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Multi-Level Stakeholder Perspectives on Determinants of Point of Care Ultrasound Implementation in a US Academic Medical Center. Diagnostics (Basel) 2021; 11:diagnostics11071172. [PMID: 34203357 PMCID: PMC8305030 DOI: 10.3390/diagnostics11071172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 12/23/2022] Open
Abstract
There is growing interest from multiple specialties, including internal medicine, to incorporate diagnostic point of care ultrasound (POCUS) into standard clinical care. However, few internists currently use POCUS. The objective of this study was to understand the current determinants of POCUS adoption at both the health system and clinician level at a U.S. academic medical center from the perspective of multi-level stakeholders. We performed semi-structured interviews of multi-level stakeholders including hospitalists, subspecialists, and hospital leaders at an academic medical center in the U.S. Questions regarding the determinants of POCUS adoption were asked of study participants. Using the framework method, team-based analysis of interview transcripts were guided by the contextual domains of the Practical Robust Implementation and Sustainability Model (PRISM). Thirty-one stakeholders with diverse roles in POCUS adoption were interviewed. Analysis of interviews revealed three overarching themes that stakeholders considered important to adoption by clinicians and health systems: clinical impact, efficiency and cost. Subthemes included two that were deemed essential to high-fidelity implementation: the development of credentialing policies and robust quality assurance processes. These findings identify potential determinants of system and clinician level adoption that may be leveraged to achieve high-fidelity implementation of POCUS applications that result in improved patient outcomes.
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Elhassan MG, Chao PW, Curiel A. The Conundrum of Volume Status Assessment: Revisiting Current and Future Tools Available for Physicians at the Bedside. Cureus 2021; 13:e15253. [PMID: 34188992 PMCID: PMC8231469 DOI: 10.7759/cureus.15253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Assessment of patients’ volume status at the bedside is a very important clinical skill that physicians need in many clinical scenarios. Hypovolemia with hypotension and tissue under-perfusion are usually more alarming to physicians, but hypervolemia is also associated with poor outcomes, making euvolemia a crucial goal in clinical practice. Nevertheless, the assessment of volume status can be challenging, especially in the absence of a gold standard test that is reliable and easily accessible to assist with clinical decision-making. Physicians need to have a broad knowledge of the individual non-invasive clinical tools available for them at the bedside to evaluate volume status. In this review, we will discuss the strengths and limitations of the traditional tools, which include careful history taking, physical examination, and basic laboratory tests, and also include the relatively new tool of point-of-care ultrasound.
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Affiliation(s)
| | - Peter W Chao
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Argenis Curiel
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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Cool JA, Huang GC. Procedural Competency Among Hospitalists: A Literature Review and Future Considerations. J Hosp Med 2021; 16:230-235. [PMID: 33734979 DOI: 10.12788/jhm.3590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience. METHODS We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures. RESULTS Our synthesis of the literature characterizes contributors to hospitalists' procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists. CONCLUSION We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.
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Affiliation(s)
- Joséphine A Cool
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Grace C Huang
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Brady AK, Spitzer CR, Kelm D, Brosnahan SB, Latifi M, Burkart KM. Pulmonary Critical Care Fellows' Use of and Self-reported Barriers to Learning Bedside Ultrasound During Training: Results of a National Survey. Chest 2021; 160:231-237. [PMID: 33539836 DOI: 10.1016/j.chest.2021.01.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Competence in ultrasonography is essential for pulmonary and critical care medicine (PCCM) fellows, but little is known about fellow-reported barriers to acquiring this crucial skill during fellowship training. RESEARCH QUESTION How do PCCM fellows acquire experience performing and interpreting ultrasonography during their training, what is their perspective on barriers to acquiring ultrasound expertise during fellowship, and what is their comfort with a range of ultrasound examinations? STUDY DESIGN AND METHODS A 20-item survey including questions about procedural training and acquisition of ultrasound skills during PCCM fellowship was developed. The survey instrument was sent to PCCM fellowship program directors to distribute to their fellows at program directors' discretion. RESULTS Four hundred seventy-five responses were received. The most common method of learning ultrasonography was performing it independently at the bedside. Fellows reported that the greatest barrier to acquiring ultrasound skills was the lack of trained faculty experts, followed by lack of a formal curriculum. Fellow comfort was greatest with thoracic ultrasound and least with advanced cardiac ultrasound. INTERPRETATION Significant barriers to ultrasound training during PCCM fellowship exist, and future educational efforts should address these barriers at both program and institutional levels.
