{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:16:12Z","timestamp":1788869772681,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["33IC30_201300\/1"],"award-info":[{"award-number":["33IC30_201300\/1"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"\n Objectives<\/jats:title>\n Lung ultrasound (LUS) is accurate for diagnosing pneumonia in the emergency department (ED), but standard training is time-intensive, limiting its widespread implementation. We evaluated LUS proficiency for pneumonia diagnosis and perceived adoption barriers after a short training programme.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n This study was conducted in the frame of the PLUS-IS-LESS trial (Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments) (\n NCT05463406<\/jats:ext-link>\n ), a pragmatic stepped-wedge cluster-randomised clinical trial evaluating a clinical management algorithm combining LUS and procalcitonin to guide antibiotic use for lower respiratory tract infections (LRTIs) in 10 Swiss EDs.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n All medical supervisors (senior registrars and senior physicians) from the participating EDs were invited to go through the PLUS-IS-LESS LUS training programme and all those who completed the training programme were included in this study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The training programme included an e-learning course, followed by a half-day on-site training session with theory and hands-on practice. For proficiency evaluation, a validated structured assessment of LUS skills (LUS-OSAUS) was adapted into a 32-question online quiz and five bedside LUS examinations. Success was defined as achieving a score \u226580% on both the online quiz and supervised practical assessment. Success rates were compared between physicians according to their characteristics (age, sex, medical experience, previous use of ultrasound or LUS, linguistic region of work and type of hospital) using a \u03c7\u00b2 test. A 6-month follow-up survey identified factors associated with non-certification and barriers to the clinical use of LUS for managing LRTIs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 122 trained physicians, 83 (68 %) completed both quiz and supervised LUS and 61 (50%) achieved certification. The most challenging items were pleural line assessment (83% success), recognition of consolidations (83%) and decision-making based on LUS findings (72%). Physicians <40 years had a higher success rate (p=0.009). Among those without complete certification, limited access to an ultrasound machine and low perceived added value of LUS were the main identified reasons. Lack of time was the most frequently reported barrier overall to LUS integration into ED workflows (77%).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n After receiving short training and focused proficiency testing, only half of physicians achieved certification, underscoring the challenges of broad LUS implementation. Limited time, equipment access and low perceived clinical value were key barriers, and integrating LUS findings into decision-making remained difficult. Ongoing support, supervision and protected time may be needed to enhance LUS adoption in EDs.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT05463406<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116508","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:00:33Z","timestamp":1788868833000},"page":"e116508","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Proficiency in lung ultrasound and perceived barriers to adoption among emergency physicians after a short pneumonia training programme: a multicentre observational study in Swiss emergency department"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct05463406","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05463406","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05463406","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6278-7767","authenticated-orcid":false,"given":"C\u00e9cile","family":"Bessat","sequence":"first","affiliation":[{"name":"Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland"},{"name":"University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliz\u00e9","family":"Erard","sequence":"additional","affiliation":[{"name":"University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia","family":"Roux","sequence":"additional","affiliation":[{"name":"Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland"},{"name":"University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Brahier","sequence":"additional","affiliation":[{"name":"Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"Suttels","sequence":"additional","affiliation":[{"name":"Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Bingisser","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Schwendinger","sequence":"additional","affiliation":[{"name":"Emergency Department, Kantonsspital Baden AG, Baden, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Bulaty","sequence":"additional","affiliation":[{"name":"Emergency Department, Kantonsspital Baden AG, Baden, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvan","family":"Fournier","sequence":"additional","affiliation":[{"name":"Emergency Department, Intercantonal Hospital of Broye, Payerne, VD, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Della Santa","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital of Neuch\u00e2tel, Neuch\u00e2tel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magali","family":"Pfeil","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Riviera-Chablais, Rennaz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Schwab","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Riviera-Chablais, Rennaz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg D","family":"Leuppi","sequence":"additional","affiliation":[{"name":"Emergency Department and University Medicine, Cantonal Hospital Baselland, Liestal, Switzerland"},{"name":"Medical Faculty, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Geigy","sequence":"additional","affiliation":[{"name":"Emergency Department and University Medicine, Cantonal Hospital Baselland, Liestal, Switzerland"},{"name":"Medical Faculty, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Steuer","sequence":"additional","affiliation":[{"name":"Emergency Department, St Clarasspital, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedemann","family":"Roos","sequence":"additional","affiliation":[{"name":"Emergency Department, St Clarasspital, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Christ","sequence":"additional","affiliation":[{"name":"Emergency Department, Cantonal Hospital of Lucerne, Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Sirova","sequence":"additional","affiliation":[{"name":"Emergency Department, Cantonal Hospital of Lucerne, Lucerne, Switzerland"},{"name":"Emergency Department, Cantonal Hospital St Gallen, St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Atzl","sequence":"additional","affiliation":[{"name":"Emergency Department, Cantonal Hospital St Gallen, St. Gallen, Switzerland"},{"name":"Intensive Care Unit, Hospital Riviera-Chablais, Rennaz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Napieralski","sequence":"additional","affiliation":[{"name":"Emergency Department, Cantonal Hospital St Gallen, St. Gallen, Switzerland"},{"name":"Intensive Care Unit, Hospital Riviera-Chablais, Rennaz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Tagan","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Riviera-Chablais, Rennaz, Switzerland"},{"name":"Division of Infectious Diseases, Infection Prevention & Travel Medicine, Cantonal Hospital St Gallen, St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner C","family":"Albricht","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Infection Prevention & Travel Medicine, Cantonal Hospital St Gallen, St. Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2312-1625","authenticated-orcid":false,"given":"Olivier","family":"Hugli","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"No\u00e9mie","family":"Boillat-Blanco","sequence":"additional","affiliation":[{"name":"Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland"},{"name":"University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4039-387X","authenticated-orcid":false,"given":"Elena","family":"Garcia","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090805002015000_16.9.e116508.1","doi-asserted-by":"crossref","DOI":"10.1056\/NEJMvcm2108203","article-title":"Basics of Point-of-Care Lung Ultrasonography","volume":"389","author":"Buda","year":"2023","journal-title":"N Engl J Med"},{"key":"2026090805002015000_16.9.e116508.2","doi-asserted-by":"crossref","first-page":"985","DOI":"10.7326\/M20-7844","article-title":"Appropriate Use of Point-of-Care Ultrasonography in Patients With Acute Dyspnea in Emergency Department or Inpatient Settings: A Clinical Guideline From the American College of Physicians","volume":"174","author":"Qaseem","year":"2021","journal-title":"Ann Intern Med"},{"key":"2026090805002015000_16.9.e116508.3","doi-asserted-by":"crossref","DOI":"10.1186\/1465-9921-15-50","article-title":"Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and 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training","volume":"10","author":"Pietersen","year":"2018","journal-title":"Crit Ultrasound J"},{"key":"2026090805002015000_16.9.e116508.7","unstructured":"The thoracic ultrasound certified training programme. European Respiratory Society. n.d. Available: https:\/\/www.ersnet.org\/education-and-professional-development\/ers-certified-training-programmes\/thoracic-ultrasound-certified-training-programme\/"},{"key":"2026090805002015000_16.9.e116508.8","doi-asserted-by":"crossref","DOI":"10.1186\/s13052-025-02089-2","article-title":"A core curriculum for pediatric lung ultrasound: an expert consensus","volume":"51","author":"Musolino","year":"2025","journal-title":"Ital J Pediatr"},{"key":"2026090805002015000_16.9.e116508.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2023.06.005"},{"key":"2026090805002015000_16.9.e116508.10","doi-asserted-by":"publisher","DOI":"10.1002\/jum.16088"},{"key":"2026090805002015000_16.9.e116508.11","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1007\/s00134-022-06666-5","article-title":"Defining basic (lung) ultrasound skills: not so basic after all?","volume":"48","author":"Kraaijenbrink","year":"2022","journal-title":"Intensive Care Med"},{"key":"2026090805002015000_16.9.e116508.12","doi-asserted-by":"crossref","first-page":"2941","DOI":"10.1002\/ehf2.12907","article-title":"What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines?","volume":"7","author":"Russell","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2026090805002015000_16.9.e116508.13","doi-asserted-by":"crossref","unstructured":"Stolz LA , Stolz U , Fields JM , et al . 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Focused whole body ultrasonography learning platform. n.d. Available: https:\/\/pocus.academy\/en_GB"},{"key":"2026090805002015000_16.9.e116508.17","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s40477-020-00454-x","article-title":"Lung-ultrasound objective structured assessment of technical skills (LUS-OSAUS): utility in the assessment of lung-ultrasound trained medical undergraduates","volume":"24","author":"Di Pietro","year":"2021","journal-title":"J Ultrasound"},{"key":"2026090805002015000_16.9.e116508.18","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1513\/AnnalsATS.201611-894OC","article-title":"Objective and Structured Assessment of Lung Ultrasound Competence. 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