Date of Presentation
5-4-2023 12:00 AM
College
School of Osteopathic Medicine
Poster Abstract
Problem Statement: Point-of-care ultrasound (POCUS) is currently not a required core competency in internal medicine (IM) residency despite its inherent benefits, and many hospitalists are not equipped to confidently acquire nor interpret basic ultrasound images.
Background: POCUS is used at the bedside by physicians to answer directed clinical questions to help guide patient management. During the COVID-19 pandemic, the use of ultrasound for quick, accurate diagnosis of life-threatening pathology has been instrumental in early detection of acute cardiopulmonary failure, monitoring treatment response, and minimizing nosocomial spread. We aimed to determine interest in learning POCUS, confidence level, self-rated proficiency, and perceived barriers to mastering imaging techniques and interpretation before and after implementing a dedicated curriculum.
Methodology: Anonymous pre- and post-curriculum surveys were obtained from 30 IM residents at a community hospital program from 2020-2021. A curriculum consisting of one monthly didactic course with an associated hands-on simulation lab was implemented in small groups of six residents over one year. Topics included basic echocardiography, identifying right heart strain, inferior vena cava variability, techniques for ultrasound-guided vascular access, locating compartmental free fluid, and identifying various pulmonary disorders. The training was facilitated using a low-cost handheld portable ultrasound machine.
Results: A total of 30 IM residents completed both the pre- and post-survey. While 100% of residents believed learning POCUS will be beneficial in the inpatient IM setting, only 20% of residents had any prior formal training on ultrasound. More specifically, 20% had no experience at all, 63.3% had some experience, and only 16.7% had a good amount of experience. However, no residents considered themselves to have enough experience or being experts. On a scale of 1-10, rating their confidence level of using ultrasound in clinical practice to guide management, the average mean score was 4.3/10 (SD 1.84) before implementation of the curriculum and 6.1/10 (SD 1.59) after implementation of the curriculum. Self-rated proficiency in obtaining and interpreting key images was poor across the board pre-curriculum, but consistently rose to average or above-average after completing the curriculum. Interestingly, the most common perceived barrier to learning ultrasound and proficiently using these skills in clinical practice was insufficient supervised practice (24/30, 80%), insufficient training (23/30, 76.7%), and insufficient knowledge/experts available (19/30, 63.3%).
Conclusions: A structured POCUS curriculum focused on cardiovascular and pulmonary pathology was successfully incorporated into an IM residency program with minimal expenses and resource utilization. POCUS is becoming an integral part of the hospitalists’ arsenal in improving efficiency and directing medical care in the inpatient setting. Our study demonstrated retention of knowledge, increased interest, and improved confidence in POCUS utilization among IM residents while also suggesting a need for more skilled attending IM providers who can deliver their expertise to medical trainees with a unified goal of improving patient care. Future directions to solidify this curriculum would be to implement an oral and written practical assessment post-curriculum to further solidify comprehension, skills, and evaluate knowledge gaps.
Keywords
Ultrasonography, Point-of-Care Testing, Physicians, Self-Evaluation Programs, Metacognition, Continuing Medical Education
Disciplines
Diagnosis | Emergency Medicine | Health and Medical Administration | Internal Medicine | Investigative Techniques | Medicine and Health Sciences
Document Type
Poster
Included in
Diagnosis Commons, Emergency Medicine Commons, Health and Medical Administration Commons, Internal Medicine Commons, Investigative Techniques Commons
Focused POCUS: Cardiopulmonary Curriculum for Internal Medicine Residents
Problem Statement: Point-of-care ultrasound (POCUS) is currently not a required core competency in internal medicine (IM) residency despite its inherent benefits, and many hospitalists are not equipped to confidently acquire nor interpret basic ultrasound images.
Background: POCUS is used at the bedside by physicians to answer directed clinical questions to help guide patient management. During the COVID-19 pandemic, the use of ultrasound for quick, accurate diagnosis of life-threatening pathology has been instrumental in early detection of acute cardiopulmonary failure, monitoring treatment response, and minimizing nosocomial spread. We aimed to determine interest in learning POCUS, confidence level, self-rated proficiency, and perceived barriers to mastering imaging techniques and interpretation before and after implementing a dedicated curriculum.
Methodology: Anonymous pre- and post-curriculum surveys were obtained from 30 IM residents at a community hospital program from 2020-2021. A curriculum consisting of one monthly didactic course with an associated hands-on simulation lab was implemented in small groups of six residents over one year. Topics included basic echocardiography, identifying right heart strain, inferior vena cava variability, techniques for ultrasound-guided vascular access, locating compartmental free fluid, and identifying various pulmonary disorders. The training was facilitated using a low-cost handheld portable ultrasound machine.
Results: A total of 30 IM residents completed both the pre- and post-survey. While 100% of residents believed learning POCUS will be beneficial in the inpatient IM setting, only 20% of residents had any prior formal training on ultrasound. More specifically, 20% had no experience at all, 63.3% had some experience, and only 16.7% had a good amount of experience. However, no residents considered themselves to have enough experience or being experts. On a scale of 1-10, rating their confidence level of using ultrasound in clinical practice to guide management, the average mean score was 4.3/10 (SD 1.84) before implementation of the curriculum and 6.1/10 (SD 1.59) after implementation of the curriculum. Self-rated proficiency in obtaining and interpreting key images was poor across the board pre-curriculum, but consistently rose to average or above-average after completing the curriculum. Interestingly, the most common perceived barrier to learning ultrasound and proficiently using these skills in clinical practice was insufficient supervised practice (24/30, 80%), insufficient training (23/30, 76.7%), and insufficient knowledge/experts available (19/30, 63.3%).
Conclusions: A structured POCUS curriculum focused on cardiovascular and pulmonary pathology was successfully incorporated into an IM residency program with minimal expenses and resource utilization. POCUS is becoming an integral part of the hospitalists’ arsenal in improving efficiency and directing medical care in the inpatient setting. Our study demonstrated retention of knowledge, increased interest, and improved confidence in POCUS utilization among IM residents while also suggesting a need for more skilled attending IM providers who can deliver their expertise to medical trainees with a unified goal of improving patient care. Future directions to solidify this curriculum would be to implement an oral and written practical assessment post-curriculum to further solidify comprehension, skills, and evaluate knowledge gaps.