rayé O. Mojoli F. Mongodi S. Lung ultrasound for diagnosis and monitoring of ventilator-associated pneumonia.Ann Transl Med. 2018; 6Google Scholar, 7Rajendram R. Souleymane M. Mahmood N. Kharal M. AlQahtani M. Point-of-care diagnostic lung ultrasound is highly applicable to the practice of medicine in Saudi Arabia but the current skills gap limits its use.Ann Thorac Med. 2021; 16: 266-273Crossref Scopus (2) Google Scholar, 8Supino M.C. Buonsenso D. Scateni S. et al.Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study.Eur J Pediatr. 2019; 178: 623-632Crossref PubMed Scopus (57) Google Scholar, 9Shumbusho J.P. Duanmu Y. Kim S.H. et al.Accuracy of resident-performed point-of-care lung ultrasound examinations versus chest radiography in pneumothorax follow-up after tube thoracostomy in Rwanda.J Ultrasound Med. 2020; 39: 499-506Crossref Scopus (6) Google Scholar More specifically, during the COVID-19 pandemic, POCLUS has been reported to be helpful in assessment and diagnoses at the bedside.10Kameda T. Mizuma Y. Taniguchi H. Fujita M. Taniguchi N. Point-of-care lung ultrasound for the assessment of pneumonia: a narrative review in the COVID-19 era.J Med Ultrasonics. 2021; 48: 31-43Crossref PubMed Scopus (21) Google Scholar, 11Lerchbaumer M.H. Lauryn J.H. Bachmann U. et al.Point-of-care lung ultrasound in COVID-19 patients: inter- and intra-observer agreement in a prospective observational study.Sci Rep. 2021; 1110678Crossref Scopus (22) Google Scholar, 12Alharthy A. Abuhamdah M. Balhamar A. et al.Residual lung injury in patients recovering from COVID-19 critical illness.J Ultrasound Med. 2021; 40: 1823-1838Crossref PubMed Scopus (26) Google Scholar, 13Alharthy A. Faqihi F. Abuhamdah M. et al.Prospective longitudinal evaluation of point-of-care lung ultrasound in critically ill patients with severe COVID-19 pneumonia.J Ultrasound Med. 2021; 40: 443-456Crossref PubMed Scopus (39) Google Scholar, 14Antúnez-Montes O.Y. Buonsenso D. Routine use of point-of-care lung ultrasound during the COVID-19 pandemic.Med Intensiva (Engl Ed). 2022; 46: 42-45Crossref Scopus (15) Google Scholar Respiratory therapy professionals continue to be valuable members of the clinical decision-making team, a fact that was particularly highlighted during the COVID-19 pandemic. The responsibility of the health care team includes improving the quality of clinical assessment tools; for example, the advantages of POCLUS warrant careful consideration. Providing a comprehensive 360° view of the pulmonary system through a simple and accessible device such as POCLUS can enhance the assessment and outcomes of the patients significantly. Interest in integrating POCLUS as a tool for RTs has increased. However, limited research has reported and evaluated the use of POCLUS within the field of respiratory care. For example, See et al15See K.C. Ong V. Wong S.H. et al.Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists.Intensive Care Med. 2016; 42: 63-71Crossref PubMed Scopus (66) Google Scholar investigated a training model that showed the effectiveness of providing RTs with only 3 h of training to perform POCLUS at the bedside. Their findings showed that RTs perform POCLUS accurately and show interpretation skills with an impressive accuracy rate of 98%. Gardner et al16Garnder D.D. Hart M. Cutts S. Respiratory therapist lung ultrasound training program.Respiratory Care Education Annual. 2020; 29: 34-40Google Scholar explored the knowledge levels of RTs concerning POCLUS content before and after a face-to-face training program. Furthermore, Karthika et al17Karthika M. Wong D. Nair S.G. Pillai L.V. Mathew C.S. Lung ultrasound: the emerging role of respiratory therapists.Respir Care. 2019; 64: 217-229Crossref PubMed Scopus (15) Google Scholar emphasized the emerging role of RTs in using POCLUS at the bedside for recognizing patients with pneumothorax, assessing the potential for weaning from mechanical ventilation, and managing airways. The authors also highlighted the limited literature on the role of RTs in using POCLUS. Most reported studies have focused on physicians as the primary operators, with limited attention given to other health care professionals. Therefore, the primary purpose of this study was to evaluate the effectiveness of an online on-demand POCLUS course specifically designed for currently practicing RTs in the United States. Additionally, the study sought to identify the barriers to implementing POCLUS and to assess the willingness of RTs regarding the implementation of POCLUS within the scope of the respiratory care profession in the United States. The study was approved by the institutional review board of Loma Linda University Health. The study used a pre-educational vs posteducational intervention design conducted between June 2022 and October 2022. Inclusion criteria included individuals currently practicing as registered RTs in the United States. Exclusion criteria included registered