Background: Point-of-care ultrasound (POCUS) is nothing less than a paradigm shift in patient care. The technology has advanced rapidly and the competence in performing, interpreting and utilizing POCUS is extremely variable. There is often an inversion in competence with medical students and residents, in general, having more competence in this modality than many of their attendings. This situation exists at our institution given the mature internal medicine (IM) POCUS program taught at our IM residency since 2011 which has been successful in training our residents through lectures, hands-on image acquisition on models, and then supervision to competency during patient care. A similar skill acquisition model has proven less efficient for our hospitalist faculty over the years.
Purpose: Leveraging our resources, we sought to more effectively train hospitalist faculty in POCUS. Our hospitalists had been exposed to introductory lectures and short 2-day courses with a mix of lectures and hands-on practice on healthy models, but few consistently utilized the modality in patient care. We postulated that the limiting factor in consistent use of clinical POCUS was the lack of comfort in using the ultrasound machine, obtaining images on real patients, and the time limitations of a hospitalist on service.
Description: We designed an intensive training week for hospitalists who had recently completed a 2-day training. Two hospitalists were paired for the week with one of three trainers who were hospitalists with significant POCUS clinical and teaching experience. Funding was secured for 6 weeks of training so 12 hospitalists were able to complete the training pilot. Trainers were removed from their clinical scheduled work for the training week and paid a stipend. The hospitalists learning POCUS were not paid and were scheduled during a week they were available but not working.A shared patient list was created in our electronic health record so partners could add patients appropriate for POCUS exams. The team examined multiple organ systems on most patients including obtaining cardiac images on as many patients as possible and integrating the findings with the patient’s clinical story. The 12 hospitalists in the pilot were each able to perform a mean of 141 total exams (cardiac (48), pulmonary (32), IVC (39), abdominal (22)) over the 5-day training period. Though there are limitations to the comparison, hospitalists (n = 10) left to “learn on their own” amidst their normal workload after a previous 2-day course performed a median of 9.5 exams (range 0-32) over the 30 days following the course.
Conclusions: Hospitalist completing the week of “real patient” POCUS training completed an otherwise impractical volume of exams. They were much more comfortable managing the machine, the process, and the discussion with patients. They demonstrated much improved image acquisition, image interpretation, and understanding of real benefits and limitations of POCUS.