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. POCUS can expedite treatment and improve care for patients in resource-limited settings or when specialists are not immediately available. POCUS can also help PHM fellows bring residents back to the bedside where it can improve their ability to teach anatomy and pathophysiology by visualizing it first-hand.
Methods: A novel POCUS curriculum for PHM fellows was launched at our institution in 2021. The curriculum is designed as a 2-week elective with two fellows taking it simultaneously. A combination of didactic teaching and hands-on training was used to train fellows to obtain and interpret basic bedside ultrasound images of the heart, lungs, abdomen, soft tissue, and spine with recognition of common pathology. The same closed-book, on-line assessment for each organ system was administered before the elective (pre-test), directly after the elective (post-test), and then ≥ 6 months after elective completion (remote-test). A hands-on, timed final assessment of fellows’ ability to obtain basic views for each organ system was also conducted at the end of the elective. The results of these tests were analyzed to assess the efficacy of the curriculum and retention of knowledge.
Results: A total of 8 fellows completed the elective from 2021-2024. Eight of the fellows successfully completed the hands-on assessment on the final day of the elective as well as the pre and post on-line tests. Data was missing for the remote-test for 2 of the fellows due to a systems error, leaving a total of 6 remote-test scores to analyze. The average overall score on the hands-on assessment was 96.3% with individual scores of 100% in ultrasound basics, 93.2% in cardiac, 98.4% in lung, 97.2% in spine, 93.8% in abdomen, and 100% in soft tissue. The pre/post/remote percentage scores were 35/97.5/95% for ultrasound basics, 28.6/82.5/66.7% for cardiac, 22.7/90.9/80.3% for lung, 40.6/96.8/95.8% for soft tissue, 59.7/94.4/98.1% for abdomen, and 29.2/81.9/84.4% for spinal imaging. The remote test was taken an average of 10 months after completion of the elective.
Conclusions: Using an intensive two-week elective, PHM fellows were able to develop basic POCUS skills. They demonstrated the ability to recognize pathology via on-line tests and completed a thorough hands-on assessment. There was attrition of some knowledge on the remote-test, which emphasizes the need to continue using POCUS outside of dedicated instruction time, although the improvement from post to remote-tests in abdomen and spinal imaging suggests that fellows’ skills are continuing to grow after the elective. The curriculum outlined here was successful with a small group of PHM fellows and could be used for other PHM fellowships interested in introducing POCUS to their program.