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Affiliation(s)
- Anna K Brady
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR.
| | - Carleen R Spitzer
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Diana Kelm
- Division of Pulmonary Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Hospital, New York, NY
| | - Mani Latifi
- Pulmonary and Critical Care, Cleveland Clinic Foundation, Cleveland, OH
| | - Kristin M Burkart
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, New York, NY
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55
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Janjigian M, Dembitzer A, Srisarajivakul-Klein C, Hardower K, Cooke D, Zabar S, Sauthoff H. Design and evaluation of the I-SCAN faculty POCUS program. BMC MEDICAL EDUCATION 2021; 21:22. [PMID: 33407431 PMCID: PMC7789543 DOI: 10.1186/s12909-020-02453-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming widely adopted with increasing accessibility of courses. Little is known about the optimal design of the introductory course or longitudinal training programs targeting hospitalists that are critical to success. METHODS Hospitalists at four academic sites participated in a two-day introductory course and a longitudinal phase comprising clinical POCUS practice, clip uploading with online feedback, hands-on teaching, and monthly ultrasound conferences. Assessments were performed immediately before and after the two-day course and after 1 year. RESULTS Knowledge increased from baseline to post two-day course (median score 58 and 85%, respectively, p < 0.001) and decreased slightly at 1 year (median score 81%, p = 0.012). After the two-day introductory course, the median score for hands-on image acquisition skills, the principal metric of participant success, was 75%. After 1 year, scores were similar (median score 74%). Confidence increased from baseline to post two-day course (1.5 to 3.1 on a 4 point Likert scale from Not at all confident (1) to Very confident (4), p < 0.001), and remained unchanged after 1 year (2.73). Course elements correlating with a passing score on the final hands-on test included number of clip uploads (r = 0.85, p,0.001), attendance at hands-on sessions (r = 0.7, p = 0.001), and attendance at monthly conferences (r = 0.50, p = 0.03). CONCLUSIONS The I-ScaN POCUS training program increased hospitalist knowledge, skill and confidence with maintained skill and confidence after 1 year. Uploading clips and attending hands-on teaching sessions were most correlative with participant success.
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Affiliation(s)
- Michael Janjigian
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, New York, USA.
| | - Anne Dembitzer
- Department of Medicine, New York University Grossman School of Medicine, VA NY Harbor Healthcare System, New York, USA
| | - Caroline Srisarajivakul-Klein
- Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, New York, USA
| | - Khemraj Hardower
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Deborah Cooke
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Sondra Zabar
- Department of Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, USA
| | - Harald Sauthoff
- Department of Medicine, New York University Grossman School of Medicine, VA NY Harbor Healthcare System, New York, USA
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van Rijn RR, Stafrace S, Arthurs OJ, Rosendahl K. Non-radiologist-performed point-of-care ultrasonography in paediatrics - European Society of Paediatric Radiology position paper. Pediatr Radiol 2021; 51:161-167. [PMID: 33211186 PMCID: PMC7796864 DOI: 10.1007/s00247-020-04843-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
Non-radiologist point-of-care ultrasonography (US) is increasingly implemented in paediatric care because it is believed to facilitate a timely diagnosis, such as in ascites or dilated renal pelvicalyceal systems, and can be used to guide interventional procedures. To date, all policy statements have been published by non-radiologic societies. The European Society of Paediatric Radiology hereby issues a position statement on paediatric non-radiologist point-of-care US from the point of view of those leading on children's imaging, i.e. paediatric radiologists. In this position statement, we will address the boundaries, education, credentialing, quality control, reporting and storage of images in paediatric practice.
