Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study

Abstract

Background and Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. Methods: Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. Results: POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Only 27% of programs use six of the eight surveyed POCUS modalities more than once per year. The top three barriers to including POCUS in residency training in 2019 have not changed since 2014, and are (1) a lack of trained faculty, (2) limited access to equipment, and (3) discomfort with interpreting images without radiologist review. Conclusions: Training in POCUS has increased in family medicine residencies over the last 5 years, although practical use of this technology in the clinical setting may be lagging behind. Further research should explore how POCUS can improve outcomes and reduce costs in the primary care setting to better inform training for this technology.

Point-of-care ultrasound (POCUS) in Norwegian general practice

“…Ultrasonography is considered to be a highly user-dependent clinical skill [8,17,18]. However, for several types of scans, such as those to detect an AAA, even novices can scan with a high level of diagnostic accuracy [3,6,7,[10][11][12][13]. There may be many causes to the low number of scans among the majority of GPs.…”

“…We did not expect to observe the effect of this in Norway during the study period. The relatively high quality of scans for simpler assessments, even by novices, may also have contributed to the increased number of scans [3,6,7,[10][11][12][13].…”

“…The three-fold increase for residual urine, fetal head position at term, first-trimester bleeding and DVT was lower than the increase in number of scanning GPs. The eight-fold increase in scanning for gallstones or AAA can partially be explained by their ease in performing [3,6,7,[10][11][12][13] and clinical significance. The 22-fold increase in scanning for skin-associated processes cannot be explained and requires further studies.…”

“…In Norway, a few general practitioners (GPs) have used ultrasound over the last 40 years for a variety of clinical problems [1,2]. As ultrasound devices have evolved, the term point-of-care ultrasound (POCUS) has become established in the field of general practice and became a major trend after 2000 [3][4][5][6][7][8][9]. POCUS is a focused examination of patient symptoms as a part of the diagnostic process that includes anamnesis and physical-and laboratory examinations, and is less comprehensive than a full diagnostic ultrasound by radiologists.…”

“…POCUS is a focused examination of patient symptoms as a part of the diagnostic process that includes anamnesis and physical-and laboratory examinations, and is less comprehensive than a full diagnostic ultrasound by radiologists. It is considered safe for GPs to perform POCUS for conditions of low to moderate complexity [3,6,7,[10][11][12][13].…”