1
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Elhassan MG, Grewal S, Nezarat N. Point-of-Care Ultrasonography in Internal Medicine: Limitations and Pitfalls for Novice Users. Cureus 2023; 15:e43655. [PMID: 37600433 PMCID: PMC10436027 DOI: 10.7759/cureus.43655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Abstract
Point-of-care ultrasound (POCUS) is increasingly being adopted in the field of internal medicine, leading to the development of POCUS curricula in undergraduate and postgraduate medical education programs. Prominent internal medicine societies and organizations worldwide recognize the expanding utilization of POCUS by internal medicine physicians, emphasizing the need for practitioners to be aware of both its benefits and limitations. Despite the growing enthusiasm for POCUS, clinicians, particularly those with limited clinical experience, must be cautious regarding its inherent limitations and the potential impact on their clinical practice. This review aims to outline the limitations and potential drawbacks of POCUS for medical students, residents, and internists who wish to stay abreast of the escalating use of POCUS in internal medicine and have a desire, or have already commenced, to incorporate POCUS into their practice. Additionally, it provides recommendations for enhancing POCUS proficiency to mitigate these limitations.
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Affiliation(s)
| | - Sarbjot Grewal
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Negin Nezarat
- Internal Medicine, Saint Agnes Medical Center, Fresno , USA
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2
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A Tool to Assess Competence in Critical Care Ultrasound Based on Entrustable Professional Activities. ATS Sch 2023; 4:61-75. [PMID: 37089679 PMCID: PMC10117444 DOI: 10.34197/ats-scholar.2022-0063oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/09/2022] [Indexed: 01/26/2023] Open
Abstract
Background Existing assessment tools for competence in critical care ultrasound (CCUS) have limited scope and interrupt clinical workflow. The framework of entrustable professional activities (EPAs) is well suited to developing an assessment tool that is comprehensive and readily integrated into the intensive care unit (ICU) training environment. Objective This study sought to design an EPA-based tool to assess competence in CCUS for pulmonary and critical care fellows and to assess the validity and reliability of the tool. Methods Eight experts in CCUS met to define the core EPAs for CCUS. A nominal group technique was used to reach consensus. An assessment tool was created based on the EPAs with a modified Ottawa entrustability scale. Trained faculty evaluated pulmonary and critical care fellows using this tool in the ICU over a 6-month study period at a single institution. An assessment of validity of the EPA-based tool is made with four sources of validity evidence: content, response process, reliability, and relation to other variables. Reliability and response process data were generated using generalizability theory analysis to estimate sources of variance in entrustment scores. Analysis of response process validity and validity by relation to other variables was performed using regression models. Results Fifty-four assessments were recorded during the study period, conducted on 23 trainees by 13 faculty. Content validity of the tool was demonstrated using expert consensus and published guidelines from critical care societies to define the EPAs. Response process validity was demonstrated by the low variance in entrustment scores due to evaluators (0.086 or 6%) and high agreement between score and trainee self-assessment (regression coefficient, 0.82; P < 0.0001). Reliability was demonstrated by the high "true" variance in entrustment score attributable to the trainee: 0.674 or 45%. Validity by relation to other variables was demonstrated using regression analysis to show correlation between entrustment score and the number of times a fellow has performed an EPA (regression coefficient, 0.023; P < 0.0001). Conclusion An EPA-based assessment tool for competence in CCUS was created. We obtained sufficient validity evidence on three of the diagnostic EPAs. Procedural EPAs were infrequently assessed, limiting generalizability in this subgroup.
