Background: Point-of-care-ultrasound is increasingly used as a diagnostic tool in a variety of specialties. Multiple studies have shown that POCUS may reduce time to diagnosis with similar accuracy to radiology scans (Healey, Fischer), may improve procedural safety (Cho, Rodrigues), and may reduce the need for additional studies and ionizing radiation (Soni). As such there is a need for hospital medicine attendings and advanced practice providers to improve their point of care ultrasound skills, both to be able to teach residents and students, to interpret scans done by trainees, and to incorporate ultrasound findings into their own clinical decision making.
Purpose: Various authors have discussed curricula for teaching ultrasound, and there exist multiple courses, fellowships, and online learning tools to improve a clinician’s ultrasound skills. I seek to evaluate a curriculum involving in-person didactics, individual online learning, and small group bedside teaching sessions on measurable improvements in hospital medicine attendings’ and APPs’ familiarity with and ability to use POCUS.This project will describe the extent to which clinicians who undergo POCUS training incorporate POCUS into their clinical evaluation, will evaluate POCUS confidence among learners pre- and post-intervention, and will measure the extent to which POCUS-trained physicians incorporate POCUS into their clinical and educational practice.
Description: This is an ongoing prospective study. I have enrolled 10 hospital medicine clinicians (5 MDs and 5 APPs) who have an interest in learning ultrasound. The lecture topics are based on an interest survey conducted by our division and include basic ultrasound physics, image acquisition and optimization, assessing volume status, cardiac views, lung exam, and ascites evaluation. During each session participants complete a pre-test survey assessing knowledge of the topic, prior training, and relative comfort with ultrasound. Each session includes a lecture and a hands-on session. Between sessions, participants are assigned homework and are encouraged to use ultrasound when clinically indicated. Scans are uploaded to a HIPAA-compliant cloud, and individuals complete worksheets describing their clinical impressions, which are then reviewed by an ultrasound-trained clinician. At the end of training participants will complete a post-test and participate in a clinical OSCE evaluating their ultrasound skills. Number and variety of scans done by each participant will be tallied.
Conclusions: Results from this study are ongoing. The project was open to all hospitalists and APPs within our division; all participants who expressed interest and enrolled in the curriculum are female, with an even split between MDs and APPs. More than 50% have had informal training in ultrasound but only 10% have received formal training in the form of a structured curriculum. Participants expressed that focused volume and basic cardiac exams are the most relevant to their practice, yet most felt not at all confident in acquiring and interpreting volume and cardiac ultrasounds. Greater than 70% felt POCUS is an important adjunct to the physical exam, but 14% feel its use will be limited by time constraints.