Background: Point-of-care ultrasound (POCUS) is increasingly being used across medical specialties, improving diagnostic accuracy in numerous medical presentations and levels of acuity. Training in these skills is currently offered through major societies, but graduate medical POCUS training in internal medicine and family medicine is not common in US residencies. Therefore, we designed a two-week inpatient elective service and training program to teach and reinforce basic ultrasound acquisition and clinical integration for elective residents while providing consultative services to primary rounding teams.
Purpose: We sought to evaluate the educational value of a 2-week inpatient, inter-departmental consultative service for POCUS requests across 14 internal medicine and family medicine inpatient services at a tertiary academic medical center.
Description: The primary objective was to measure residents’ cognitive ability to integrate POCUS images into clinical cases (“knowledge” testing) and their ability to acquire POCUS images (“skills” testing) before and after a dedicated two-week POCUS elective training course.The elective started with a two-day “boot camp” of didactics and hands-on practice using standardized patients in focused cardiac, pleural/lung, abdominal, and deep venous exams.Afterwards, residents then used these skills to respond to consult questions from primary inpatient rounding teams in the mornings, followed by formal “gel rounds” in the afternoons with one of four rotating POCUS competent faculty supervisors. During gel rounds, faculty and residents refined image acquisition and integration into the patient’s clinical presentation, shared findings with the primary team, and followed-up on diagnostic or therapeutic changes as a result of their exams. At the end of the two week elective, residents were tested again on their knowledge and practical skills. Mean of hands-on skills scores increased over 60 percentage points before (average 36.1%) and after (average 96.3%) the elective. P = 0.002Mean of written/knowledge exam scores increased from 12/20 to 18/20 (P<5x10-6) after the two week course.Mean of overall confidence self-assessment improved from 21% to 70% (p<5x10-8).Residents rated the elective as high quality (mean survey result: 92/100).We plan on repeating knowledge and skills testing 6 months after elective completion to evaluate retention.
Conclusions: A two-week POCUS elective using a consultative model is a feasible model for inpatient resident education. Residents improved dramatically in their knowledge and practical skills and rated the experience highly. With further expansion and training, we aim to create a group of expert residents that will be able to serve as instructors for future electives.