Background: Point-of-care ultrasound is defined as a goal-directed, bedside ultrasound examination performed by a health care provider to answer a specific diagnostic question or to guide the performance of an invasive procedure. Its use has been endorsed by the American Academy of Family Physicians, American College of Physicians, and the Society of Hospital Medicine. Yet despite being touted as the fifth pillar of the physical exam, many providers are without formal instruction in point-of-care ultrasound. Furthermore, training in point-of-care ultrasound has been adopted as a requirement by the ACGME for an ever-expanding number of specialties. There is a wide variety of individual POCUS examinations that provide impactful clinical information to hospitalists, however, most, if not all, traditional instruction is expensive and time consuming to obtain.
Purpose: Given the barriers that time and cost that presented by the traditional ultrasound courses currently available, our curriculum’s purpose is to create “microlessons” that teach hospitalists POCUS skills that they can competently utilize at the bedside without onerous expense of time or money.
Description: Learners are practicing physicians, physician assistants, and nurse practitioners from the Division of Hospital Internal Medicine at Mayo Clinic in Rochester, Minnesota, voluntarily recruited via email and announcements made at division meetings. Educational sessions are divided into a skills session as well as video didactic session. Prior to skills sessions, all participants view an introductory 10-minute video describing the relevant indications, anatomy, steps of the relevant exam, and role of exam findings within the I-AIM framework for POCUS. Afterwards, participants are transitioned to firsthand skill sessions with access to a simulated patient(s) and a GE Venue Go cart-based ultrasound machine for practicing image acquisition. Skills sessions are led by hospital medicine physicians, physician assistants, and nurse practitioners who have been identified as skilled POCUS users via either prior training and experience with POCUS, active participation in obtaining certification or already having been certified in POCUS by the Society of Hospital Medicine and/or the American Society of Chest Physicians. Skill sessions are scheduled to last from 20-50 minutes depending on the examination being taught. Microlessons are offered at multiple dates and times to accommodate hospitalist schedules and are free to members of the Division of Hospital Internal Medicine. The inaugural series focus is on ultrasound measurement of JVP.
Conclusions: To our knowledge, this “microlesson” model of developing POCUS curriculum is a novel way of increasing POCUS utilization and skill for hospitalists while simultaneously circumventing the most prevalent barriers of cost and time that prevent many from pursuing POCUS training. Furthermore, this framework allows for the learner to select areas within POCUS that are most relevant or beneficial to their individual clinical practice or interests. Finally, the curriculum framework lends itself well to further study relating to POCUS, such as most effective way of assessing competency and the most effective ways to teach image acquisition (areas currently being studied by the authors). This serves as an important precursor to broader implementation of POCUS within a hospital practice, particularly when thorny issues such as billing for POCUS are under consideration.