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Affiliation(s)
- Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital-Amsterdam UMC, University of Amsterdamn, Meibergdreef 9, 1105 AZ, Amsterdam Zuid-Oost, the Netherlands.
| | - Samuel Stafrace
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- UCL GOS Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
- The Arctic University of Norway, Tromsø, Norway
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57
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Hussain A, Ma IWY. Internal Medicine Point of Care Ultrasound in the 21st Century: A 'FoCUS' on the Middle East. J Saudi Heart Assoc 2020; 32:479-482. [PMID: 33537196 PMCID: PMC7849845 DOI: 10.37616/2212-5043.1225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Arif Hussain
- Cardiac Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Irene W Y Ma
- John A. Buchanan Chair, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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58
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Maw AM, Huebschmann AG, Mould-Millman NK, Dempsey AF, Soni NJ. Point-of-Care Ultrasound and Modernization of the Bedside Assessment. J Grad Med Educ 2020; 12:661-665. [PMID: 33391586 PMCID: PMC7771602 DOI: 10.4300/jgme-d-20-00216.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anna M Maw
- Assistant Professor, Division of Hospital Medicine, University of Colorado School of Medicine
| | - Amy G Huebschmann
- Associate Professor, Division of General Internal Medicine, University of Colorado School of Medicine
| | - Nee-Kofi Mould-Millman
- Associate Professor, Department of Emergency Medicine, University of Colorado School of Medicine
| | - Amanda F Dempsey
- Professor, Department of Pediatrics, University of Colorado Anschutz Medical Campus
| | - Nilam J Soni
- Professor, Division of Pulmonary and Critical Care Medicine and Division of General and Hospital Medicine, University of Texas Health San Antonio, Section of Hospital Medicine, South Texas Veterans Health Care System
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The Role of Imaging in the Management of Suspected or Known COVID-19 Pneumonia. A Multidisciplinary Perspective. Ann Am Thorac Soc 2020; 17:1358-1365. [PMID: 33124905 DOI: 10.1513/annalsats.202006-600fr] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease (COVID-19) is an illness caused by a novel coronavirus that has rapidly escalated into a global pandemic leading to an urgent medical effort to better characterize this disease biologically, clinically, and by imaging. In this review, we present the current approach to imaging of COVID-19 pneumonia. We focus on the appropriate use of thoracic imaging modalities to guide clinical management. We also describe radiologic findings that are considered typical, atypical, and generally not compatible with COVID-19. Furthermore, we review imaging examples of COVID-19 imaging mimics, such as organizing pneumonia, eosinophilic pneumonia, and other viral infections.
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60
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Maw A, Ortiz-Lopez C, Morris M, Jones CD, Gee E, Tchernodrinski S, Kramer HR, Galen B, Dempsey A, Soni NJ. Hospitalist Perspectives of Available Tests to Monitor Volume Status in Patients With Heart Failure: A Qualitative Study. Cureus 2020; 12:e8844. [PMID: 32617243 PMCID: PMC7325405 DOI: 10.7759/cureus.8844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute decompensated heart failure is the leading admitting diagnosis in patients 65 years and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in five geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.