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3
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Soni NJ, Nathanson R, Andreae M, Khosla R, Vadamalai K, Kode K, Boyd JS, LoPresti CM, Resop D, Basrai Z, Williams J, Bales B, Sauthoff H, Wetherbee E, Haro EK, Smith N, Mader MJ, Pugh J, Finley EP, Schott CK. Development of a multisystem point of care ultrasound skills assessment checklist. Ultrasound J 2022; 14:17. [PMID: 35551527 PMCID: PMC9096739 DOI: 10.1186/s13089-022-00268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Many institutions are training clinicians in point-of-care ultrasound (POCUS), but few POCUS skills checklists have been developed and validated. We developed a consensus-based multispecialty POCUS skills checklist with anchoring references for basic cardiac, lung, abdominal, and vascular ultrasound, and peripheral intravenous line (PIV) insertion. Methods A POCUS expert panel of 14 physicians specializing in emergency, critical care, and internal/hospital medicine participated in a modified-Delphi approach to develop a basic POCUS skills checklist by group consensus. Three rounds of voting were conducted, and consensus was defined by ≥ 80% agreement. Items achieving < 80% consensus were discussed and considered for up to two additional rounds of voting. Results Thirteen POCUS experts (93%) completed all three rounds of voting. Cardiac, lung, abdominal, and vascular ultrasound checklists included probe location and control, basic machine setup, image quality and optimization, and identification of anatomical structures. PIV insertion included additional items for needle tip tracking. During the first round of voting, 136 (82%) items achieved consensus, and after revision and revoting, an additional 21 items achieved consensus. A total of 153 (92%) items were included in the final checklist. Conclusions We have developed a consensus-based, multispecialty POCUS checklist to evaluate skills in image acquisition and anatomy identification for basic cardiac, lung, abdominal, and vascular ultrasound, and PIV insertion. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00268-4.
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Affiliation(s)
- Nilam J Soni
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA. .,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.
| | - Robert Nathanson
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Mark Andreae
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rahul Khosla
- Veterans Affairs Medical Center, Washington, DC, USA.,George Washington University, Washington, DC, USA
| | | | - Karthik Kode
- Department of Medicine, University of Hawai'i at Manoa John A. Burns School of Medicine, Honolulu, HI, USA
| | - Jeremy S Boyd
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Charles M LoPresti
- Medicine Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA.,Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Dana Resop
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA.,Emergency Department, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Zahir Basrai
- Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Jason Williams
- Section of Hospital Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Division of Hospital Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Brian Bales
- Emergency Medicine, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA.,Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harald Sauthoff
- Medicine Service, Veterans Affairs New York Harbor Healthcare System, New York, NY, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Erin Wetherbee
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.,Pulmonary, Critical Care, and Sleep Apnea, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Elizabeth K Haro
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Natalie Smith
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Michael J Mader
- Research Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Jacqueline Pugh
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA
| | - Erin P Finley
- Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 7982, San Antonio, TX, 78229, USA.,Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Christopher K Schott
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Health Care Systems, Pittsburgh, PA, USA
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Lambrecht JE, Zhang K, Tierney DM, Millner P, Giovannini D, Barron K, Novak W, Patel SA, Dversdal R, Cox EJ, LoPresti CM. Integration of Point-of-Care Ultrasound Education Into the Internal Medicine Core Clerkship Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:33-40. [PMID: 33797767 DOI: 10.1002/jum.15702] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Point-of-care ultrasound (POCUS) is becoming an essential skill for internists. To date, there are no professional guidelines for how POCUS skills should be taught to medical students. A panel of POCUS experts from seven academic medical centers in the United States was convened to describe the components of independently developed IM clerkship POCUS training programs, identify areas of similarity and difference, and propose recommendations for alignment.
