Implementation of a Longitudinal POCUS Curriculum in the Core Internal Medicine Residency Program at Dalhousie University

Main Article Content

Whitney Faiella
Allen Tran
Simon Houston
Ashley Miller
Chris Gray
Alex Nelson
Brent Culligan
Ciorsti MacIntyre
Kim Styles
Sarah Ramer
Babar Haroon
Marko Balan
Nabha Shetty
Ian Epstein
Christine Short
Sharon Mulvagh

Point-of-care ultrasound, standardized curriculum, residency programs

Abstract

Background
Point-of-care ultrasound (POCUS) has become a useful diagnostic tool across multiple specialties. However, no standardized curriculum is currently in place for Canadian Internal Medicine (IM) residency programs. This report aims to describe the development of a longitudinal POCUS curriculum at Dalhousie University and reports on resident knowledge, confidence, and perceived clinical utility of POCUS also.
Methods
Residents in the core IM program were invited to complete a POCUS survey and knowledge test in December 2019. The survey evaluated self-reported confidence in acquired POCUS skills and clinical use in practice, whereas the knowledge test evaluated image interpretation skills.
Results
A total of 34/45 (75.6%) residents participated, who agreed that POCUS training should be a formal component of residency (4.56 ± 0.56). Scores on the knowledge test improved based on time spent in the curriculum, with postgraduate year (PGY) 1s scoring an average of 70.0% (21/30) and PGY3s 82.8% (24.9/30; P = 0.02). Residents reported the strongest confidence in lung imaging for detecting A and B lines (4.10 ± 0.79), pleural effusions (3.92 ± 0.90), and lung sliding (3.89 ± 0.92).
Conclusion
Dalhousie University is among the first IM programs in Canada to implement a formal longitudinal POCUS curriculum, which has enabled the incremental acquisition of POCUS knowledge, confidence, and clinical utility amongst residents.


Résumé
Contexte
L’échographie au point d’intervention (POCUS) est devenue un outil de diagnostic utile dans de multiples spécialités. Toutefois, aucun programme normalisé n’est en place actuellement dans les programmes de résidence en médecine interne au Canada. Ce rapport vise à décrire l’élaboration d’un programme longitudinal sur la POCUS à l’Université Dalhousie et rend compte des connaissances et de l’assurance des résidents relatives à la POCUS et de leur perception quant à son utilité clinique.
Méthodologie
Des résidents du programme de médecine interne tronc commun ont été invités à répondre à un sondage sur la POCUS et à effectuer un test de connaissances en décembre 2019. Le sondage a évalué le degré d’assurance quant aux compétences acquises sur la POCUS et à son utilisation clinique dans la pratique, tandis que le test de connaissances a évalué les compétences en matière d’interprétation des images.
Résultats
Au total, 34 des 45 résidents ayant participé au sondage (75,6 %) sont d’avis que la formation sur la POCUS devrait être une composante officielle de la résidence (4,56 ± 0,56). Les scores du test de connaissances s’améliorent en fonction du temps passé dans le programme, le score des résidents de première année d’études postdoctorales (PGY-1) étant de 70,0 % (21/30) en moyenne et celui des résidents de troisième année (PGY-3) de 82,8 % (24,9/30; P = 0,02). Les résidents mentionnent faire preuve de la meilleure assurance en matière d’imagerie pulmonaire dans la détection des lignes A et B (4,10 ± 0,79), des épanchements pleuraux (3,92 ± 0,90) et des glissements pulmonaires (3,89 ± 0,92).
Conclusion
L’Université Dalhousie figure parmi les premiers programmes de médecine interne au Canada à mettre en œuvre un programme longitudinal officiel sur la POCUS, ce qui a permis l’acquisition progressive parmi les résidents des connaissances et de l’assurance relatives à la POCUS et de l’utilité clinique de cet outil de diagnostic.

