Background: Point-of-care ultrasound (POCUS) is a growing interest in pediatric hospital medicine, however few Pediatric Hospital Medicine (PHM) fellowships incorporate POCUS training formally into their curriculum. In addition to its ability to expedite care, POCUS can improve the ability of pediatric hospitalists to take care of patients in resource-limited settings or when specialists are not immediately available. POCUS can help PHM fellows bring residents out of their team rooms and back to the bedside where it can improve their ability to teach anatomy and pathophysiology by visualizing it first-hand.
Purpose: A novel POCUS curriculum for PHM fellows is presented here that can act as a model for other PHM fellowship programs interested in expanding POCUS training. The curriculum is designed as a two-week elective with two fellows taking it simultaneously. The overall goal of the rotation is for fellows to be able to obtain and interpret basic bedside ultrasound images of the heart, lungs, abdomen, soft tissue, and vasculature with recognition of common pathology.
Description: Fellows are expected to complete background reading prior to the elective. Each day covers a new topic and begins with a didactic overview of the ultrasound views related to that organ system and then examples of pathology that are discussed as a small group. The fellows and faculty instructor then spend 1-2 hours doing guided, hands-on scanning of relevant anatomy for the day. The fellows then independently scan for 3-4 hours to reinforce learned skills for that organ system. An on-line quiz for each organ system is administered before the elective (pre-test), directly after the elective (post-test), and finally ≥ 6 months after elective completion (remote-test) to assess the effectiveness of teaching as well as retention of knowledge. A hands-on, timed final assessment of fellows’ ability to obtain basic views for each organ system is conducted at the end of the elective. A portfolio is developed by each fellow that demonstrates 85 independently obtained images of each organ system with normal and abnormal images of pre-designated views and pathologies. This portfolio is designed to be completed by the end of the fellowship year to allow for time to encounter different pathologies throughout the year and encourage fellows to continue to use ultrasound skills after the elective finishes.
Conclusions: Using an intensive two-week elective, PHM fellows are able to develop POCUS skills that will serve them well from a patient care and teaching perspective regardless of their ultimate career path and practice environment. PHM fellowship represents a unique opportunity to spend time honing ultrasound skills. The curriculum outlined here has been enthusiastically embraced by our current PHM fellows and could be a useful first step for PHM fellowship directors interested in introducing POCUS to their program.
