Point-of-Care Ultrasound Needs Assessment, Curriculum Design, and Curriculum Assessment in a Large Academic Internal Medicine Residency Program

Anstey, James; Jensen, Trevor; Afshar, Nima

doi:10.14423/smj.0000000000000831

Cited by 32 publications

(45 citation statements)

References 12 publications

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“…They similarly reported frequent POCUS utilization in clinical practice that was out of proportion to self‐reported confidence in skill level. Their study also found that most residents did not feel adequately supervised when using POCUS on the medicine wards 18 . While we did not directly ask about supervision in our survey, trainees in our survey frequently cited lack of just‐in‐time expert feedback as a barrier.…”

Section: Discussionmentioning

confidence: 81%

“…To meet the rapid growth of POCUS utilization, several professional societies have published guidelines, consensus statements, or expert opinions detailing recommendations for POCUS application in both adults and children 10‐17 . However, incorporation of these guidelines into GME training programs is variable and limited 18‐21 . Furthermore, many providers completed their GME training prior to incorporation of POCUS educational goals into GME program requirements yet still desire POCUS training.…”

Section: Introductionmentioning

confidence: 99%

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Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system

Wenger

Steinbach

Carlbom

et al. 2020

J of Clinical Ultrasound

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Purpose We sought to understand current POCUS practices and comfort as well as assess opinions about POCUS across our medical system via a survey to guide program development. Methods This study was conducted as a 19 question RedCap survey with multiple parts. Respondents were queried for demographics as well as experience with, attitudes toward, and clinical use of POCUS in common critical care scenarios. Results The survey was completed by 343 individuals, a response rate of 30%. Most respondents “agreed” that POCUS is a needed skill and helped them provide safer care (78% and 86% agreement). Most faculty and trainees reported some POCUS training (62% and 88%) and at least weekly use. Trainees rated themselves more comfortable than faculty for most exam types. The majority of faculty rated their POCUS education as inadequate while trainees had mixed responses. Conclusions POCUS is a frequently used tool, yet users are less confident in their skills than expected. POCUS applications are viewed as needed for future practice but there is a substantial need for improved education among faculty and trainees. Pooling resources and sharing educational initiatives across multiple specialties may help improve POCUS implementation.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system

Wenger

Steinbach

Carlbom

et al. 2020

J of Clinical Ultrasound

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“…The results of this research demonstrated an effective way to increase the performance and favorable attitudes of bedside ultrasound in residents. Anstey et al demonstrated an effective PoCUS curriculum for internal medicine residents that produced long-term gains in knowledge and high con dence achievements [26]. Emergency medicine residents struggle in overcrowded emergency departments to manage various patients with severe needs, which results in a stressed and dissatis ed training period [27,28], which often leads residents to overload themselves to complete the mandatory ultrasound practice off duty.…”

Section: Discussionmentioning

confidence: 99%

Operating bedside cardiac ultrasound program in emergency medicine residency: a retrospective observation study from the perspective of performance improvement

Kim

Jung

Park

et al. 2020

Preprint

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Background Point-of-care Ultrasound is one of useful diagnostic tools in emergency medicine practice and considerably depends on physician’s performance. This study was performed to evaluate performance improvements and favorable attitudes through structured cardiac ultrasound program for emergency medicine residents. Methods Retrospective observational study using the Point-of-care ultrasound (PoCUS) database in one tertiary academic-teaching hospital emergency department has been conducted. Cardiac ultrasound education and rotation program has been implemented in emergency medicine residency program. Structured evaluation sheet for cardiac ultrasound and questionnaire toward PoCUS have been developed. An early-phase and a late-phase case were selected randomly for each participant. Two emergency medicine specialists with expertise in PoCUS evaluated saved images independently. We used a paired t-test to compare the performance score of each phase and the results of the questionnaire. Multivariable linear regression analysis was conducted to evaluate the association between the characteristics of participants and performance improvements. Results During the study period, a total of 1,652 bedside cardiac ultrasounds were administered. Forty-six examinations conducted by 23 emergency medicine residents were randomly selected for analysis. The performance score increased from 39.5 to 56.1 according to expert A and 45.3 to 62.9 according to expert B (p-value < 0.01 for both). The average questionnaire score, which was analyzed for 17 participants, showed improvement from 18.9 to 20.7 (p-value < 0.01). In multivariable linear regression analysis, younger age, higher early-phase score and higher confidence had a negative association with a greater improvement of performance, while the number of examinations had a positive association. Conclusions Bedside cardiac ultrasound performance and attitudes toward PoCUS have been improved through structured residency program.

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“…Point of care ultrasound (POCUS) refers to the use of ultrasound by the treating provider at the bedside to answer focused clinical questions. The use of POCUS has become increasingly popular within the field of Internal Medicine (IM) worldwide [1][2][3][4][5]. In settings where material and human resource constraints limit the availability of many diagnostic modalities, POCUS is a particularly valuable tool [4,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Steven Fox, MD 1 ; Michelle Fleshner, MD MPH 1 ; Collin Flanagan, DO 2 ; Thomas Robertson, MD 2 ; Ayako Wendy Fujita, MD 1 ; Divya Bhamidipati, MD 1 ; Abdulrahman Sindi, MD 3 ; Raghunandan Purushothaman, MD 1 ; Thuy Bui, MD 1 (1) University of Pittsburgh Medical Center, Presbyterian. Internal Medicine.…”

mentioning

confidence: 99%

Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track

Fox

Fleshner

Flanagan

et al. 2020

POCUS

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Background: A quality assurance system is vital when using point-of-care ultrasound (POCUS) to ensure safe and effective ultrasound use. There are many barriers to implementing a quality assurance system including need for costly software, faculty time, and extra work to log images. Methods: With minimal funding or protected faculty time, we successfully developed an effective remote quality assurance system between residents rotating internationally and faculty in the US. Results: 270 total exams were logged using this system (41 per resident over a 7 week period). Over the course of the implementation period, a significant increase was seen in average image quality (p = 0.030) and percent agreement with reviewer (p = 0.021). No significant increase was seen for percent images with quality rating 5/5 (p = 0.068) or for studies per resident per week (p = 0.30). Discussion/Conclusions: A quality assurance system for remote review and feedback of POCUS exams was successfully developed with limited available funding, using consumer-level software and an educational collaboration. Residents used the system regularly and demonstrated improvement in reviewer-rated image acquisition and interpretation skills. A similar system can be applied for physicians in any geographic area looking to learn POCUS, in partnership with local or international POCUS mentors. We detail a step-by-step approach, challenges encountered, and lessons learned, to help guide others seeking to implement similar programs.

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Point-of-Care Ultrasound Needs Assessment, Curriculum Design, and Curriculum Assessment in a Large Academic Internal Medicine Residency Program

Abstract: We used a needs assessment to guide the development of a longitudinal, multidisciplinary POCUS curriculum. Residents who completed all components showed substantial long-term gains in knowledge in all major applications and high use of and confidence in cardiac and pulmonary applications.

Cited by 32 publications

References 12 publications

Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system

Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system

Operating bedside cardiac ultrasound program in emergency medicine residency: a retrospective observation study from the perspective of performance improvement

Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track

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