Background: For the past 4 years, we have taught PGY-2 residents basic skills in lung, cardiac, abdominal, and vascular POCUS based on national courses. Current methods of assessing POCUS skills focus on image acquisition and image interpretation without clinical context, however using POCUS for patient care requires the clinician to integrate their findings to a case. We developed an objective structured clinical examination (OSCE) to assess learners’ ability to obtain ultrasound images, simulate their scanning, and integrate images with data from a clinical case.
Purpose: We aim to pilot a method for assessing clinical integration of point-of-care ultrasound (POCUS) skills.
Description: Thirty-seven PGY-2 residents took the OSCE. The resident was presented with a patient case, then asked to obtain images from a human model. The preceptor would then show images from the actual patient via slideshow at the location the resident scanned. The OSCE was scored via a 45-question rubric. Questions pertaining to anatomy were scored on a binary scale (yes/no). Quality of images were scored with a three-point scale (not done, partially done, well done), or ‘not attempted’ if the learner did not attempt the view. After the scans and interpretations were completed, faculty then asked the learner to generate a differential diagnosis and management plan. The two major findings from the case were bilateral pleural effusions and cardiac tamponade.In the lung portion of the case, learners focused mostly on the apices. Thirteen percent of learners did not attempt to view the left base, and 21% of learners did not attempt to view the right base; these learners would be unable to exclude pleural effusion. All learners scored a ‘Well done’ or ‘Partly done’ when interpreting clips. Based on these interpretations, they were able to generate 10 diagnoses on their differentials. Of these diagnoses, 5 of them were supported by the information provided. Five diagnoses were not supported. All learners elected to scan the heart after receiving information that the patient was in shock. All residents except for one were able to obtain interpretable images of the heart. All residents were able to articulate concern for tamponade except for one. All residents were able to generate a reasonable management plan.
Conclusions: This assessment revealed gaps in our curriculum’s ability to help the resident understand how to examine an organ system with POCUS. However, in scenarios where the finding is very obvious even with one view, residents are able to use the POCUS information effectively. Additionally, the residents’ ability to obtain ultrasound images was variable. If our goal is to fully ensure our residents are proficient in POCUS, then further work in our curriculum should focus largely on systematic methods of assessment and improving image acquisition.