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Affiliation(s)
| | - Kang Zhang
- University of Washington School of Medicine Spokane Campus, Spokane, Washington, USA
| | - David M Tierney
- Department of Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Millner
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Keith Barron
- Prisma Health Midlands, Columbia, South Carolina, USA
- University of South Carolina School of Medicine, Columbia, South Carolina, USA
| | - William Novak
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Sanjay A Patel
- Division of Hospital Medicine, Cook County Health, Chicago, Illinois, USA
- Rush University Medical School, Chicago, Illinois, USA
| | - Renee Dversdal
- Oregon Health & Science University, Portland, Oregon, USA
| | - Emily J Cox
- Providence Medical Research Center, Spokane, Washington, USA
| | - Charles M LoPresti
- Section of Acute Medicine, Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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5
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Lee WF, Chenkin J. Exploring Eye-tracking Technology as an Assessment Tool for Point-of-care Ultrasound Training. AEM EDUCATION AND TRAINING 2021; 5:e10508. [PMID: 33898911 PMCID: PMC8052995 DOI: 10.1002/aet2.10508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/21/2020] [Accepted: 07/10/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Eye-tracking technology has emerged as a potentially useful learner assessment tool in several medical specialties. In the fields of general surgery and anesthesiology, it has been shown to reliably differentiate between different levels of expertise in procedural skills. In the field of radiology, it has been shown to be a valid assessment tool for diagnostic test interpretation. Current methods of competency assessment in point-of-care ultrasound (POCUS) remain a challenge, because they require significant direct observation time by an instructor. The purpose of this study was to determine if eye-tracking technology can accurately distinguish between novice and experts in the interpretation of POCUS clips, specifically of the focused assessment using sonography in trauma (FAST) scan. METHODS A convenience sample of medical students, residents, and emergency physicians from a single academic emergency department were invited to participate. Participants included both novices and experts in POCUS. Each participant completed a baseline questionnaire and viewed 16 video clips of a FAST ultrasound examination while their gaze patterns were recorded by a commercially available eye-tracking device. The primary outcome was total gaze time on the area of interest (AOI). Secondary outcomes included total time to fixation, mean number of fixations, and mean duration of first fixation on the AOI. RESULTS Fifteen novices and 15 experts completed this study. For total gaze time on the AOI, experts fixated their gaze significantly longer than novices (75.8 ± 16.2 seconds vs. 56.6 ± 12.8 seconds, p = 0.001). Similarly, experts were significantly faster to fixate on the AOI and had a higher fixation count on the AOI (8.5 ± 4.0 seconds vs. 15.1 ± 6.8 seconds, p = 0.003; and 170 ± 30 vs. 143 ± 28 seconds, p = 0.016). There were no differences on the mean duration of first fixation on the AOI (0.42 ± 0.12 seconds vs. 0.39 ± 0.09 seconds, p = 0.467). CONCLUSION Eye-tracking technology shows the potential to differentiate between experts and novices by their gaze patterns on video clips of FAST examinations. The total gaze time on the AOI may be a useful metric to help in the assessment of competency in POCUS image interpretation. In addition, the evaluation of gaze patterns may help educators identify causes of interpretation errors. Future studies are needed to further validate these metrics in a larger cohort.
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Affiliation(s)
- Wei Feng Lee
- Emergency DepartmentSunnybrook Health Sciences CentreTorontoOntarioCanada
- Emergency DepartmentNg Teng Fong General HospitalSingapore
| | - Jordan Chenkin
- Emergency DepartmentSunnybrook Health Sciences CentreTorontoOntarioCanada
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6
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Buesing J, Weng Y, Kugler J, Wang L, Blaha O, Hom J, Ahuja N, Kumar A. Handheld Ultrasound Device Usage and Image Acquisition Ability Among Internal Medicine Trainees: A Randomized Trial. J Grad Med Educ 2021; 13:76-82. [PMID: 33680304 PMCID: PMC7901629 DOI: 10.4300/jgme-d-20-00355.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is insufficient knowledge about how personal access to handheld ultrasound devices (HUDs) improves trainee learning with point-of-care ultrasound (POCUS). OBJECTIVE To assess whether HUDs, alongside a yearlong lecture series, improved trainee POCUS usage and ability to acquire images. METHODS Internal medicine intern physicians (n = 47) at a single institution from 2017 to 2018 were randomized 1:1 to receive personal HUDs (n = 24) for patient care/self-directed learning vs no-HUDs (n = 23). All interns received a repeated lecture series on cardiac, thoracic, and abdominal POCUS. Main outcome measures included self-reported HUD usage rates and post-intervention assessment scores using the Rapid Assessment of Competency in Echocardiography (RACE) scale between HUD and no-HUD groups. RESULTS HUD interns reported performing POCUS assessments on patients a mean 6.8 (SD 2.2) times per week vs 6.4 (SD 2.9) times per week in non-HUD arm (P = .66). There was no relationship between the number of self-reported examinations per week and a trainee's post-intervention RACE score (rho = 0.022, P = .95). HUD interns did not have significantly higher post-intervention RACE scores (median HUD score 17.0 vs no-HUD score 17.8; P = .72). Trainee confidence with cardiac POCUS did not correlate with RACE scores. CONCLUSIONS Personal HUDs without direct supervision did not increase the amount of POCUS usage or improve interns' acquisition abilities. Interns who reported performing more examinations per week did not have higher RACE scores. Improved HUD access and lectures without additional feedback may not improve POCUS mastery.
