Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group

Abstract

Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1–3) and expanded (general internal medicine PGY 4–5) training programs. We recommend four POCUS applications for the core PGY 1–3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4–5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine?

“…Similar curricula are being or have been developed in a number of other countries for internal medicine, with a Canadian group recently publishing their recommendations. 42 Having a curriculum in place is important to standardise training in this emerging field; however, establishing it will need an adequate number of trainers. This has been seen in respiratory medicine where despite thoracic ultrasound being a mandatory part of the curriculum, trainees have reported difficulties in getting formally signed off.…”

Curriculum for Fundamentals of Ultrasound in Clinical Practice

“…Exchange of ideas and expertise through conference calls, an in‐person meeting, and a common writing platform, with the guidance of AIUM Quality Initiatives Coordinator Kathi Minton, contributed to a consensus. This document reflects the product of that activity …”

Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point‐of‐Care Ultrasound Fellowship

“…This potentially results in the undesirable situation in which trainees have greater specific knowledge and experience than their supervising residents and faculty. This discrepancy is not due to a lack of awareness of the utility of CPUS in IM, as its applications are well described, with multiple subspecialties releasing consensus guidelines . A needs assessment and national guideline for IM CPUS training have been published in Canada, and the American College of Physicians has recently released a statement on the importance of CPUS in IM, but the development of expertise within IM practice environments and subspecialties remains a considerable challenge .…”

“…[7][8][9][10][11] A needs assessment and national guideline for IM CPUS training have been published in Canada, and the American College of Physicians has recently released a statement on the importance of CPUS in IM, but the development of expertise within IM practice environments and subspecialties remains a considerable challenge. 8,[12][13][14][15] There are more than 400 IM residency programs in the United States, each with a need for education on CPUS in the inpatient, outpatient, and critical care settings. Although several specialties (most notably critical care, rheumatology, cardiology, and nephrology) are integrating US into their fellowship training, there is a concern that subspecialty interest will exacerbate the dearth of skilled users in general IM training by recruitment of UScompetent IM resident graduates into their fellowship programs At the time of this publication, there are only 2 IM CPUS fellowships currently available in the US, which clearly provides inadequate throughput for future needs.…”