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

Abstract

Objectives We aimed to decrease barriers to acquiring Point‐of‐Care Ultrasound (POCUS) knowledge among attending physicians and improve the safety of trainee POCUS use through a novel flexible and cognitive based curriculum. Methods We developed three educational pathways using varied approaches to educational delivery: a novel and asynchronous cognitive curriculum to allow Educational Supervision, a hands‐on pathway for Limited Practice, and a more robust pathway for Independent Practice and credentialing. Results From November 2018 through June 2021, 102 of 116 hospitalists engaged in some portion of the curriculum. Twenty‐four completed the Educational Supervision pathway, 31 completed the Limited Practice pathway, and 17 enrolled in the Independent Practice pathway with three achieving independent practice. Faculty who completed the Educational Supervision pathway had improved scores on a comprehensive POCUS knowledge assessment, 43.5% [95% Confidence Interval (CI) 38.2–48.8] versus 72.0% [95% CI 65.2–78.8], P < .001. Junior faculty were more likely to engage in the supervision pathway and senior faculty were more likely to complete an intensive course to complete the Limited Practice pathway. Conclusions A flexible, cognitive focused POCUS curriculum was effective in creating high levels of engagement, and a cognitive only curriculum resulted in significant improvement in hospitalists' POCUS knowledge without hands on training. Finally, we found that hospitalist engagement in the curriculum did not follow the lowest barrier to entry or time commitment and engagement varied by time in practice. Training faculty to independent practice remains a substantial challenge.

“Teaching old dogs new tricks” – POCUS Education for Senior Faculty

“…These faculty members frequently spontaneously voiced these sentiments as having the potential to mitigate burnout. Additionally, through our continuing educational review sessions, non-super users have acquired skills in image interpretation despite not recalling how to acquire them – which is in keeping with what others have found in training similar populations using asynchronous cognitive-focused curricula 10 . The faculty who completed their super-user training continues to scan actively and use POCUS in their clinical decision making on a near daily basis and are actively engaged in our image review sessions.…”

Point‐counterpoint: Should point‐of‐care ultrasound be a required skill of hospitalists?

“…There is good agreement amongst POCUS experts that rigorous training programs for both trainees and hospitalists must include a combination of hands‐on, didactic, and image interpretation skills over time, with a formal mechanism for feedback and quality assurance on an ongoing basis. Several HMGs have published institutional protocols for POCUS training combining these elements, 28,29 and external certificate programs, such as the SHM POCUS Certificate of Completion Program, also offer robust and comprehensive training for hospitalists. Additionally, access to POCUS training is improving as more novel training options are now available for hospitalists, including self‐directed learning modules and simulators with artificial intelligence.…”

“…Most importantly, no recent studies have evaluated how many graduating internal medicine residents have sufficient knowledge and skills to incorporate POCUS into their clinical practice, and barriers to education after residency training are significant—hospitalists report lacking time and financial support for training, as well as a paucity of skilled educators to lead faculty development sessions 3,28 . A universal requirement for POCUS training during internal medicine (IM) residency is needed so that graduating residents can enter the workforce capable of independent POCUS practice analogous to other aspects of clinical care, rather than relying on POCUS skill development to occur outside of the residency training environment.…”

Minutes matter: Time it takes to perform point‐of‐care ultrasound

“…1,3 Point-of-care ultrasound (PoCUS) improves efficiency by integrating physical examination and history findings with visual diagnostic data to narrow the differential diagnosis. [4][5][6] PoCUS reduces unnecessary use of overburdened hospital resources, reduces health care costs, and increases patient satisfaction. [7][8][9] The realtime, adaptable assessment PoCUS offers bypasses the time and resources required of other diagnostic modalities.…”