Background: Point-of-care ultrasound (POCUS) has become a ubiquitous tool in clinical care. However, the optimal timing and methods of POCUS integration into medical education remains unknown. We aim to identify and evaluate the baseline competency, improvement and feedback from trainees after participating the POCUS curriculum.

Methods: In 2017, National Taiwan University hospitalists established a standardized POCUS educational program for under-graduate senior medical students and post-graduate year residents. We organized five individual fields of POCUS teaching sessions (cardiac, abdomen, lung, musculoskeletal and protocols). Each session included both lecture and hands-on teaching with both healthy volunteers and with patients with pathology. The whole training program was designed to be completed in a monthly rotation. Quality assurance and feedback for medical students and residents were performed by ultrasound instructors after each session. On-line survey was performed in the next month after attending the monthly curriculum no matter how many sessions had been completed. All reporting items in the on-line survey were scored from 1 (the lowest) to 10 (the highest).

Results: A 14-month longitudinal ultrasound educational curriculum was performed from Sep 2017 to Nov 2018. Fourteen of 20 (70%) medical students and seven of 11 (63.6%) post-graduate year residents responded to the survey. Twelve of 21 (57.1%) trainees completed all five sessions, 8 (38.1%) completed four sessions, and 1 completed 2 sessions. Compared to medical students, PGY residents scored significantly higher baseline competency on both knowledge and skills of ultrasonography (5.9 vs. 3.1, p=0.001 and 6.6 vs. 3.1, p=0.006, respectively), and significant higher in all five individual fields. However, medical students scored significant higher self-rated improvement of overall knowledge and skill after curriculum (2.9 vs. 0.7, p=0.002 and 2.7 vs.0.4, p=0.030, respectively), which held significant in three individual fields except for lung and musculoskeletal sessions. Among five sessions, the lung session resulted in the highest scored skill improvement for PGY residents which caused no statistical difference compared to that medical students. Similarly, the musculoskeletal session resulted in the lowest scored skill improvement for medical students which caused no statistical difference compared to that for PGY residents. The overall curriculum satisfactions were equally high for medical students and PGY residents (8.8 and 9.1 respectively). PGY resident scored significant higher for the usefulness in clinical care as compared to medical students (9.4 v.s 7.8, p=0.027).

Conclusions: A hospitalist-led POCUS educational curriculum is effective to improve competency of ultrasonography for both medical students and PGY residents. While medical students perceived more significant improvement in knowledge and skills in using ultrasonography, PGY residents perceived higher usefulness in assisting their clinical care. POCUS is perceived more useful in clinical care for residents compared to medical students. POCUS instructors may need to adjust the learning objective for different population.

IMAGE 1: Self-reported knowledge and skills of under-graduate year (UGY) medical students and post-graduate year (PGY) residents before and after POCUS curriculum

IMAGE 2: Self-reported satisfaction, usefulness, helpfulness of POCUS curriculum for under-graduate year (UGY )medical students and post-graduate year (PGY) residents