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Affiliation(s)
- Anna Maw
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Megan Morris
- Family Medicine, University of Colorado, Denver, USA
| | | | - Elaine Gee
- Medicine, Weill Cornell Medical College, New York, USA
| | | | | | | | | | - Nilam J Soni
- Medicine, University of Texas Health San Antonio, San Antonio, USA.,Medicine, South Texas Veterans Health Care System, San Antonio, USA
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61
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Wong J, Montague S, Wallace P, Negishi K, Liteplo A, Ringrose J, Dversdal R, Buchanan B, Desy J, Ma IWY. Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. Ultrasound J 2020; 12:19. [PMID: 32307598 PMCID: PMC7167384 DOI: 10.1186/s13089-020-00167-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Point-of-care ultrasound (POCUS) is increasingly used in internal medicine, but a lack of trained faculty continues to limit the spread of POCUS education. Using a framework based on organizational change theories, this study sought to identify barriers and enablers for hospital-based practicing internists to learn and use POCUS in clinical practice. Methods We invited practicing internists at six North American institutions to participate in an electronic survey on their opinions regarding 39 barriers and enablers. Results Of the 342 participants invited, 170 participated (response rate 49.3%). The top barriers were lack of training (79%), lack of handheld ultrasound devices (78%), lack of direct supervision (65%), lack of time to perform POCUS during rounds (65%), and lack of quality assurance processes (53%). The majority of participants (55%) disagreed or strongly disagreed with the statement “My institution provides funding for POCUS training.” In general, participants’ attitudes towards POCUS were favourable, and future career opportunities and the potential for billing were not considered significant factors by our participants in the decision to learn or use POCUS. Conclusions This survey confirms the perceived importance of POCUS to practicing internists. To assist in closing faculty development gap, interventions should address training, supervision, quality assurance processes, availability of handheld devices, as well as dedicated time to perform POCUS during clinical care.
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Affiliation(s)
- Jonathan Wong
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Steven Montague
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Paul Wallace
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kay Negishi
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Liteplo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Ringrose
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Renee Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Brian Buchanan
- Department of Critical Care, University of Alberta, Edmonton, AB, Canada
| | - Janeve Desy
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Irene W Y Ma
- Department of Medicine, Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
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Glogoza M, Urbach J, Rosborough TK, Olet S, St Hill CA, Smith CS, Tierney DM. Tablet vs. station-based laptop ultrasound devices increases internal medicine resident point-of-care ultrasound performance: a prospective cohort study. Ultrasound J 2020; 12:18. [PMID: 32300979 PMCID: PMC7163000 DOI: 10.1186/s13089-020-00165-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is becoming an important part of internal medicine (IM) residency training. Achieving competency requires performing a large volume of clinical exams which can be difficult within the constraints of residency. Often-cited barriers include insufficient resident time and the interruption of daily workflow. Despite availability of hospital station-based laptop ultrasound machines, we hypothesized that the addition of ward team-based tablet ultrasound devices would lower barriers and increase clinical POCUS volume within an IM residency POCUS curriculum at a 670-bed, quaternary care, teaching hospital. IM resident POCUS volumes and characteristics during an 18-mo. baseline (station-based laptop devices only) period were compared to matched months during the intervention (station-based + tablet). Results Total patients examined with POCUS by 6 inpatient resident teams during the 18-mo. baseline and intervention periods were 1386 and 1853, respectively. Patients examined per month increased during the intervention by 34% (77 vs. 103, p = 0.002). The number of areas (e.g., abdominal, cardiac) and items (e.g., bladder, pericardial effusion) examined per month increased by 27% (p = 0.021) and 23% (p = 0.073), respectively. Conclusions A combined program infrastructure of station-based laptop and “in-the-pocket” tablet ultrasound devices lowered common POCUS barriers of inadequate time and workflow disruption for IM residents and resulted in a meaningful increase of exams within a longitudinal residency-based training program where station-based laptop devices already existed.
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Affiliation(s)
- Matt Glogoza
- Department of Graduate Medical Education #11135, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA
| | - Jonathan Urbach
- Department of Graduate Medical Education #11135, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA
| | - Terry K Rosborough
- Department of Graduate Medical Education #11135, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA
| | - Susan Olet
- Clinical Research Informatics and Analytics, Allina Health, Minneapolis, MN, USA
| | | | - Claire S Smith
- Department of Care Delivery Research, Allina Health, Minneapolis, MN, USA
| | - David M Tierney
- Department of Graduate Medical Education #11135, Abbott Northwestern Hospital, 800 E. 28th Street, Minneapolis, MN, 55407, USA.
