BackgroundSignificant gaps currently exist in the Canadian internal medicine point-of-care ultrasound (POCUS) curriculum. From a learner’s perspective, it remains unknown what key POCUS skills should be prioritized. This needs assessment study seeks to establish educational priorities for POCUS for internal medicine residents at five Canadian residency training programs.MethodsAll internal medicine trainees [postgraduate year (PGY) 1–5] from five internal medicine residency training programs in Canada (n = 598) were invited to complete an online survey on 15 diagnostic POCUS applications, 9 bedside procedures, and 18 POCUS knowledge items. For POCUS applications and procedures, participants were asked how applicable they are to patient care in internal medicine and the participants’ reported skills in those domains. Self-reported knowledge and skills were rated on a 5-point Likert scale, where 1 = very poor and 5 = very good. Applicability was rated, where 1 = not at all applicable and 5 = very applicable.ResultsA total of 253 of 598 residents (42%) participated in our study. Data from one centre (n = 15) was removed because of low response rate (15%) and significant baseline differences between those trainees and the remaining participants. Of the remaining analyzable data from four training programs (n = 238), participants reported highest applicability to internal medicine for the following applications and procedures: identifying ascites/free fluid [mean applicability score of 4.9 ± standard deviation (SD) 0.4]; gross left ventricular function (mean 4.8 ± SD 0.5) and pericardial effusion (mean 4.7 ± SD 0.5); thoracentesis (mean score 4.9 ± SD 0.3), central line insertion (mean 4.9 ± SD 0.3), and paracentesis (mean 4.9 ± SD 0.3), respectively. Overall reported knowledge/skills was low, with skill gaps being the highest for identifying deep vein thrombosis (mean gap 2.7 ± SD 1.1), right ventricular strain (mean 2.7 ± SD 1.1), and gross left ventricular function (mean 2.7 ± SD 1.0).ConclusionsMany POCUS applications and procedures were felt to be applicable to the practice of internal medicine. Significant skill gaps exist in the four Canadian training programs included in the study. POCUS curriculum development efforts should target training based on these perceived skill gaps.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1326-8) contains supplementary material, which is available to authorized users.
Azimuthal resistivity surveys increasingly are being used by hydrogeologists in the identification and characterization of fractured rocks. In these investigations, electrical resistivity is measured as a function of azimuth about a fixed central point. In most recent published examples, any observed change in apparent resistivity with azimuth is interpreted as being indicative of fracture anisotropy. However, interpretation of rotational sounding data is actually more complicated, as azimuthal variations in apparent resistivity are also produced by the presence of dipping stratigraphy and other lateral changes in formation resistivity. Such effects are generally overlooked because the field techniques normally employed are incapable of detecting them. Consequently, it is quite probable that the results of many published surveys have been wrongly interpreted. An alternative field procedure and interpretation methodology has been developed to differentiate anisotropy, dipping layers, and lateral effects. This approach makes use of the offset Wenner technique and examines the different responses of the individual Wenner resistances above different geological structures. Analysis of data obtained using the azimuthal offset Wenner technique from sites in Britain and Ireland have successfully identified subsurface structures and determined the anisotropy where it is present.
Rotational or azimuthal resistivity sounding is frequently employed for determining the electrical anisotropy of the subsurface, from which the orientation of fracturing, which might give rise to the anisotropy, is interpreted. However, symmetrical 4‐electrode arrays, such as the Wenner, Schlumberger and square, are ambiguous and will also produce an anisotropy‐style signature over dipping strata or a gradational lateral change in rock resistivity. This problem may be overcome by use of a 5‐electrode offset‐Wenner array. Simple tank modelling of an anisotropic bedrock overlain by an isotropic overburden demonstrates that rotational offset‐Wenner sounding will clearly indicate whether observed anisotropy is real or whether it is merely due to the similar and ambiguous effects of a varying overburden thickness.
Rotational or azimuthal resistivity sounding is frequently employed for determining the electrical anisotropy of the subsurface. From this, the orientation of fracturing which might give rise to the anisotropy is interpreted. However, 4‐electrode arrays, such as the Wenner or Schlumberger, are strongly ambiguous and will produce an anisotropy‐style signature also over dipping strata or a gra‐dational lateral change in rock resistivity. However, this problem may be overcome by use of a 5‐electrode offset Wenner array. Simple computer modelling of rotational soundings is sufficient to demonstrate that azimuthal Wenner surveys, conducted on ground where there is a lateral variation in resistivity, will produce results similar to those recorded on truly anisotropic ground, whereas alternative techniques, such as offset Wenner azimuthal sounding, will successfully differentiate the two models.
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