Background: Point-of-care ultrasound (POCUS) has expanded in popularity and practice amongst hospitalists, critical care physicians, and is a standard part of the emergency medicine curriculum for a multitude of reasons: increased diagnostic accuracy and speed, cost reduction, and reduced radiation exposure. Internal medicine (IM) residents are exposed to the practice of using POCUS at all stages of their training in almost every setting. These experiences, as well as the increasing accessibility of portable ultrasound devices, drive the IM residents’ strong interest in learning POCUS.
Purpose: Despite strong interest in learning POCUS, no formal curriculum exists. Our curriculum seeks to train IM residents to safely integrate POCUS into their clinical practice.
Description: The curriculum consists of three phases spanning the 2019-2020 academic year:1. Pretesting: Residents complete an online knowledge quiz, a confidence survey, and a hands-on POCUS test with a standardized model to establish their baseline knowledge and skill. 2. Training workshops: Residents participate in a series of three workshops consisting of lectures and hands-on training on human models covering views of the heart, lungs/pleura, abdomen, and lower extremity vasculature. At the conclusion of the final workshop, residents complete a satisfaction survey, a retrospective pre-post confidence survey and repeat the online knowledge test.3. Skill building: For the remainder of the academic year, residents will participate in weekly hands-on scanning sessions with local experts, monthly didactic conferences, and online feedback on uploaded ultrasound images. These clips can then be used to build a portfolio of images in accordance with national standards established by the Society of Hospital Medicine. At the end of the academic year the residents will repeat the satisfaction survey, confidence survey, online knowledge test, and the hands-on test.55 categorical and primary care PGY-2 residents are currently participating in the curriculum. In the hands-on portion of the pretest, no resident scored >80% well done; for reference, to pass the equivalent faculty course, the attending’s score must be >80% well done. In the image interpretation portion of the pretest, the average resident score was 53%. Prior to starting the course, 6 residents (20%) report receiving training in POCUS, however 17 (58%) reported using POCUS in their practices. After the workshop, overall confidence in both image acquisition, interpretation, and likelihood to evaluate a patient clinically with POCUS significantly increased. In addition, the image interpretation quiz was repeated after the workshop, with the average score increasing to 78%, which is a statistically significant increase. The residents’ overall rating of the course was 4.5/5.
Conclusions: Despite low hands-on pre-intervention scores in image acquisition and interpretation, more than half of residents report using POCUS in their clinical practice. This underscores the need for a structured curriculum to teach and supervise use of this new technology. Our course is a highly-rated addition to the standard resident curriculum and has thus far has increased resident confidence and has increased resident scores in the domain of image interpretation. Our next steps will be to complete the skill building phase of the curriculum and assess resident retention of abilities and knowledge following the completion of the full year course.