Developing a Longitudinal Point-of-Care Ultrasound (POCUS) Curriculum for Internal Medicine Residents

TL;DR

This paper describes a POCUS curriculum for internal medicine residents, showing improved confidence but low completion due to time and equipment barriers.

Contribution

A multimodal, longitudinal POCUS curriculum for internal medicine residents with evaluation of its feasibility and effectiveness.

Findings

Only 11% of participants completed the POCUS curriculum, with significant confidence improvements in cardiac and volume assessments.

In-person didactics and independent scanning were rated as the most effective learning methods.

Barriers included time constraints, inconsistent equipment access, and variability in supervising residents' POCUS experience.

Abstract

Introduction

Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable tool, enhancing diagnostic accuracy and reducing complications. Despite these benefits, barriers such as limited faculty training, equipment access, and time constraints hinder POCUS integration into internal medicine programs. We evaluated the feasibility of a multimodal, longitudinal ultrasound curriculum designed for internal medicine residents.

Methods

The POCUS Training Program (PTP) was implemented in an internal medicine residency program at a quaternary care center. This longitudinal curriculum comprised self-directed online modules, faculty-led didactic and scanning sessions, and the compilation of a portfolio. Program effectiveness was assessed through pre- and post-program surveys with five-point Likert scales measuring confidence with image acquisition and interpretation.

Results

Among the 50 initial program enrollees for the 2021-2022 academic year, only nine completed the curriculum, with two meeting full requirements including completing the image portfolio. Post-program surveys responses (derived from 11 respondents among 96 total program participants at the end of 2023, 11% response rate) indicated significant improvements in confidence with the cardiac and volume assessments. In-person didactics and independent scanning were rated as the most effective learning modalities. Time constraints, inconsistent equipment access, and POCUS experience variability among supervising senior residents and attendings were the most commonly cited barriers. Suggestions for improvement included more supervised image reviews, patient scanning sessions, and streamlined image-saving workflows.

Discussion

We demonstrated that implementing a longitudinal POCUS curriculum can be challenging with low completion rates for the full program, but such a curriculum has the potential to improve confidence with POCUS exams. Addressing barriers, including equipment accessibility and faculty training, is paramount. Integrating POCUS into core residency curricula and increasing faculty development may also improve efficacy. This pilot program serves as a scaffold for future iterations.