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7
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Wenger J, Steinbach TC, Carlbom D, Farris RW, Johnson NJ, Town J. Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:443-451. [PMID: 32734612 DOI: 10.1002/jcu.22894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
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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Affiliation(s)
- Jesse Wenger
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Trevor C Steinbach
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - David Carlbom
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Reid Wd Farris
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Nicholas J Johnson
- Department of Emergency Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - James Town
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
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Kim DJ, Thiessen M, Strony R. Point-of-Care Ultrasound Credentialing: Big Picture Principles for Big Health Systems. Jt Comm J Qual Patient Saf 2020; 46:435-437. [DOI: 10.1016/j.jcjq.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
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Haney RM, Halperin M, Diamond E, Ratanski D, Shokoohi H, Huang C, Liteplo AS. Clinical Integration of Point-of-care Ultrasound by Emergency Medicine Residents: A Single-center Mixed-methods Study. AEM EDUCATION AND TRAINING 2020; 4:212-222. [PMID: 32704590 PMCID: PMC7369500 DOI: 10.1002/aet2.10463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) competence consists of image acquisition, image interpretation, and clinical integration. Limited data exist on POCUS usage patterns and clinical integration by emergency medicine (EM) residents. We sought to determine actual POCUS usage and clinical integration patterns by EM residents and to explore residents' perspectives on POCUS clinical integration. METHODS We conducted an explanatory sequential mixed-methods study at a 4-year EM residency program. In phase 1, EM ultrasound (US) attendings observed PGY-4 EM residents' clinical integration of POCUS in real time while on shift in the emergency department (ED). EM US attendings evaluated residents on their intent to perform POCUS, actual POCUS usage, and competence per patient encounter. We used logistic regression to analyze these parameters. In phase 2, we conducted semi-structured interviews with the observed PGY-4 residents regarding POCUS usage and clinical integration in the ED. We analyzed qualitative data for themes. RESULTS Emergency medicine US attendings observed 10 PGY-4 EM residents during 254 high-acuity patient encounters from December 2018 to March 2019. EM US attendings considered POCUS indicated for 26% (66/254) of patients, possibly indicated for 12% (30/254) and not indicated for 62% (158/254). Of the 66 patients for whom EM US attendings considered POCUS indicated, PGY-4s intended to perform POCUS for patient management 61% (40/66) of the time. PGY-4s subsequently incorporated POCUS into patient management 73% (48/66) of the time. EM US attendings considered PGY-4s entrustable to perform POCUS independently 81% (206/254) of the time. We did not find a statistically significant association between shift volume, shift type, or POCUS application, and resident intent to perform POCUS nor competence. Interviews identified three factors that influence PGY-4's POCUS clinical integration: motivations to use POCUS, barriers to utilization, and POCUS educational methods. CONCLUSIONS This mixed-methods study identified a significant gap in POCUS utilization and clinical integration by PGY-4 EM residents for clinically indicated cases identified by EM US attendings. As clinical integration is a cornerstone of POCUS competence, it is important to ensure that EM resident POCUS curricula emphasize training on clinical utilization and indications for POCUS while on shift in the ED.
