Background: Point-of-care ultrasound (POCUS) is becoming an important part of internal medicine (IM) residency training. Achieving competency requires performing a large volume of clinical exams which can be difficult within the constraints of residency. Often cited barriers include insufficient resident time and the interruption of daily workflow.
Methods: Prospective cohort study within a 700-bed, quaternary care, teaching hospital. IM Resident POCUS exam volumes and characteristics during an 18-mo. baseline (station-based laptop devices only) period were compared to matched months during the intervention period (station-based + tablet).
Results: Total patients examined with POCUS by 6 inpatient resident teams during the 18-mo. baseline and intervention periods were 1,386 and 1,853 respectively. An observed knee/elbow was identified in September of 2017, corresponding with the introduction of the tablet US devices. Patients examined per month increased during the intervention by 34% (77 vs. 103, p=0.002). The number of areas (e.g. abdominal, cardiac) and items (e.g. bladder, pericardial effusion) examined per month increased by 27% (p=0.021) and 23% (p=0.073) respectively. Frequency of tablet vs. laptop utilization for pulmonary, abdominal, and cardiac areas was 41.2% vs. 58.9%, 30.1% vs. 69.9%, and 49.2% vs. 50.8% respectively.
Conclusions: A combined program infrastructure of station-based laptop and “in-the-pocket” tablet ultrasound machines lowered common POCUS barriers of inadequate time and workflow disruption for IM residents and resulted in a meaningful increase of exams within a longitudinal residency-based training program where station-based laptop devices already existed.