RTs who already had completed an official POCLUS course and those not engaged in a hospital-based practice. Participants were recruited using a flyer posted on social media and a snowball sampling method. Additionally, participants were awarded two continuing respiratory care education credits approved by the American Association for Respiratory Care on successfully completing the course. After providing informed consent, participants completed a baseline survey to collect demographic information and their prior experience of performing POCLUS. Subsequently, participants were given access to an online learning management system to complete an on-demand POCLUS course. Participants were given 2 weeks to complete the course from the date of course registration. Successful completion was defined as achieving a 75% pass rate on the final examination at the end of the course. After participants finished the course, they were asked to complete a follow-up survey 2 weeks after the course completion date. This was achieved by emailing or texting the participant the survey link, or both. The course content was developed and designed exclusively by the authors and was approved by the American Association for Respiratory Care as a continuous respiratory care education course for two continuous respiratory care education credits. The course was designed as an asynchronous online on-demand course in which participants were given access to it after they signed the informed consent form. The course contains a total of six modules; each module has a recorded video presentation that covers specific objectives (e-Table 1). The faculty for the course included an RT experienced with lung ultrasound along with expert educators in the field of curriculum development and education. The course description was as follows: “This course aims to educate respiratory therapists on . . . POCLUS basics from a didactic on-demand perspective. The course will cover areas such as identifying POCLUS equipment and its purpose, POCLUS interpretation skills, and identifying different signs on POCLUS, such as B-lines, shred signs, and a bat sign. In addition, the learner will be able to identify proper methods for obtaining images from a didactic perspective. At the end of the course, the learner will be able to evaluate assessment findings to obtain a proper assessment when viewing a POCLUS image.” To achieve the objectives of this study, the authors designed two surveys: a baseline survey and a follow-up survey conducted 2 weeks after the course. The baseline survey explored different aspects, including participants’ demographics, professional experiences, and POCLUS-related inquiries, such as their prior experience, the likelihood of integrating POCLUS into bedside practice and assessment using a five-point Likert scale (ranging from extremely likely to extremely unlikely), and their interest in observing health care professionals performing POCLUS in their clinical practice using a five-point Likert scale (ranging from very not interested to very interested). The follow-up survey explored encountered or anticipated barriers and willingness to perform and promote POCLUS. The surveys underwent a thorough content validation process overseen by the authors, who included a team of RTs, a pulmonary and critical care physician, and a statistician. The authors reviewed the questions to make sure that they address the objectives of the study. The main outcome measures were willingness to use and promote POCLUS after undergoing the course, its application to the respiratory therapy profession, and possible encountered barriers if implemented. Data analysis was conducted using SPSS version 28.0 for Windows (SPSS Inc.). The Shapiro-Wilk test and boxplots were carried out to evaluate the normality of continuous variables. The characteristics of the participants were summarized using frequencies and relative frequencies (percentages) for categorical variables, mean ± SD for continuous variables, and median (interquartile range) for outcomes that exhibited nonnormal distribution. To ascertain any significant differences in the proportion of participants who were interested in expanding their knowledge about POCLUS after the course compared with before the course, the χ2 test of independence was used. The level of significance was set at P ≤ .05. A total of 93 participants initially enrolled in the study and provided informed consent; however, 23 of them dropped out by not completing the course within the given time frame. Therefore, a final cohort of 70 participants successfully completed both the course and the study. The mean ± SD age of the participants was 38.8 ± 9.0 years. Most were women (n = 50 [71.4%]) and had been practicing as a registered RT for > 1 year (n = 65 [92.9%]). Thirty-three participants (47.1%) held an associate’s degree, 30 participants (42.9%) held a bachelor’s degree, and seven participants (10%) held