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Ma IWY. Consensus-Based Expert Development of Critical Items for Direct Observation of Point-of-Care Ultrasound Skills. J Grad Med Educ 2020; 12:176-184. [PMID: 32322351 PMCID: PMC7161337 DOI: 10.4300/jgme-d-19-00531.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly used in a number of medical specialties. To support competency-based POCUS education, workplace-based assessments are essential. OBJECTIVE We developed a consensus-based assessment tool for POCUS skills and determined which items are critical for competence. We then performed standards setting to set cut scores for the tool. METHODS Using a modified Delphi technique, 25 experts voted on 32 items over 3 rounds between August and December 2016. Consensus was defined as agreement by at least 80% of the experts. Twelve experts then performed 3 rounds of a standards setting procedure in March 2017 to establish cut scores. RESULTS Experts reached consensus for 31 items to include in the tool. Experts reached consensus that 16 of those items were critically important. A final cut score for the tool was established at 65.2% (SD 17.0%). Cut scores for critical items are significantly higher than those for noncritical items (76.5% ± SD 12.4% versus 53.1% ± SD 12.2%, P < .0001). CONCLUSIONS We reached consensus on a 31-item workplace-based assessment tool for identifying competence in POCUS. Of those items, 16 were considered critically important. Their importance is further supported by higher cut scores compared with noncritical items.
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Blaivas M, Arntfield R, White M. DIY AI, deep learning network development for automated image classification in a point-of-care ultrasound quality assurance program. J Am Coll Emerg Physicians Open 2020; 1:124-131. [PMID: 33000024 PMCID: PMC7493582 DOI: 10.1002/emp2.12018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/01/2019] [Accepted: 01/13/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) is increasingly a part of daily life and offers great possibilities to enrich health care. Imaging applications of AI have been mostly developed by large, well-funded companies and currently are inaccessible to the comparatively small market of point-of-care ultrasound (POCUS) programs. Given this absence of commercial solutions, we sought to create and test a do-it-yourself (DIY) deep learning algorithm to classify ultrasound images to enhance the quality assurance work-flow for POCUS programs. METHODS We created a convolutional neural network using publicly available software tools and pre-existing convolutional neural network architecture. The convolutional neural network was subsequently trained using ultrasound images from seven ultrasound exam types: pelvis, heart, lung, abdomen, musculoskeletal, ocular, and central vascular access from 189 publicly available POCUS videos. Approximately 121,000 individual images were extracted from the videos, 80% were used for model training and 10% each for cross validation and testing. We then tested the algorithm for accuracy against a set of 160 randomly extracted ultrasound frames from ultrasound videos not previously used for training and that were performed on different ultrasound equipment. Three POCUS experts blindly categorized the 160 random images, and results were compared to the convolutional neural network algorithm. Descriptive statistics and Krippendorff alpha reliability estimates were calculated. RESULTS The cross validation of the convolutional neural network approached 99% for accuracy. The algorithm accurately classified 98% of the test ultrasound images. In the new POCUS program simulation phase, the algorithm accurately classified 70% of 160 new images for moderate correlation with the ground truth, α = 0.64. The three blinded POCUS experts correctly classified 93%, 94%, and 98% of the images, respectively. There was excellent agreement among the experts with α = 0.87. Agreement between experts and algorithm was good with α = 0.74. The most common error was misclassifying musculoskeletal images for both the algorithm (40%) and POCUS experts (40.6%). The algorithm took 7 minutes 45 seconds to review and classify the new 160 images. The 3 expert reviewers took 27, 32, and 45 minutes to classify the images, respectively. CONCLUSIONS Our algorithm accurately classified 98% of new images, by body scan area, related to its training pool, simulating POCUS program workflow. Performance was diminished with exam images from an unrelated image pool and ultrasound equipment, suggesting additional images and convolutional neural network training are necessary for fine tuning when using across different POCUS programs. The algorithm showed theoretical potential to improve workflow for POCUS program directors, if fully implemented. The implications of our DIY AI for POCUS are scalable and further work to maximize the collaboration between AI and POCUS programs is warranted.
