Background: There is growing interest in point-of-care ultrasound (POCUS) for addressing clinical questions at the bedside, particularly in the intensive care unit (ICU), where it is widely used by intensivists. This trend has prompted education initiatives for residents across various specialties, including internal medicine, emergency medicine, anesthesia, and pediatrics. While several studies focus on training residents to be competent in POCUS skills, little is known about residents clinical use and barriers to practical application. Reviews of POCUS in both resource-rich and resource-poor settings identify primary barriers such as lack of training and limited access to equipment. The University of Colorado Internal Medicine (UC IM) program has implemented a formal ultrasound curriculum in 2022 in which all current residents have participated. This study aims to identify POCUS use by residents in this structured educational setting and ongoing barriers.
Methods: This retrospective observational study utilized a web-based survey to assess current POCUS usage and barriers among residents in the UC IM program. The optional survey was distributed to residents at all training levels and included questions to quantify use and identify clinical scenarios where residents applied POCUS skills. The survey also asked participants to identify barriers to POCUS use in the ICU, such as lack of personal expertise in acquiring and interpreting images, limited access to ultrasound machines, perceived irrelevance to clinical management, time constraints, insufficient supervision, and lack of integration into clinical decision-making by attendings.
Results: 76 out of 151 (50%) residents completed this survey, including 24 interns and 52 upper-level residents. Notably, 92% of respondents indicated they use POCUS to aid in clinical decision making, 97% had used POCUS for procedures, and 67% had used it to complete the program’s assigned portfolio. The predominant barrier identified was a lack of time (79%), followed by expertise gaining images (50%), access to ultrasound machines (46%), and expertise interpreting images (46%). Interns and upper-level residents identified similar barriers, although upper levels were more likely to indicate that POCUS would not change clinical management (4% vs 27%, p< 0.05).
Conclusions: Of resident survey respondents, 92% reported using POCUS to aid in clinical decision making, indicating strong support for the role POCUS can play in advancing patient care. The primary barrier to POCUS use identified by residents was a lack of time. The top barriers to POCUS use were logistical, being lack of time and access to ultrasound machines, and related to skill level, including resident expertise obtaining and interpreting images. Understanding barriers to POCUS use is an important step toward increasing clinical application. Strategies to mitigate barriers could include increasing the availability of ultrasound machines and integrating supervised scanning into daily workflows.