a master’s degree. In addition of being a registered respiratory therapist with the National Board for Respiratory Care, participants identified that they hold additional specialty credentials by the NBRC. Examples of these credentials were neonatal pediatric specialist (n = 13 [18.6%]) and adult critical care specialist (n = 7 [10%]). The participants reported residing in different states, with most being from California (31.4% [n = 22]), followed by Georgia (18.6% [n = 13]), Iowa (8.6% [n = 6]), Nebraska (7.1% [n = 5]), and other states (Table 1). Regarding the practice locations, each participant had the option to select multiple primary practice settings. Most participants were situated primarily in the ICU (92.9% [n = 65]), followed by the general floor (84.3% [n = 59]), emergency room (74.3% [n = 52]), and in-house transport (54.3% [n = 38]). Participants primarily were employed in teaching hospitals (51.4% [n = 36]) and community hospitals (41.4% [n = 29]). Hospital sizes were reported as medium (52.9% [n = 37]) and large (27.1% [n = 19]) (Table 1).Table 1Participants’ Characteristics (N = 70)CharacteristicDataAge, y38.8 ± 9.0Sex. . . Male20 (28.6) Female50 (71.4)Education. . . AA33 (47.1) BA or BS30 (42.9) MS7 (10)Years of practiceaPercentages do not add up to 100% because of missing data.. . . < 14 (5.7) ≥ 165 (92.9)Credentials. . . RRT70 (100) NPS13 (18.6) ACCS7 (10) RPFT1 (1.4) CPFT2 (2.9) SDS2 (2.9)Area of practice. . . ED52 (74.3) ICU65 (92.9) General floor59 (84.3) In-house transport38 (54.3) Outpatient14 (20) Specialty (pulmonary rehabilitation, acute rehabilitation, labor and delivery)22 (31.4) Other (ABG laboratory, telemedicine)Hospital typeaPercentages do not add up to 100% because of missing data.. . . Teaching36 (51.4) Community29 (41.4) Rehabilitation/LTACH4 (5.7)Hospital size, no. of beds. . . < 10014 (20) 100-≤ 50037 (52.9) > 50019 (27.1)States. . . Alabama2 (2.9) Arkansas1 (1.4) California22 (31.4) Georgia13 (18.6) Illinois1 (1.4) Iowa6 (8.6) Maryland2 (2.9) Missouri1 (1.4) Nebraska5 (7.1) New York3 (4.3) North Dakota1 (1.4) Ohio1 (1.4) Tennessee4 (5.7) Texas3 (4.3) Utah1 (1.4) Wisconsin4 (5.7)Data are presented as No. (%) or mean ± SD. AA = associate of arts; ACCS = adult critical care specialist; BA = bachelor of arts; BS = bachelor of science; CPFT = certified pulmonary function technologist; MS = master of science; NPS = neonatal pediatric specialist; RPFT = registered pulmonary function technologist; RRT = registered respiratory therapist; SDS = sleep disorder specialist.a Percentages do not add up to 100% because of missing data. Open table in a new tab Data are presented as No. (%) or mean ± SD. AA = associate of arts; ACCS = adult critical care specialist; BA = bachelor of arts; BS = bachelor of science; CPFT = certified pulmonary function technologist; MS = master of science; NPS = neonatal pediatric specialist; RPFT = registered pulmonary function technologist; RRT = registered respiratory therapist; SDS = sleep disorder specialist. In the baseline course survey, when asked about the likelihood of integrating POCLUS into bedside practice and assessment, 68.6% of participants (n = 48) stated they were likely to add POCLUS, whereas 15.7% of participants (n = 11) remained neutral, neither likely nor unlikely to add POCLUS, and 15.7% of participants (n = 11) were unlikely to include POCLUS in their practice. Most participants (87.1% [n = 61]) observed POCLUS being performed on a patient. Also, 90% of participants (n = 63) expressed their interest in observing health care professionals performing POCLUS in their clinical practice. When asked how curious participants were to use POCLUS, participants rated their interest on a scale from 1 to 10. The median curiosity level was 10 (minimum = 6, maximum = 10), indicating a high level of curiosity. In the follow-up survey, after 2 weeks of taking the course, most participants (97.11% [n = 68]) thought that POCLUS should be part of the clinical assessment of the scope of practice for RTs. Also, 91.4% of participants (n = 64) discussed the elements of POCLUS with their colleagues, and 72.9% of participants (n = 51) searched online to further their knowledge about POCLUS. Also, 90% of participants (n = 63) expressed that they were willing to use POCLUS in their clinical practice; however, only 20 participants (28.6%) attempted the procedure. Among those who attempted POCLUS, 50% reported feeling comfortable with the procedure, 25% remained neutral, and 25% expressed discomfort with its use (Fig 1). When asked about the barriers that RTs might face when performing POCLUS, the top four barriers were the absence of a formal curriculum (55.7% [n = 39]), limited availability of POCLUS devices (41.4% [n = 29]), time constraints resulting from additional responsibilities of RTs (41.4% [n = 29]), and the acceptance of the procedure by the RT staff as part of their daily tasks (38.6% [n = 27]) (Fig 2). The