Novel Internal Medicine Residency Ultrasound Curriculum Led by Critical Care and Emergency Medicine Staff

Abstract

Introduction Point-of-care ultrasound (POCUS) is an integral aspect of critical care and emergency medicine curriculums throughout the country, but it has been slow to integrate into internal medicine residency programs. POCUS has many benefits for internal medicine providers, guiding diagnostic decisions and aiding in procedures. Additionally, POCUS is a convenient and portable resource specifically for internal medicine providers in the military when practicing in deployed or critical care settings. Critical care and emergency medicine clinicians are excellent resources to lead these courses. We sought to develop a new POCUS curriculum for internal medicine residents within the Naval Medical Center Portsmouth Internal Medicine Residency program with the support of emergency medicine and critical care medicine staff to lead and oversee the training. The project’s aim was to increase internal medicine resident confidence with POCUS by 20% and proficiency with POCUS as evidenced by pretest and posttest analysis by 10%. Materials and Methods The program consisted of a 2-day, 9-hour, introductory course, combining lecture with hands-on scanning taught by emergency medicine physicians who had completed emergency ultrasound fellowship-level training. This was followed by a longitudinal component of hands-on scanning throughout the academic year built into the residents’ schedules. Emergency and critical care medicine ultrasound staff reviewed all studies for quality assurance (QA). The residents were given both precourse and post-course knowledge tests and confidence surveys, which utilized a 5-point Likert scale. The knowledge assessments were analyzed with a paired t-test, and the Likert scale data were analyzed using the Wilcoxon signed-rank test. The Naval Medical Center Portsmouth Institutional Review Board deemed this project nonhuman subjects’ research. Results Twenty participants were enrolled, with 10 (50%) of those enrolled completing all course requirements. The average precourse knowledge assessment score was 76.60%, and postcourse assessment score was 80.95% (+4.35%, P = .33). The confidence survey scores were initially 73.33% and improved to 77.67% (+4.34%, P = .74). Conclusions A curriculum comprised of a 9-hour workshop followed by a longitudinal hands-on experience can provide improvement in internal medicine resident POCUS knowledge and confidence. This model emphasizes the benefit of emergency and critical care cooperation for ultrasound training and provides an emphasis on medicine-relevant scans and longitudinal training.

Point-of-Care Ultrasound Curriculum for Internal Medicine Residents During the COVID-19 Era: A Pilot Study

“…Also, the originally planned purchase of an image-saving platform to serve as an opportunity for residents to save their images in order to receive feedback from faculty, and due to financial restraints during the pandemic, the purchase was postponed. This was expected to improve the residents' image acquisition as well as image interpretation skills and even patient management as shown in other studies [ 9 , 11 ].…”

“…Due to the COVID-19 pandemic, hands-on workshops were not instituted as originally planned due to social distancing guidelines mandated by the hospital. A similar POCUS curriculum study at a small Internal Medicine Program included a total of nine-hour workshop that was spread over a few weeks along with longitudinal hands-on experience, which showed an improvement in the confidence survey scores and pre- and post-assessments as well [ 9 ]. We recognize that ultrasound is a user-dependent tool, and appropriate education and familiarity are of utmost importance during utilization.…”

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

“…One potential idea to implement in a POCUS curriculum is to have a software platform where residents can save images for faculty to review and provide constructive feedback when available, in addition to the traditional one-to-one feedback during direct clinical skills observation. This longitudinal program can potentially improve residents' POCUS knowledge assessments [37][38][39][40].…”