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Affiliation(s)
- Michael Blaivas
- Department of MedicineDepartment of Emergency MedicineUniversity of South Carolina School of MedicineSt. Francis HospitalColumbusGeorgia
| | | | - Matthew White
- Department of Critical Care MedicineWestern UniversityOntario
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Wyman MF, Yocum MD, Schnobrich DJ. Fulfilling the Potential of Point-of-Care Ultrasound in Hospital Medicine. J Hosp Med 2020; 15:190-191. [PMID: 32155409 DOI: 10.12788/jhm.3384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Molly F Wyman
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Matthew D Yocum
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
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Kelleher M, Kinnear B, Olson A. Clinical Progress Note: Point-of-Care Ultrasound in the Evaluation of the Dyspneic Adult. J Hosp Med 2020; 15:173-175. [PMID: 31869295 DOI: 10.12788/jhm.3340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Matthew Kelleher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew Olson
- Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
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67
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Kinnear B, Kelleher M, Chorny V. Clinical Progress Note: Point-of-Care Ultrasound for the Pediatric Hospitalist. J Hosp Med 2020; 15:170-172. [PMID: 31891559 DOI: 10.12788/jhm.3325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/30/2019] [Accepted: 09/04/2019] [Indexed: 01/24/2023]
Affiliation(s)
- Benjamin Kinnear
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Matthew Kelleher
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Valeriy Chorny
- Department of Pediatrics, SUNY Downstate and Kings County Hospital Center, Brooklyn, New York
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68
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Fox S, Fleshner M, Flanagan C, Robertson T, Fujita AW, Bhamidipati D, Sindi A, Purushothaman R, Bui T. Developing and Evaluating a Remote Quality Assurance System for Point-of-Care Ultrasound for an Internal Medicine Residency Global Health Track. POCUS JOURNAL 2020; 5:46-54. [PMID: 36896436 PMCID: PMC9979927 DOI: 10.24908/pocus.v5i2.14433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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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Affiliation(s)
- Steven Fox
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Michelle Fleshner
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Collin Flanagan
- Allegheny General Hospital, Internal Medicine Pittsburgh, PA
| | | | - Ayako Wendy Fujita
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Divya Bhamidipati
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
| | - Abdulrahman Sindi
- Department of Emergency Medicine, King Abdulaziz University Jeddah Saudi Arabia
| | | | - Thuy Bui
- Internal Medicine, University of Pittsburgh Medical Center, Presbyterian Pittsburgh, PA
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69
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LoPresti CM, Jensen TP, Dversdal RK, Astiz DJ. Point-of-Care Ultrasound for Internal Medicine Residency Training: A Position Statement from the Alliance of Academic Internal Medicine. Am J Med 2019; 132:1356-1360. [PMID: 31400298 DOI: 10.1016/j.amjmed.2019.07.019] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Charles M LoPresti
- Section of Acute Care Medicine, Department of Medicine, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Trevor P Jensen
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Renee K Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Donna J Astiz
- Atlantic Health, Department of Medicine, Morristown Medical Center, Morristown, New Jersey
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70
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Olszynski P, Kim DJ, Ma IWY, Clunie M, Lambos P, Guzowski T, Butz M, Thoma B. The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan. Ultrasound J 2019; 11:28. [PMID: 31624937 PMCID: PMC6797680 DOI: 10.1186/s13089-019-0142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards. METHODS A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan's annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system. RESULTS The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents. CONCLUSION The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.
