A growing body of evidence supports the use of point of care ultrasound increasingly as augmentation of the physical exam and clinical decision making. The literature also supports that trainees, both medical students and residents, can acquire these skills. However, there is no consensus on the training approach and development of competency for hospitalists using this novel technology.
To implement and study the effectiveness of a comprehensive introductory training curriculum and competency assessments for hospitalists to use bedside ultrasound for patient care.
The innovative training program focused on hospitalists was conducted at a large tertiary care medical center and included 50 providers from 2015-2016.
The primary program adapted off of CHEST consisted of a 3-day comprehensive introductory ultrasound course followed by portfolio development. Educational components included ten hours of online modules that were a prerequisite to the intensive three day course. The three day in-person course consisted of alternating didactic sessions with small group hands-on ultrasound practice sessions, image interpretation sessions, and ultrasound simulations. Assessments were completed pre-and-post the 3-day introductory course as well as with a subset who took a 1-day refresher course 6 months after their initial training. Providers also were provided the option of receiving further supervised feedback during monthly 90 minute image aquisition and interpretation sessions.
For the 50 inpatient providers who completed skills based assessments, performance increased after the 3-day course from a mean pre-assessment score of 3.6 (scale, 0-20, 18% correct) to a mean post-assessment score 18.9 (95 % correct). This performance continued to remain better than the baseline pre-assessment even at 6 months with a mean score of 14.1 (71 % correct). Though there was notable skills attrition at 6 months compared to the immediate post-assessment of the 3-day course, this was improved with a 1 day refresher course at 6 months to 19.7 (99% correct).
Providers also rated improvement in several key self-rating parameters including confidence in ability to assess volume status which increased from a pre-course rating of 3.0 (scale, 0-5) to a post-course rating of 4.2, increasing further to 4.4 at the 6 months interval-assessment.
Self-reported value of their physical exam to narrow differential diagnosis improved from a pre-course rating of 2.8 (scale, 0-5) to a post-course rating (physical exam + ultrasound) of 4.0, rising to 4.2 after the refresher course at 6 months.
A comprehensive 3 day ultrasound training program including 10 hours of pre-course online modules followed by portfolio development and competency assessments yields significantly improved ultrasound acquisition skills in hospital medicine physicians. Many skills were retained 6 months later, though with some image acquisition decline that was remedied by a 1 day refresher course. Additionally, the training program was positively received by learners who felt that these skills would serve them well in their clinical practice.
Future studies may further assess behavioral changes, clinical outcomes, and medical costs through the use of this technology in hospital medicine.