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Affiliation(s)
- Rachel M. Haney
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- theDepartment of Emergency MedicinePeacehealth Southwest Medical CenterVancouverWAUSA
| | - Michael Halperin
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- Department of Emergency MedicineJacobi/North Central Bronx HospitalsThe BronxNYUSA
| | - Eden Diamond
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Daniel Ratanski
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Hamid Shokoohi
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Calvin Huang
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Andrew S. Liteplo
- Department of Emergency MedicineDivision of Emergency UltrasoundMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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10
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Standardized adult-gerontology acute care nurse practitioner point-of-care ultrasound training: A new perspective in the age of a pandemic. J Am Assoc Nurse Pract 2020; 32:416-418. [PMID: 32511190 DOI: 10.1097/jxx.0000000000000448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.
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11
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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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12
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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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13
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Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, Robison SW, Edwards GG, Lewis MD, Maniaci MJ. A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:935-942. [PMID: 31807108 PMCID: PMC6839571 DOI: 10.2147/amep.s220153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 05/29/2023]
Abstract
PURPOSE Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program. PATIENTS AND METHODS This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment. RESULTS In total, 42 residents consented for participation. The residents' monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not. CONCLUSION A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.
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Affiliation(s)
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jed C Cowdell
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brett T Hiroto
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Monia E Werlang
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah W Robison
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Grace G Edwards
- Department of Education, Mayo Clinic, Jacksonville, FL, USA
- The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michele D Lewis
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Baston CM, Wallace P, Chan W, Dean AJ, Panebianco N. Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point-of-Care Ultrasound Fellowship. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2209-2215. [PMID: 30592332 DOI: 10.1002/jum.14908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Cameron M Baston
- Department of Medicine, Division of Pulmonary and Critical Care, Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paul Wallace
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Wilma Chan
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anthony J Dean
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nova Panebianco
- Division of Emergency Ultrasound, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Goyal A, Garibaldi B, Liu G, Desai S, Manesh R. Morning report innovation: Case Oriented Report and Exam Skills. ACTA ACUST UNITED AC 2019; 6:79-83. [PMID: 30901311 DOI: 10.1515/dx-2018-0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/18/2019] [Indexed: 11/15/2022]
Abstract
Morning report is a valuable educational conference but is often a stand-alone classroom-based discussion which misses the opportunity for bedside education. In this report, we describe an innovative morning report structure - the Case Oriented Report and Exam Skills (CORES) - that addresses this pitfall of the traditional case conference format and brings learners to the bedside. The key components of CORES include highlighting concepts of clinical reasoning, emphasizing evidence-based and hypothesis-driven physical exam (HDPE), and integrating emerging bedside technologies such as point-of-care ultrasound (POCUS).
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Affiliation(s)
- Amit Goyal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gigi Liu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sanjay Desai
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reza Manesh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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16
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Kumar A, Kugler J, Jensen T. Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments. J Gen Intern Med 2019; 34:1025-1031. [PMID: 30924088 PMCID: PMC6544692 DOI: 10.1007/s11606-019-04945-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Point-of-care ultrasonography (POCUS) has the potential to transform healthcare delivery through its diagnostic expediency. Trainee competency with POCUS is now mandated for emergency medicine through the Accreditation Council for Graduate Medical Education (ACGME), and its use is expanding into other medical specialties, including internal medicine. However, a key question remains: how does one define "competency" with this emerging technology? As our trainees become more acquainted with POCUS, it is vital to develop validated methodology for defining and measuring competency amongst inexperienced users. As a framework, the assessment of competency should include evaluations that assess the acquisition and application of POCUS-related knowledge, demonstration of technical skill (e.g., proper probe selection, positioning, and image optimization), and effective integration into routine clinical practice. These assessments can be performed across a variety of settings, including web-based applications, simulators, standardized patients, and real clinical encounters. Several validated assessments regarding POCUS competency have recently been developed, including the Rapid Assessment of Competency in Echocardiography (RACE) or the Assessment of Competency in Thoracic Sonography (ACTS). However, these assessments focus mainly on technical skill and do not expand upon other areas of this framework, which represents a growing need. In this review, we explore the different methodologies for evaluating competency with POCUS as well as discuss current progress in the field of measuring trainee knowledge and technical skill.