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Affiliation(s)
- Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michelle Clunie
- Department of Anesthesia and Perioperative Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Peggy Lambos
- Department of Pediatrics, University of Saskatchewan, Prince Albert, Canada
| | - Tom Guzowski
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Matthew Butz
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
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71
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Fong TC, Auerbach AD. Ultrasound Guidance for Lumbar Puncture: A Consideration, Not an Obligation. J Hosp Med 2019; 14:636-637. [PMID: 31251155 DOI: 10.12788/jhm.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Tiffany C Fong
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew D Auerbach
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, California
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72
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Soni NJ, Franco-Sadud R, Kobaidze K, Schnobrich D, Salame G, Lenchus J, Kalidindi V, Mader MJ, Haro EK, Dancel R, Cho J, Grikis L, Lucas BP. Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:591-601. [PMID: 31251163 PMCID: PMC6817310 DOI: 10.12788/jhm.3197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
When ultrasound equipment is available, along with providers who are appropriately trained to use it, we recommend that ultrasound guidance should be used for site selection of lumbar puncture to reduce the number of needle insertion attempts and needle redirections and increase the overall procedure success rates, especially in patients who are obese or have difficult-to-palpate landmarks. We recommend that ultrasound should be used to more accurately identify the lumbar spine level than physical examination in both obese and nonobese patients. We suggest using ultrasound for selecting and marking a needle insertion site just before performing lumbar puncture in either a lateral decubitus or sitting position. The patient should remain in the same position after marking the needle insertion site. We recommend that a low-frequency transducer, preferably a curvilinear array transducer, should be used to evaluate the lumbar spine and mark a needle insertion site. A high-frequency linear array transducer may be used in nonobese patients. We recommend that ultrasound should be used to map the lumbar spine, starting at the level of the sacrum and sliding the transducer cephalad, sequentially identifying the lumbar spine interspaces. We recommend that ultrasound should be used in a transverse plane to mark the midline of the lumbar spine and in a longitudinal plane to mark the interspinous spaces. The intersection of these two lines marks the needle insertion site. We recommend that ultrasound should be used during a preprocedural evaluation to measure the distance from the skin surface to the ligamentum flavum from a longitudinal paramedian view to estimate the needle insertion depth and ensure that a spinal needle of adequate length is used. We recommend that novices should undergo simulation-based training, where available, before attempting ultrasound-guided lumbar puncture on actual patients. We recommend that training in ultrasound-guided lumbar puncture should be adapted based on prior ultrasound experience, as learning curves will vary. We recommend that novice providers should be supervised when performing ultrasound-guided lumbar puncture before performing the procedure independently on patients.
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Affiliation(s)
- Nilam J Soni
- Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
- Corresponding Author: Nilam J Soni, MD, MSc; E-mail: ; Telephone: 210-743-6030
| | - Ricardo Franco-Sadud
- Division of Hospital Medicine, Naples Community Hospital, Naples, Florida
- Department of Medicine, University of Central Florida College of Medicine, Orlando, Florida
| | - Ketino Kobaidze
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta,
Georgia
| | - Daniel Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Gerard Salame
- Division of Hospital Medicine, University of Colorado and Denver Health and Hospital Authority, Denver, Colorado
| | - Joshua Lenchus
- Division of Hospital Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Michael J Mader
- Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Elizabeth K Haro
- Division of General and Hospital Medicine, University of Texas Health San Antonio, San Antonio, Texas
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas
| | - Ria Dancel
- Division of Hospital Medicine, University of North Carolina, Chapel Hill, North Carolina
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente Medical Center, San Francisco, California
| | - Loretta Grikis
- White River Junction VA Medical Center, White River Junction, Vermont
| | | | - Brian P Lucas
- Medicine Service, White River Junction VA Medical Center, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
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73