participants were asked about expanding their knowledge regarding POCLUS before and after taking the course. The proportion of participants who were interested after the course was 97.1% (n = 68) compared with 71.4% (n = 50) before taking the course (c2 = 17.4; P < .001). The main objective of this study was to evaluate the effectiveness of an online on-demand POCLUS course for RTs in the United States. The study also sought to assess RTs’ willingness to implement this procedure in their bedside clinical examinations while identifying potential barriers to implementation. The results of the study demonstrate that RTs display a strong interest and willingness to use POCLUS as a supplementary tool in their clinical assessments, despite any barriers they may face. The focus of this study was not on whether the RT is able to use ultrasound, as highlighted by a scoping review by Kappel et al,18Hayward S. Innes S. Smith M. Challenges and opportunities in point-of-care ultrasound: a qualitative exploration of respiratory physiotherapists’ experiences of lung ultrasound training and its adoption in critical care.Ultrasound. 2022; 30: 126-133Crossref PubMed Scopus (6) Google Scholar who found that “teaching POCUS skills to RTs seems feasible.” Rather, we specifically sought to capture a wide sample population of RTs’ willingness and further interest after their exposure to POCLUS. Because debates concerning user proficiency, standardized curricula, and diagnostic accuracy in POCLUS remain, we aimed to determine the level of interest among RT professionals across the United States in an online, on-demand course introducing this diagnostic tool. Furthermore, we sought to explore whether this initial interest would evolve over time (Fig 1).1Arts L. Lim E.H.T. van de Ven P.M. Heunks L. Tuinman P.R. The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis.Sci Rep. 2020; 10: 7347Crossref Scopus (41) Google Scholar Our findings showed that most participants who observed POCLUS being performed on a patient reported that they were interested in learning more about the procedure. This observation suggests that RTs are inherently willing and curious and learn to become more familiar with ultrasound as an additional assessment tool in their clinical practice. This assertion is supported further by the survey results, whose median score of 10 demonstrates the participants’ highest level of curiosity, willingness, and interest. Consequently, the data strongly support the notion that RTs are motivated intrinsically and are driven to include POCLUS in their patient assessments. Furthermore, Figure 1 shows the willingness to implement POCLUS after participating in this study. The purpose of investigating willingness was to evaluate it as a driving force behind the implementation of POCLUS after the completion of an online on-demand course on the topic. The results indicate that although many participants had not personally received formal training in POCLUS, a significant number of them did engage in further online searches on the subject of POCLUS. An additional example of the willingness to implement POCLUS after participating in this study included sharing information about the procedure with supervisors, managers, and other health care providers such as physicians and physician assistants and engaging in discussions about POCLUS with fellow RTs. We also assessed the relationship between acceptance and willingness to implement and use POCUS within the RT profession and workload. The results show that the participant’s perception of the value of POCLUS before versus after the educational intervention significantly increased their level of willingness. This implies a potential link between curiosity, motivation, and willingness to engage in further exploration and implementation among health care professionals when RTs perceive adequate support and resources. Providing sufficient support and resources also may increase curiosity and willingness among RTs and other health care practitioners.19Sreedharan J.K. Karthika M. Alqahtani J.S. et al.Routine application of lung ultrasonography in respiratory care: knowledge, perceptions, and barriers to instigate.AMEP. 2022; 13: 1395-1406Crossref Scopus (0) Google Scholar Equally important are the perceived barriers to the implementation of POCLUS in clinical practice. Despite its evident positive benefits, adopting this familiar procedure and skill has been slow beyond current medical practice.20Brady A.K. Spitzer C.R. Kelm D. Brosnahan S.B. Latifi M. Burkart K.M. Pulmonary critical care fellows’ use of and self-reported barriers to learning bedside ultrasound during training: results of a national survey.Chest. 