Abstract 221 | pdf Downloads 53 html Downloads 18

References

1. Moore C, Copel J. Point-of-care ultrasonography. N Engl J Med 2011;364(8):749–57.
2. Smallwood N, Dachsel M. Point-of-care ultrasound (POCUS): unnecessary gadgetry of evidence-based medicine? Clin Med 2018; 18(3):219–224.
3. American College of Physicians. ACP statement in support of point-of-care ultrasound in internal medicine [Internet]. Available from: https://www.acponline.org/meetings-courses/focused-topics/point-of-care-ultrasound-pocus-for-internal-medicine/acp-statement-in-support-of-point-of-care-ultrasound-in-internal-medicine
4. Bhagra A, Tierney D, Sekiguchi H, et al. Point-of-care ultrasonography
for primary care physicians and general internists. Mayo Clin Proc 2016;91(12):1811–27.
5. Zanobetti M, Scorpiniti M, Gigl C, et al. Point-of-care ultrasonography for evaluation of acute dyspnea in the ED. Chest 2017; 151(6):1295–301.
6. Mulvagh S, Bhagra A, Nelson B, et al. Handheld ultrasound devices and the training conundrum: how to get to “seeing is believing”. J Am Soc Echocardiogr 2014; 27(3):310–13.
7. Havelock T, Teoh R, Laws D, et al. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline. Thorax 2010;65(S2):i61–76.
8. Nazeer S, Dewbre H, Miller A. Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Am J Emerg Med 2005; 23(3):363–7.
9. Jones P, Moyers J, Rogers J, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003; 123(2):418–23.
10. Patel P, Ernst F, Gunnarsson C. Evaluation of hospital complications and costs associated with using ultrasound guidance during abdominal paracentesis procedures. J Med Econ 2012; 15(1):1–7.
11. Wilkinson J, Barake W, Smith C, et al. Limitations of condensed teaching strategies to develop hand-held cardiac ultrasonography skills in internal medicine residents. Can J Cardiol 2016; 32:1034–7.
12. Cawthorn T, Nickel C, O’Reilly M, et al. Development and evaluation of methodologies for teaching focused cardiac ultrasound skills to medical students. J Am Soc Echocardiogr 2014; 27(3):302–9.
13. Johri A, Durbin J, Newbigging J, et al. Cardiac point-of-care ultrasound: state-of-the-art in medical school education. J Am Soc Echocardiogr 2018;31(7):749–60.
14. Schnobrich D, Gladding S, Olson A, et al. Point-of-care ultrasound in internal medicine: a National Survey of Educational Leadership. J Grad Med Educ 2013; 5(3):498–502.
15. Peh W, Kang M. A pilot survey on an understanding of point of care bedside ultrasound (POCUS) among medical doctors in internal medicine: exposure,
perceptions, interest and barriers to training. Proc Singapore Healthc 2018; 27(2):85–95.
16. Ailon J, Mourad O, Nadjafi M, et al. Point of care ultrasound as a competency
for general internists: a survey of internal medicine training programs in Canada. Can Med Educ J 2016; 7(2):e51–69.
17. Wong J, Montague S, Wallace P, et al. Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions. J Ultrasound 2020; 12(19):1-7.
18. Ma I, Arlshenkoff S, Wiseman J, et al. Internal medicine point-of-care ultrasound curriculum: consensus recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. J Gen Intern Med 2017; 32(9):1052–57.
19. Ambasta A, Balan M, Mayette M, et al. 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; 34:2123–9.
20. Lewis K, Martin L, Mazzetti A, et al. Implementation of a progressive three-year point of care ultrasound curriculum forinternal medicine residents; Can J Gen Intern Med 2018; 13(1):41–9.
21. Kugler J. Point-of-Care ultrasound in internal medicine: challenges and opportunities for expanding use. South Med J 2016; 109(12):750–3.
22. Kelm D, Ratelle J, Azeem N, et al. Longitudinal ultrasound curriculum improves long-term retention among internal medicine residents. J Grad Med Educ 2015; 7(3):454–57.
23. Kimura B, Sliman S, Waalen J, et al. Retention of ultrasound skills and training in “point-of-care” cardiac ultrasound. J Am Soc Echocardiogr 2016;29(10):992–7.
24. Mourad M, Ranji S, Sliwka D. A randomized controlled trial of the impact of a teaching procedure service on the training of internal medicine residents. J Grad Med Educ 2012; 4(2):170–5.
25. Clay R, Lee E, Kurtzman M, et al. Teaching the internist to see: effectiveness of a 1-day workshop in bedside ultrasound for internal medicine residents. Crit Ultrasound J 2016; 8(1):1–6.
26. Eisen L, Leung S, Gallagher A, et al. Barriers to ultrasound training in critical care medicine fellowships: a survey of program directors. Crit Care Med
2010; 38(10):978–3.
27. Royal College of Physicians and Surgeons of Canada. Competency by Design [Internet]. Available from: http://www.royalcollege.ca/rcsite/cbd/competence-by-design-cbd-e
28. Kirkpatrick J, Grimm R, Johri A, et al. Recommendations for echocardiography laboratories participating in cardiac point of care cardiac ultrasound (POCUS) and critical care echocardiography training: report from the american society of echocardiography; J Am Soc Echocardiogr 2020; 33(4):9–22.
29. American College of Emergency Physicians. Ultrasound Guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine; Ann Emerg Med. 2017; 69:e27–54. x

Most read articles by the same author(s)