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Ambasta A, Balan M, Mayette M, Goffi A, Mulvagh S, Buchanan B, Montague S, Ruzycki S, Ma IWY. Education Indicators for Internal Medicine Point-of-Care Ultrasound: a Consensus Report from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2019; 34:2123-2129. [PMID: 31240603 PMCID: PMC6816798 DOI: 10.1007/s11606-019-05124-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 02/06/2019] [Accepted: 04/19/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Curriculum development and implementation for internal medicine point-of-care ultrasound (IM POCUS) continues to be a challenge for many residency training programs. Education indicators may provide a useful framework to support curriculum development and implementation efforts across programs in order to achieve a consistent high-quality educational experience. OBJECTIVE This study seeks to establish consensus-based recommendations for education indicators for IM POCUS training programs in Canada. DESIGN This consensus study uses a modified nominal group technique for voting in the initial round, followed by two additional rounds of online voting, with consensus defined as agreement by at least 80% of the participants. PARTICIPANTS Participants were 22 leaders with POCUS and/or education expertise from 13 Canadian internal medicine residency programs across 7 provinces. MAIN MEASURES Education indicators considered were those that related to aspects of the POCUS educational system, could be presented by a single statistical measure, were readily understood, could be reliably measured to provide a benchmark for measuring change, and represented a policy issue. We excluded a priori indicators with low feasibility, are impractical, or assess learner reactions. Candidate indicators were drafted by two academic internists with post-graduate training in POCUS and medical education. These indicators were reviewed by two internists with training in quality improvement prior to presentation to the expert participants. KEY RESULTS Of the 52 candidate education indicators considered, 6 reached consensus in the first round, 12 in the second, and 4 in the third round. Only 5 indicators reached consensus to be excluded; the remaining indicators did not reach consensus. CONCLUSIONS The Canadian Internal Medicine Ultrasound (CIMUS) group recommends 22 education indicators be used to guide and monitor internal medicine POCUS curriculum development efforts in Canada.
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Affiliation(s)
- Anshula Ambasta
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marko Balan
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
| | - Michael Mayette
- Internal Medicine and Critical Care Medicine Division, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharon Mulvagh
- Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian Buchanan
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Steven Montague
- Division of General Internal Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Shannon Ruzycki
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Irene W Y Ma
- Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada.
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74
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LoPresti CM, Boyd JS, Schott C, Core M, Lucas BP, Colon-Molero A, Kessler C, Mader MJ, Haro EK, Finley EP, Restrepo MI, Pugh J, Soni NJ. A National Needs Assessment of Point-of-Care Ultrasound Training for Hospitalists. Mayo Clin Proc 2019; 94:1910-1912. [PMID: 31486389 DOI: 10.1016/j.mayocp.2019.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jeremy S Boyd
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN; Department of Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
| | - Christopher Schott
- Critical Care Service, Veterans Affairs Pittsburgh Health Care Systems, PA; Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, PA
| | - Megan Core
- Department of Emergency Medicine Service, Orlando Veterans Affairs Medical Center, FL; Department of Medicine, University of Central Florida College of Medicine, Orlando, FL
| | - Brian P Lucas
- Medicine Service, White River Junction Veterans Affairs Medical Center, VT; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Angel Colon-Molero
- Veterans Health Administration Specialty Care Service, Veterans Affairs Central Office, Washington, DC
| | - Chad Kessler
- Department of Medicine, Duke University School of Medicine, Durham, NC; Primary Care Service, Durham Veterans Affairs Health Care System, NC
| | - Michael J Mader
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
| | - Erin P Finley
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
| | - Marcos I Restrepo
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
| | - Jacqueline Pugh
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
| | - Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio; Department of Medicine, UT Health San Antonio, TX
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75
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Hopkins A, Doniger SJ. Point-of-Care Ultrasound for the Pediatric Hospitalist's Practice. Hosp Pediatr 2019; 9:707-718. [PMID: 31405888 DOI: 10.1542/hpeds.2018-0118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.
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Affiliation(s)
- Akshata Hopkins
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
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76
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Using point-of-care ultrasound: Shock. JAAPA 2019; 32:43-48. [PMID: 31348101 DOI: 10.1097/01.jaa.0000569796.06694.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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77
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Koratala A, Segal MS, Kazory A. Integrating Point-of-Care Ultrasonography Into Nephrology Fellowship Training: A Model Curriculum. Am J Kidney Dis 2019; 74:1-5. [PMID: 30910369 DOI: 10.1053/j.ajkd.2019.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/11/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Abhilash Koratala
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL.
| | - Mark S Segal
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL
| | - Amir Kazory
- Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL
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