2021; 160: 231-237Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar The lack of a formal RT curriculum in POCLUS was the primary reason for the limited use of POCLUS in the clinical setting. This finding aligns with the results of Sreedharan et al,21Miller A.G. Roberts K.J. Smith B.J. et al.Prevalence of burnout among respiratory therapists amid the COVID-19 pandemic.Respir Care. 2021; 66: 1639-1648Crossref Scopus (23) Google Scholar who investigated RTs in Saudi Arabia and identified the absence of a standard curriculum as a significant barrier. Likewise, a lack of a standard curriculum also was a significant barrier reported by pulmonary and critical care fellows.22Algarni S.S. Algihab A.A. Dahmash H.A.B. et al.Burnout among respiratory therapists in a tertiary hospital in Saudi Arabia.Respir Care. 2023; 68: 228-233Crossref Scopus (3) Google Scholar Furthermore, in this study, participants expressed equal concern (41%) about the additional time required to complete the POCLUS examination alongside their other responsibilities and the availability of the ultrasound machine itself. This finding is not surprising, given the previously reported increased workload of RTs, especially during the COVID-19 pandemic, along with shortages of RTs and burnout.22Algarni S.S. Algihab A.A. Dahmash H.A.B. et al.Burnout among respiratory therapists in a tertiary hospital in Saudi Arabia.Respir Care. 2023; 68: 228-233Crossref Scopus (3) Google Scholar, 23Evans D.L. The impact of COVID-19 on respiratory therapist burnout.Respir Care. 2021; 66: 881-883Crossref Scopus (2) Google Scholar, 24Miller AG, Burr KL, Juby J, et al. Enhancing respiratory therapists well-being: battling burnout in respiratory care [published online December 5, 2022]. Respir Care. https://doi.org/10.4187/respcare.10632Google Scholar, 25Strickland S.L. Roberts K.J. Smith B.J. et al.Burnout among respiratory therapists amid the COVID-19 pandemic.Respir Care. 2022; 67: 1578-1587Crossref Scopus (3) Google Scholar, 26Roberts K.J. Silvestri J.A. Klaiman T. et al.Well-being among respiratory therapists in an academic medical center during the COVID-19 pandemic.Respir Care. 2022; 67: 1588-1596Crossref Scopus (0) Google Scholar, 27Budhram G. Elia T. Rathlev N. Implementation of a successful incentive-based ultrasound credentialing program for emergency physicians.West J Emerg Med. 2013; 14: 602-608Crossref PubMed Scopus (20) Google Scholar The scarcity of POCLUS machines also emerged as a barrier, which is corroborated by a similar finding reported in a study of fellows.22Algarni S.S. Algihab A.A. Dahmash H.A.B. et al.Burnout among respiratory therapists in a tertiary hospital in Saudi Arabia.Respir Care. 2023; 68: 228-233Crossref Scopus (3) Google Scholar This highlights a common issue shared by both RTs and MDs regarding the availability of devices as a significant barrier to clinical implementation. Surprisingly, we found that the pay incentive was not at the RTs’ forefront of barriers when implementing POCLUS. Although this was not the largest or most concerning barrier among RTs nationwide at this time, in the future, it certainly will be a topic of interest as it relates to incentives and added skills to motivate the RT further, regardless of workload.29 It is suggested that RT departments may consider incentivizing additional skills and knowledge, leading to the formation of specialty teams or cross-trained RTs. This study has several limitations. First, the small sample size limits the generalizability of the study. However, despite this limitation, our findings can be used as a valuable needs assessment for the respiratory care profession in the United States regarding the willingness and interest of RTs in learning POCLUS. Second, we did not include a clinical check assessment or evaluation, which might have affected the participants’ willingness and sustained interest in the learning process significantly. Therefore, future prospective studies are recommended to incorporate a clinical competency component into the educational course, which would allow for the evaluation and assessment of RTs’ practical skills. This approach will enhance our knowledge and understanding regarding willingness, curiosity, and learning in health care education. To delve deeper into this subject, future studies also should explore additional factors such as incentives, workload, and curriculum implementation. This exploration will provide insights into the dynamics influencing the engagement and proficiency of RTs in POCLUS training and application. This study successfully identified the significant impact of exposure to a POCLUS online course, specifically geared toward RTs, as a powerful motivating factor to integrate POCLUS into their practice. Our findings indicate that RTs support the integration of POCLUS into their regular clinical assessment routine. RTs also display higher interest and willingness after completing online, on-demand didactic education. We hope these results can be used as a needs assessment for the profession to expand the role of clinical examinations for RTs. The authors have reported to CHEST Pulmonary that no funding was received for this study.