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Affiliation(s)
- Andre Kumar
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA.
| | - John Kugler
- Department of Medicine, Stanford University School of Medicine, Pasteur Drive, Stanford, CA, USA
| | - Trevor Jensen
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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17
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Patel SA, Pierko K, Franco-Sadud R. Ultrasound-guided Bedside Core Needle Biopsy: A Hospitalist Procedure Team's Experience. Cureus 2019; 11:e3817. [PMID: 30868031 PMCID: PMC6402864 DOI: 10.7759/cureus.3817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tissue pathology is integral for the diagnosis of various conditions, especially malignancy. Traditionally, biopsy procedures, including core needle biopsy (CNB), are performed by surgeons or radiologists. With the increasing utilization of point of care ultrasound (POCUS) skills and competence in bedside procedures by general internists, CNB can be safely moved to the patient's bedside with maintained accuracy and increased cost savings compared to traditional procedural methods. We aim to review the experience of our hospitalist-run medical procedure service in performing these ultrasound-guided procedures at the bedside.
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Affiliation(s)
- Sanjay A Patel
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Krzysztof Pierko
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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18
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Soni NJ, Schnobrich D, Mathews BK, Tierney DM, Jensen TP, Dancel R, Cho J, Dversdal RK, Mints G, Bhagra A, Reierson K, Kurian LM, Liu GY, Candotti C, Boesch B, LoPresti CM, Lenchus J, Wong T, Johnson G, Maw AM, Franco-Sadud R, Lucas BP. Point-of-Care Ultrasound for Hospitalists: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14:E1-E6. [PMID: 30604779 PMCID: PMC8021128 DOI: 10.12788/jhm.3079] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Many hospitalists incorporate point-of-care ultrasound (POCUS) into their daily practice to answer specific diagnostic questions or to guide performance of invasive bedside procedures. However, standards for hospitalists in POCUS training and assessment are not yet established. Most internal medicine residency training programs, the major pipeline for incoming hospitalists, have only recently begun to incorporate POCUS in their curricula. The purpose of this document is to inform a broad audience on what POCUS is and how hospitalists are using it. This document is intended to provide guidance for the hospitalists who use POCUS and administrators who oversee its use. We discuss POCUS 1) applications, 2) training, 3) assessments, and 4) program management. Practicing hospitalists must continue to collaborate with their local credentialing bodies to outline requirements for POCUS use. Hospitalists should be integrally involved in decision-making processes surrounding POCUS program management.
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Affiliation(s)
- Nilam J Soni
- Division of General and Hospital Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA.
- Section of Hospital Medicine, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Daniel Schnobrich
- Divisions of General Internal Medicine and Hospital Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Benji K Mathews
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - David M Tierney
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Trevor P Jensen
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ria Dancel
- Division of Hospital Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joel Cho
- Department of Hospital Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California; USA
| | - Renee K Dversdal
- Division of Hospital Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Gregory Mints
- Division of Hospital Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kreegan Reierson
- Department of Hospital Medicine, HealthPartners Medical Group, Regions Hospital, St. Paul, Minnesota, USA
| | - Linda M Kurian
- Division of Hospital Medicine, Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York, USA
| | - Gigi Y Liu
- Hospitalist Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Carolina Candotti
- Division of Hospital Medicine, University of California Davis, Davis, California, USA
| | - Brandon Boesch
- Division of Hospital Medicine, Alameda Health System-Highland Hospital, Oakland, California, USA
| | - Charles M LoPresti
- Louis Stokes Cleveland Veterans Affairs Hospital, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Joshua Lenchus
- Division of Hospital Medicine, University of Miami, Miami, Florida, USA
| | - Tanping Wong
- Division of Hospital Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Gordon Johnson
- Division of Hospital Medicine, Legacy Healthcare System, Portland, Oregon, USA
| | - Anna M Maw
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado, USA
| | | | - Brian P Lucas
- White River Junction VA Medical Center, White River Junction, Vermont, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
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