Original Article

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

Authors: James E. Anstey, MD, Trevor P. Jensen, MD, Nima Afshar, MD

Abstract

Objectives: Internal medicine (IM) residency point-of-care ultrasound (POCUS) curricula are being developed but often are limited in scope or components. In this article, we discuss the demonstration of a need for POCUS training in our large academic IM residency program; the development of a longitudinal curriculum; and the impact of the curriculum on POCUS knowledge, use, and confidence.

Methods: In 2014, we designed a cross-sectional POCUS survey and knowledge test for all IM residents at the University of California, San Francisco. The results of this assessment drove the design of a longitudinal POCUS curriculum that included a 2-hour workshop for all IM interns and a 1-month elective offered to all IM residents. Residents were tested on their POCUS knowledge and image interpretation before the elective and were given the same test 6 months after the elective. The posttest included a survey of self-reported POCUS use and confidence.

Results: In the needs assessment, residents scored a mean of 27% on the knowledge test, and across all applications the percentage of residents reporting confidence in their POCUS skills was lower than the percentage reporting use of the application in clinical practice. Residents scored a mean of 37% on the elective pretest and 74% on the posttest, an increase of 37% (95% confidence interval 31.6–42.8, P < 0.001), with improvements seen across all applications. After the elective, self-reported use of POCUS and confidence in POCUS skills were increased for the applications, using the needs assessment as an approximate baseline. For core cardiac and pulmonary applications, 76% to 95% of residents, depending on application, reported “high” or “very high” use and 79% to 100% reported “high” or “very high” confidence in their POCUS skills.

Conclusions: 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.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Ma IWY, Arishenkoff S, Wiseman J, et al. Internal medicine point-of-care ultrasound curriculum: consensus recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2017; 32:1052-1057.
 
2. Arienti V, Di Giulio R, Cogliati C, et al. Bedside ultrasonography (US), echoscopy and US point of care as a new kind of stethoscope for internal medicine departments: the training program of the Italian Internal Medicine Society (SIMI). Intern Emerg Med 2014;9:805-814.
 
3. Lucas BP, Tierney DM, Jensen TP, et al. Credentialing of hospitalists in ultrasound-guided bedside procedures: a position statement of the Society of Hospital Medicine. J Hosp Med 2018;13:117-125.
 
4. Kessler C, Bhandarkar S. Ultrasound training for medical students and internal medicine residents-a needs assessment. J Clin Ultrasound 2010;38:401-408.
 
5. Rao S, van Holsbeeck L, Musial JL, et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med 2008;27:745-749.
 
6. Schnobrich DJ, Gladding S, Olson AP, et al. Point-of-care ultrasound in internal medicine: a national survey of educational leadership. J Grad Med Educ 2013;5:498-502.
 
7. Skalski JH, Elrashidi M, Reed DA, et al. Using standardized patients to teach point-of-care ultrasound-guided physical examination skills to internal medicine residents. J Grad Med Educ 2015;7:95-97.
 
8. Wrightson JM, Bateman KM, Hooper C, et al. Development and efficacy of a 1-d thoracic ultrasound training course. Chest 2012;142:1359-1361.
 
9. Dulohery MM, Stoven S, Kurklinsky AK, et al. Ultrasound for internal medicine physicians: the future of the physical examination. J Ultrasound Med 2014;33:1005-1011.
 
10. Keddis MT, Cullen MW, Reed DA, et al. Effectiveness of an ultrasound training module for internal medicine residents. BMC Med Educ 2011;11:75.
 
11. Schnobrich DJ, Olson AP, Broccard A, et al. Feasibility and acceptability of a structured curriculum in teaching procedural and basic diagnostic ultrasound skills to internal medicine residents. J Grad Med Educ 2013;5:493-497.
 
12. Kelm DJ, Ratelle JT, Azeem N, et al. Longitudinal ultrasound curriculum improves long-term retention among internal medicine residents. J Grad Med Educ 2015;7:454-457.
 
13. Abbott Northwestern Hospital Internal Medicine Residency Program. The IMBUS program. http://imbus.anwresidency.com. Accessed January 17, 2017.