Fulfilling the Potential of Point‐of‐Care Ultrasound in Hospital Medicine

Abstract

T he enthusiasm surrounding point-of-care ultrasound (POCUS) is clear and well founded. POCUS is a powerful tool that produces valuable diagnostic information for common and important clinical problems faced by hospitalists, such as pneumonia, soft-tissue infections, 1 and myriad other applications. It can inform the evaluation and management of complex clinical problems such as dyspnea. 2 Beyond its diagnostic potential, POCUS is well known to improve common procedures performed by adult and pediatric hospitalists by improving success rates and decreasing complications.Excitement surrounding this technology continues to grow among hospitalists, leading to a proliferation of high-quality educational programs over the last 5 years. Most notable among these offerings has been the more comprehensive training available through the Society of Hospital Medicine (SHM) certificate-based pathway, though many other strong options exist, including institution-based curricula, such as the HealthPartners CHAMP program, 3 and pediatric-focused programs. Growth in training is also occurring among medical students and residents. As of a 2012 survey, the majority (51%) of US medical schools had begun to weave ultrasound into their curricula, 4 and this growth is also occurring in internal medicine and pediatric residency programs. 5 Given the high potential for this technology and the growth in interest, it is an excellent time to pause and review some of the challenges faced by practitioners, hospitalist groups, and educators seeking to optimize POCUS implementation. A deliberate approach to POCUS education, the development of shared standards for high-quality use, and an ongoing dedication to develop specialty-specific practices will largely determine how much of this potential is fulfilled.The largest challenge is likely to be educational. Educating clinicians to be able to integrate POCUS into practice is a complex, multistep process requiring not only an adequate core of didactic training and access to machines, but also the structured opportunity to develop rudimentary hands-on skills. Such initial training should be followed by continued practice and feedback as developing POCUS users progress toward independent practice. The study by Kumar et al. 6 reaffirms that brief didactic lectures and access to machines are necessary, but they are clearly insufficient for learners to be able to use POCUS independently for a wide variety of applications. Their intervention also contrasts markedly with the 20 hours of didactics and 150 supervised scans recommended by the American College of Emergency Physicians prior to independent use for a core of six applications. 7 Shared standards for education, use, and oversight will be crucial to fulfilling the potential of POCUS within hospital medicine. Our belief is that much can be learned from the thoughtful approach taken during the development of POCUS as a mainstream tool in emergency medicine in the early 2000s. In this approach, emergency physicians determined a sufficient and achie...

Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users

“…Its utility has now expanded beyond these two specialties, encompassing various medical training such as anesthesia, obstetrics and gynecology, nephrology, and rheumatology [6][7][8][9][10]. Recently, there has been an increased interest and enthusiasm for POCUS in general internal medicine, both in inpatient and outpatient settings [11][12][13]. This surge in enthusiasm can be attributed to the development of compact and affordable pocketsized ultrasound devices, which are replacing the large and cumbersome cart-based ultrasound machines when it comes to personal use.…”