Minding the Gap(s): Hospitalists Experience Aspirational, Safety, and Knowledge Deficits That Prevent Them From Practicing POCUS

Abstract

Point-of-care ultrasound (POCUS) has been a mainstay of clinical decision-making in the intensive care unit and emergency department for more than a decade, but adoption into hospital medicine has lagged behind. Recently, internal medicine residency programs have started to develop POCUS curricula for trainees, though concurrent hospitalist training programs have been limited to date, with little consensus on what hospitalist-oriented curricula should entail. As such, there is wide variability amongst hospitalists with respect to utilization of, training in, and proficiency in POCUS. We conducted a two-part survey of internal medicine hospitalists at our institution: (1) needs assessment that focused on prior training, attitudes and perspectives, current practices, desired use, and barriers to clinical integration; and (2) knowledge test of exam indications, image interpretation, medical decision-making, and understanding of limitations. Our results demonstrate that a majority of hospitalists felt that POCUS was important for diagnostic purposes and that they would benefit from POCUS-specific education. Inadequate training was the most cited barrier to POCUS use. Hospitalist knowledge was lacking in all domains, particularly image interpretation and clinical integration. As a result, we created a three-tiered training program meant to engage: (1) All hospitalists in basic knowledge and appropriate use of POCUS, (2) Some hospitalists in hands-on skill acquisition and image interpretation, and (3) Few hospitalists in mastery of POCUS with resultant formal credentialing. A tiered approach to POCUS training for hospitalists ensures a fundamental cognitive understanding of POCUS for all, but also facilitates hands-on training for those who are committed to further skillset development.

Teaching the Teachers: A Flexible, Cognitive‐Focused Curriculum in Point‐of‐Care Ultrasound Education for Hospital Medicine Faculty

“…Despite this, resident POCUS use on hospital medicine wards continues to expand, with studies showing that residents' confidence often exceeds their knowledge 12–14 . Our own previous work uncovered similar supervision and safety gaps, with the majority of faculty lagging behind the trainees they supervise in POCUS knowledge and competence 11 . Meanwhile ultra‐portable ultrasound machines are less expensive and more readily available.…”

“…8,9 The deficit in POCUS-trained faculty has been described in several studies and largely attributed to the time, cost, and training barriers that faculty experience. 10,11 Despite this, resident POCUS use on hospital medicine wards continues to expand, with studies showing that residents' confidence often exceeds their knowledge. [12][13][14] Our own previous work uncovered similar supervision and safety gaps, with the majority of faculty lagging behind the trainees they supervise in POCUS knowledge and competence.…”

“…[12][13][14] Our own previous work uncovered similar supervision and safety gaps, with the majority of faculty lagging behind the trainees they supervise in POCUS knowledge and competence. 11 Meanwhile ultra-portable ultrasound machines are less expensive and more readily available. Multiple ultrasound companies are also developing and studying artificial intelligence (AI) guided ultrasound technology which may further lower the barrier to ultrasound image acquisition at the point of care.…”

“…However, national surveys have reported that the largest barrier to residents' training is lack of faculty supervision 8,9 . The deficit in POCUS‐trained faculty has been described in several studies and largely attributed to the time, cost, and training barriers that faculty experience 10,11 . Despite this, resident POCUS use on hospital medicine wards continues to expand, with studies showing that residents' confidence often exceeds their knowledge 12–14 .…”

Point-of-Care Ultrasound

“…For instance, one survey of hospitalists at a single center demonstrated that 16% of providers were using POCUS but only a fraction felt confident in their skill set (both acquisition and interpretation). A large proportion of users had a knowledge deficit regarding accepted uses for POCUS and 21% were using POCUS for uses that are generally not recommended for POCUS examinations such as evaluation of aortic valve disease [ 63 ]. Some hospital medicine programs have established a multi-disciplinary infrastructure to standardize credentialing and ongoing quality assurance.…”