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.
The myocardial stress response to exercise is dependent on exercise intensity and thus understanding the molecular responses between various exercise intensity levels might aid in exercise prescription. Nuclear factor kappa B (NF-κB) is a ubiquitous transcription factor that mediates a variety of cellular processes including inflammation, immune responses, apoptosis and cell growth/development. NF-κB can be comprised of homo- and/or heterodimers formed from five distinct proteins: p50 (NF-κB1), p52 (NF-κB2), RelA (p65), c-Rel, and RelB. NF-κB is located in the cytoplasm and kept inactive by inhibitory proteins but following the exposure to a myriad of stimuli, an activated NF-κB dimer translocates to the nucleus and exerts transcriptional effects on upwards of 150 genes. To examine the activation of NF-κB in the myocardium following exercise, male Sprague-Dawley rats (n = 24) were exercised by treadmill running at 20 m/min for 30 min or 30 m/min for 20 min. At 0, 2, or 24 h following exercise, animals were anesthetized, hearts excised and immediately frozen in liquid nitrogen. Portions of hearts were homogenized, protein concentrations determined and extracts assayed for NF-κB activation (DNA binding activity) using electrophoretic mobility shift assays (EMSA). Visual examination of EMSA autoradiographs revealed an enhanced NF-κB activation in the hearts from exercised animals when compared with non-running controls. Subsequent supershift analyses using antibodies specific for NF-κB subunits showed the higher intensity exercise was associated with p65 (RelA) in the activated NF-κB complex while the NF-κB complex in hearts from animals exercised at the lower intensity was comprised primarily of p50. These data suggest exercise is capable of activating myocardial NF-κB and that a threshold for the activation of specific NF-κB subunits may exist.
BackgroundPoint-of-care ultrasound (POCUS) has become a useful diagnostic tool across multiple specialties. However, no standardized curriculum is currently in place for Canadian Internal Medicine (IM) residency programs. This report aims to describe the development of a longitudinal POCUS curriculum at Dalhousie University and reports on resident knowledge, confidence, and perceived clinical utility of POCUS also.MethodsResidents in the core IM program were invited to complete a POCUS survey and knowledge test in December 2019. The survey evaluated self-reported confidence in acquired POCUS skills and clinical use in practice, whereas the knowledge test evaluated image interpretation skills.ResultsA total of 34/45 (75.6%) residents participated, who agreed that POCUS training should be a formal component of residency (4.56 ± 0.56). Scores on the knowledge test improved based on time spent in the curriculum, with postgraduate year (PGY) 1s scoring an average of 70.0% (21/30) and PGY3s 82.8% (24.9/30; P = 0.02). Residents reported the strongest confidence in lung imaging for detecting A and B lines (4.10 ± 0.79), pleural effusions (3.92 ± 0.90), and lung sliding (3.89 ± 0.92).ConclusionDalhousie University is among the first IM programs in Canada to implement a formal longitudinal POCUS curriculum, which has enabled the incremental acquisition of POCUS knowledge, confidence, and clinical utility amongst residents. RésuméContexteL’échographie au point d’intervention (POCUS) est devenue un outil de diagnostic utile dans de multiples spécialités. Toutefois, aucun programme normalisé n’est en place actuellement dans les programmes de résidence en médecine interne au Canada. Ce rapport vise à décrire l’élaboration d’un programme longitudinal sur la POCUS à l’Université Dalhousie et rend compte des connaissances et de l’assurance des résidents relatives à la POCUS et de leur perception quant à son utilité clinique.MéthodologieDes résidents du programme de médecine interne tronc commun ont été invités à répondre à un sondage sur la POCUS et à effectuer un test de connaissances en décembre 2019. Le sondage a évalué le degré d’assurance quant aux compétences acquises sur la POCUS et à son utilisation clinique dans la pratique, tandis que le test de connaissances a évalué les compétences en matière d’interprétation des images. RésultatsAu total, 34 des 45 résidents ayant participé au sondage (75,6 %) sont d’avis que la formation sur la POCUS devrait être une composante officielle de la résidence (4,56 ± 0,56). Les scores du test de connaissances s’améliorent en fonction du temps passé dans le programme, le score des résidents de première année d’études postdoctorales (PGY-1) étant de 70,0 % (21/30) en moyenne et celui des résidents de troisième année (PGY-3) de 82,8 % (24,9/30; P = 0,02). Les résidents mentionnent faire preuve de la meilleure assurance en matière d’imagerie pulmonaire dans la détection des lignes A et B (4,10 ± 0,79), des épanchements pleuraux (3,92 ± 0,90) et des glissements pulmonaires (3,89 ± 0,92). ConclusionL’Université Dalhousie figure parmi les premiers programmes de médecine interne au Canada à mettre en œuvre un programme longitudinal officiel sur la POCUS, ce qui a permis l’acquisition progressive parmi les résidents des connaissances et de l’assurance relatives à la POCUS et de l’utilité clinique de cet outil de diagnostic.
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