Methods: We evaluated a POCUS elective offered to trainees in a large academic IM residency program. We used a pretest, posttest and post survey to evaluate the elective’s impact on POCUS knowledge, self confidence, use of POCUS after the elective, and likelihood of recommending the elective to peers.
POCUS elective residents between February 2015 and May 2016 were eligible for inclusion in the study. Participation was optional. Prior to the elective, participants were offered an anonymous 26-question multiple choice test of core POCUS knowledge and image intrepretation designed by local POCUS instructors in emergency and internal medicine. The participants then underwent a month-long POCUS elective that employed a flipped classroom approach, where reading was done beforehand and elective time was used for hands-on experiences in emergency departments, intensive care units, echocardiography labs, and hospital medicine wards. One to three months after the elective residents were offered the same test as well as survey with likert-scale questions about their elective experience and their post-elective POCUS use. Both tests and the survey were administered online through Qualtrics. (Provo, UT). Test scores and survey results were analyzed in Microsoft Excel (Redmond, WA).
Results: Twenty three residents took the POCUS elective during the study period. All (100%) elective residents took the pre test and 16 (70%) completed the post test and survey. Correct answers on the knowledge test increased from a mean of 9.6 (37%) on the pretest to 18.5 (71%) on the post test. Nearly all residents were either “very confident” (23%) or “somewhat confident” (69%) in their overall ability to use POCUS after the elective. Residents were most confident assessing global left ventricular function and volume status via IVC and IJ and identifying pleural and pericardial effusions, ascites, pulmonary edema, and pneumothorax. These were also the applications that residents utilized most regularly after the elective. All residents were either “very likely” (69%) or “somewhat likely” (31%) to recommend the elective to other residents.
Conclusions: The month-long POCUS elective was effective at increasing POCUS knowledge, confidence and use among residents and was highly recommended to their peers. More work should be done to further assess the impact of this curriculum on other components of competency like image acquisition, with an ultimate goal of creating a standardized approach to POCUS education and competency evaluation within internal medicine.