Background: Point-of-care ultrasound (POCUS) is increasingly used in internal medicine, but a lack of trained faculty continues to limit the spread of POCUS education. Using a framework based on organizational change theories, this study sought to identify barriers and enablers for hospital-based practicing internists to learn and use POCUS in clinical practice. Methods: We invited practicing internists at six North American institutions to participate in an electronic survey on their opinions regarding 39 barriers and enablers. Results: Of the 342 participants invited, 170 participated (response rate 49.3%). The top barriers were lack of training (79%), lack of handheld ultrasound devices (78%), lack of direct supervision (65%), lack of time to perform POCUS during rounds (65%), and lack of quality assurance processes (53%). The majority of participants (55%) disagreed or strongly disagreed with the statement "My institution provides funding for POCUS training." In general, participants' attitudes towards POCUS were favourable, and future career opportunities and the potential for billing were not considered significant factors by our participants in the decision to learn or use POCUS. Conclusions: This survey confirms the perceived importance of POCUS to practicing internists. To assist in closing faculty development gap, interventions should address training, supervision, quality assurance processes, availability of handheld devices, as well as dedicated time to perform POCUS during clinical care.
Objectives-To develop a consensus statement on the use of lung ultrasound (LUS) in the assessment of symptomatic general medical inpatients with known or suspected coronavirus disease 2019 .Methods-Our LUS expert panel consisted of 14 multidisciplinary international experts. Experts voted in 3 rounds on the strength of 26 recommendations as "strong," "weak," or "do not recommend." For recommendations that reached consensus for do not recommend, a fourth round was conducted to determine the strength of those recommendations, with 2 additional recommendations considered.Results-Of the 26 recommendations, experts reached consensus on 6 in the first round, 13 in the second, and 7 in the third. Four recommendations were removed because of redundancy. In the fourth round, experts considered 4 recommendations that reached consensus for do not recommend and 2 additional scenarios; consensus was reached for 4 of these. Our final recommendations consist of 24 consensus statements; for 2 of these, the strength of the recommendations did not reach consensus.Conclusions-In symptomatic medical inpatients with known or suspected COVID-19, we recommend the use of LUS to: (1) support the diagnosis of pneumonitis but not diagnose COVID-19, (2) rule out concerning ultrasound features, (3) monitor patients with a change in the clinical status, and (4) avoid unnecessary additional imaging for patients whose pretest probability of an alternative or superimposed diagnosis is low. We do not recommend the use of LUS to guide admission and discharge decisions. We do not recommend routine serial LUS in patients without a change in their clinical condition.
BackgroundCurriculum development and implementation for internal medicine point-of-care ultrasound (IM POCUS) continues to be a challenge for many residency training programs. Education indicators may provide a useful framework to support curriculum development and implementation efforts across programs in order to achieve a consistent high-quality educational experience.ObjectiveThis study seeks to establish consensus-based recommendations for education indicators for IM POCUS training programs in Canada.DesignThis consensus study uses a modified nominal group technique for voting in the initial round, followed by two additional rounds of online voting, with consensus defined as agreement by at least 80% of the participants.ParticipantsParticipants were 22 leaders with POCUS and/or education expertise from 13 Canadian internal medicine residency programs across 7 provinces.Main MeasuresEducation indicators considered were those that related to aspects of the POCUS educational system, could be presented by a single statistical measure, were readily understood, could be reliably measured to provide a benchmark for measuring change, and represented a policy issue. We excluded a priori indicators with low feasibility, are impractical, or assess learner reactions. Candidate indicators were drafted by two academic internists with post-graduate training in POCUS and medical education. These indicators were reviewed by two internists with training in quality improvement prior to presentation to the expert participants.Key ResultsOf the 52 candidate education indicators considered, 6 reached consensus in the first round, 12 in the second, and 4 in the third round. Only 5 indicators reached consensus to be excluded; the remaining indicators did not reach consensus.ConclusionsThe Canadian Internal Medicine Ultrasound (CIMUS) group recommends 22 education indicators be used to guide and monitor internal medicine POCUS curriculum development efforts in Canada.Electronic supplementary materialThe online version of this article (10.1007/s11606-019-05124-1) contains supplementary material, which is available to authorized users.
BackgroundPoint-of-care lung ultrasound (LUS) examination is increasingly utilized in Internal Medicine. To improve the standardization of LUS education and clinical use, explicit minimal criteria for defining what is an acceptable and clinically useful image are needed.MethodsA 97-item online survey of potential minimal criteria for common uses of LUS in Internal Medicine was developed and sent to 10 international point-of-care ultrasound experts. Their opinion on the inclusion of each item was sought and items not achieving consensus (defined as agreement by at least 70% of the experts) were reassessed in subsequent rounds. A total of three rounds were conducted.ResultsSeventy-four minimal criteria were agreed upon for inclusion, 24 were agreed upon for exclusion, and two did not reach consensus.ConclusionsExperts agreed on 74 minimal criteria for Internal Medicine LUS. The use of these minimal criteria during teaching and clinical use is strongly recommended. RésuméContexteL’échographie pulmonaire au point d’intervention est de plus en plus utilisée en médecine interne. Pour améliorer l’uniformisation de la formation sur l’échographie pulmonaire et de son utilisation clinique, il faut des critères minimaux explicites pour définir ce qu’est une image acceptable et utile sur le plan clinique.MéthodologieUn sondage en ligne de 97 éléments portant sur des critères minimaux possibles dans l’utilisation courante de l’échographie pulmonaire en médecine interne a été élaboré et soumis à 10 experts internationaux en échographie au point d’intervention. Leur avis sur l’inclusion de chaque élément a été sondé, et les éléments pour lesquels il n’y avait pas de consensus (défini par l’accord d’au moins 70 % des experts) ont été réévalués lors de tours suivants. Au total, trois tours ont été effectués.RésultatsSoixante-quatorze critères minimaux ont été acceptés, 24 ont été exclus et deux n’ont pas fait consensus.ConclusionsLes experts se sont entendus sur 74 critères minimaux relatifs à l’échographie pulmonaire en médecine interne. L’utilisation de ces critères minimaux au cours de l’enseignement et de l’utilisation clinique est fortement recommandée.
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