Background: We have markedly expanded Point-of-Care Ultrasound (PoCUS) education within our Internal Medicine residency program through multifaceted instructional interventions. But despite an increasing number of trainees familiar with PoCUS, there remained insufficient real-time clinical use and supervision due to a lack of formal PoCUS training and experience among attending faculty. Traditional PoCUS faculty development programs have largely used a multi-day block or “bolus” course approach which can be resource-intensive, inefficient, and disruptive to clinical schedules. Moreover, retention of PoCUS skills quickly wanes without subsequent skills reinforcement. Our focused, “drip” method is a dramatic shift from most approaches to faculty PoCUS training.
Purpose: The primary goal of our innovation is to increase the number of hospitalist faculty with core skills in PoCUS by implementing novel faculty development methods. Our secondary goals are to demonstrate an increasing clinical use of PoCUS by hospitalists as well as enhanced integration of PoCUS into bedside teaching rounds.
Description: Our faculty development program is guided by a theoretical framework for the acquisition of expert performance. We aim to increase training efficiency and skills retention by: (1) focusing on six core PoCUS views with the greatest relevance; and (2) building on prior conceptual and theoretical work in medical education including scaffolding learning in small “chunks”, providing opportunity for deliberate practice with direct observation and feedback, and utilizing quizzes for test-enhanced learning. We instituted twenty four recurrent hands-on noon hour training sessions for teaching hospitalists over a two year period. Pre-session video work replaced didactics using a “flipped classroom” model. Residents that had completed our POCUS elective rotation helped serve as hands-on POCUS instructors for teaching faculty across eight standardized patient stations during each session.
Conclusions: Our supportive, low stakes faculty development setting has enabled hospitalists to overcome initial perceived barriers to learning POCUS and has provided a solid foundation of core POCUS skillsets for our faculty. Our work has resulted in the development of novel assessment tools, including: (1) a direct observation tool to assess imaging acquisition skills; and (2) on-line quizzes utilizing clinical vignettes and hand-held POCUS videos to assess image interpretation and clinical decision-making skills. Assessment results illustrate excellent faculty skill acquisition through the program. Additionally, we have detailed a steady increase in the integration of point-of-care ultrasound into our clinical teaching services through sequential faculty and resident surveys, rotation evaluations, ultrasound machine logs, and intermittent “diary” sampling of resident teams. Given the faculty development program’s successes, we plan to continue the hands-on series and assessment strategies for new faculty during the next academic year.