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Education, Teaching, and Quality Improvement |

Creation and Evaluation of a Novel Point-of-Care Ultrasound Program for Internal Medicine Residents

Matthew Moll, MD; Andrew Camerato; Gopal Yadavalli; Frank Schembri
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Boston University, Boston, MA


Chest. 2015;148(4_MeetingAbstracts):464A. doi:10.1378/chest.2246440
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Abstract

SESSION TITLE: Education and Simulation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Point-of-care (POC) ultrasound is a powerful diagnostic tool that extends the physical exam and aids in the safe performance of procedures. A growing number of internal medicine (IM) residency programs have implemented ultrasound curricula, but it is unclear what content should be included and what impact they ultimately have on incorporation of ultrasound into direct patient care.

METHODS: A 1-week POC ultrasound course was developed based on the American College of Chest Physicians (ACCP) Statement on Competence in Critical Care Ultrasonography, a previously described IM ultrasound curriculum, and an internal needs-assessment survey. Twenty-one residents enrolled in an immersive ultrasound course employing a variety of teaching methods including pre-and post-tests, didactics, simulation and direct patient scanning. Ultrasound use, comfort level and objective knowledge were assessed before teaching, immediately after, and 6 months later.

RESULTS: IM residents were most interested in learning ultrasound-guided venous access, lung ultrasound, cardiac ECHO, and assessing IVC size for volume status; they were least interested in learning abdominal ultrasound and DVT studies. Immediate post-course testing showed improved objective ultrasound knowledge across multiple areas including cardiac, lung/pleural, abdominal, and vascular (all p<0.01), and this was sustained at 6 months (all p<0.05). Additionally, at 6 months, ultrasound usage and comfort levels for both diagnostic and procedural purposes increased significantly (p <0.05) and residents indicated that POC ultrasound changed their clinical practice.

CONCLUSIONS: A 1-week ultrasound course based on ACCP guidelines led to immediate and sustained improvements in ultrasound knowledge, comfort level, and usage for IM residents.

CLINICAL IMPLICATIONS: While internists are increasingly being trained in POC ultrasound, it is important to ensure standardization and competency. Until competency guidelines for POC ultrasound are developed for internists, the ACCP guidelines can serve as a guide for curricular development. This is the first study to assess the changes in practice after a structured ultrasound curriculum for IM residents. Future research assessing how bedside ultrasonography affects clinical practice and patient outcomes amongst IM residents is warranted.

DISCLOSURE: The following authors have nothing to disclose: Matthew Moll, Andrew Camerato, Gopal Yadavalli, Frank Schembri

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