Background: Diagnostic point-of-care ultrasound (POCUS) is an ACGME requirement in emergency medicine and critical care training programs. Though many POCUS applications are equally relevant to internal medicine (IM), there are no formal guidelines for IM residencies and few faculty use POCUS in their own practice. Hence, the optimal method to teach POCUS to IM residents is unclear. For faculty, the focus has been on immersive POCUS workshops, but the size and breadth of IM residency programs limits the feasibility of a designated POCUS course.
Purpose: To design and evaluate an easily-learned and high-yield POCUS curriculum that could be delivered to residents longitudinally during a clinical rotation.
Description: Given the demands of residency, our goal was to design a POCUS curriculum that could be taught in four one-hour sessions, delivered weekly during residents’ month-long inpatient rotations. We intentionally limited the content included in the curriculum to account for the teaching time allocated. We therefore focused the curriculum solely on select exams in volume assessment, chosen out of over 15 exams taught in most IM POCUS courses because they are well-studied, technically straightforward, and valuable on general inpatient medicine. The four sessions included: 1) knobology/jugular venous pressure, 2) inferior vena cava, 3) pulmonary (B-lines, pleural effusions), and 4) review. The first three sessions consisted of 20 minutes of didactics followed by directed POCUS on pre-identified and consented hospitalized patients, and the final session was spent on skill development entirely at the bedside. Each session was led by a faculty member trained in the curriculum and consisted of three to five resident learners.
We piloted the POCUS curriculum on a single general medicine team over three month-long rotations. At the end of each month, all IM residents (including those rotating on the intervention team and those on control/non-intervention teams) were surveyed on levels of comfort with POCUS, frequency of POCUS use, and factual knowledge (i.e. ability to identify key pathology on still ultrasound images). Residents who rotated on the intervention teams reported greater POCUS comfort, use, and knowledge (Figure).
Conclusions: POCUS is increasingly recognized as an effective tool in IM, but the time required to reach proficiency in its vast applications is a barrier to training residents. By choosing focused content, we successfully delivered a longitudinal curriculum within the timeframe of a clinical resident rotation. Using real-time patient applications of POCUS allowed both for learner skill development and garnered buy-in on the value of POCUS in the clinical setting, maximizing key principles of adult learning theory. By increasing portable ultrasound equipment and training a small group of core faculty, we hope to expand this pilot so that it becomes integrated into all IM resident inpatient medicine rotations.
.jpg)