scholarly journals A Call for Point-of-Care Ultrasound Fellowship Training Programs for General Internal Medicine in Canada

2021 ◽  
Vol 16 (2) ◽  
pp. 31-33
Author(s):  
Katie Wiskar ◽  
Irene Ma ◽  
Shane Arishenkoff ◽  
Robert Arntfield
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Fellowship Training ◽  
Medecine Interne ◽  
Point Of Care Ultrasound ◽  
Nous Proposons ◽  
General Internal ◽  
Formation Complémentaire ◽  
Program Creation ◽  
Training Opportunities

Point-of-care ultrasound (POCUS) offers numerous benefits and is recognized as an important competency within Internal Medicine (IM). Despite this, a significant educational gap exists, owing in large part to a lack of expertly trained faculty and structured training opportunities. A robust POCUS training program requires not only technical excellence among faculty but also leadership with expertise in program creation and administration, quality assurance, medical education, and research. A dedicated 6- to 12-month POCUS fellowship model in programs with well-established infrastructure allows for the development of these competencies and the establishment of a network of key POCUS contacts, and prepares trainees to create or expand POCUS programs at their centers. We propose that the expansion of dedicated General IM POCUS fellowships in Canada is imperative to addressing this educational bottleneck and shaping the future leaders of Canadian IM POCUS. RésuméL’échographie au point d’intervention (POCUS) offre de nombreux avantages et est considérée comme une compétence importante en médecine interne. Pourtant, il existe une lacune importante au chapitre de la formation, attribuable en grande partie au manque d’enseignants qualifiés et d’occasions de formation structurée. Un programme de formation solide sur la POCUS exige non seulement une excellence technique parmi le corps professoral, mais aussi un leadership démontrant une expertise dans la création et l’administration de programmes, l’assurance de la qualité, l’éducation médicale et la recherche. Un modèle de formation complémentaire de 6 à 12 mois consacrée à la POCUS dans des programmes dont l’infrastructure est bien établie permet d’acquérir ces compétences et d’établir un réseau de personnes-ressources clés sur la POCUS, et prépare les personnes en cours de formation à créer ou à élargir des programmes sur la POCUS dans leur centre. Nous proposons qu’il soit impératif d’élargir les formations complémentaires sur la POCUS en médecine interne générale au Canada pour remédier à ce goulot d’étranglement en matière de formation et façonner les futurs chefs de file de la POCUS en médecine interne au Canada.

scholarly journals Minimal Criteria for Lung Ultrasonography in Internal Medicine

2021 ◽  
Vol 16 (2) ◽  
pp. 6-13
Author(s):  
Janeve Desy ◽  
Vicki E. Noble ◽  
Andrew S. Liteplo ◽  
Paul Olszynski ◽  
Brian Buchanan ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Online Survey ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Medecine Interne ◽  
Point Of Care Ultrasound ◽  
Clinical Use ◽  
Lung Ultrasonography

BackgroundPoint-of-care lung ultrasound (LUS) examination is increasingly utilized in Internal Medicine. To improve the standardization of LUS education and clinical use, explicit minimal criteria for defining what is an acceptable and clinically useful image are needed.MethodsA 97-item online survey of potential minimal criteria for common uses of LUS in Internal Medicine was developed and sent to 10 international point-of-care ultrasound experts. Their opinion on the inclusion of each item was sought and items not achieving consensus (defined as agreement by at least 70% of the experts) were reassessed in subsequent rounds. A total of three rounds were conducted.ResultsSeventy-four minimal criteria were agreed upon for inclusion, 24 were agreed upon for exclusion, and two did not reach consensus.ConclusionsExperts agreed on 74 minimal criteria for Internal Medicine LUS. The use of these minimal criteria during teaching and clinical use is strongly recommended. RésuméContexteL’échographie pulmonaire au point d’intervention est de plus en plus utilisée en médecine interne. Pour améliorer l’uniformisation de la formation sur l’échographie pulmonaire et de son utilisation clinique, il faut des critères minimaux explicites pour définir ce qu’est une image acceptable et utile sur le plan clinique.MéthodologieUn sondage en ligne de 97 éléments portant sur des critères minimaux possibles dans l’utilisation courante de l’échographie pulmonaire en médecine interne a été élaboré et soumis à 10 experts internationaux en échographie au point d’intervention. Leur avis sur l’inclusion de chaque élément a été sondé, et les éléments pour lesquels il n’y avait pas de consensus (défini par l’accord d’au moins 70 % des experts) ont été réévalués lors de tours suivants. Au total, trois tours ont été effectués.RésultatsSoixante-quatorze critères minimaux ont été acceptés, 24 ont été exclus et deux n’ont pas fait consensus.ConclusionsLes experts se sont entendus sur 74 critères minimaux relatifs à l’échographie pulmonaire en médecine interne. L’utilisation de ces critères minimaux au cours de l’enseignement et de l’utilisation clinique est fortement recommandée.

scholarly journals Point-of-care ultrasound as a competency for general internists: a survey of internal medicine training programs in Canada

2016 ◽  
Vol 7 (2) ◽  
pp. e51-69 ◽  
Author(s):  
Jonathan Ailon ◽  
Maral Nadjafi ◽  
Ophyr Mourad ◽  
Rodrigo Cavalcanti
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Clinical Use ◽  
Internal Medicine Training ◽  
Program Leaders ◽  
University Of Toronto ◽  
General Internal ◽  
General Internists ◽  
The University

Background: Point-of-care ultrasound (POCUS) is increasingly used on General Internal Medicine (GIM) inpatient services, creating a need for defined competencies and formalized training. We evaluated the extent of training in POCUS and the clinical use of POCUS among Canadian GIM residency programs.Method: Internal Medicine trainees and GIM Faculty at the University of Toronto were surveyed on their clinical use of POCUS and the extent of their training. We separately surveyed Canadian IM Program Directors and Division Directors on the extent of POCUS training in their programs, barriers in the implementation of POCUS curricula, and recommendations for POCUS competencies in IM.Results:  A majority of IM trainees (90/118, 76%) and GIM Faculty (15/29, 52%) used POCUS clinically. However, the vast majority of resident (111/117, 95%) and GIM Faculty (18/28, 64%) had received limited training. Of the Program Leaders surveyed, half (9/17, 53%) reported POCUS clinical use by their trainees; however only one quarter (4/16, 25%) reported offering formal curricula. Most respondents agreed that POCUS training should be incorporated into IM residency curricula, specifically for procedural guidance.Conclusions: A considerable discrepancy exists between the clinical use of POCUS and the extent of formal training among Canadian IM residents and GIM Faculty. We propose that formalized POCUS training should be incorporated into IM residency programs, GIM fellowships, and Faculty development sessions, and identify POCUS skills that could be incorporated into future IM curricula.

Implementation of point-of-care testing in a general internal medicine practice: A confirmation study

2017 ◽  
Vol 473 ◽  
pp. 71-74 ◽  
Author(s):  
Elizabeth-Lee Lewandrowski ◽  
Sunu Yeh ◽  
Jason Baron ◽  
J. Benjamin Crocker ◽  
Kent Lewandrowski
Keyword(s):  
Internal Medicine ◽  
General Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
General Internal ◽  
General Internal Medicine Practice

Innovation Through Collaboration: Creation of a Combined Emergency and Internal Medicine Point‐of‐Care Ultrasound Fellowship

2018 ◽  
Vol 38 (8) ◽  
pp. 2209-2215 ◽  
Author(s):  
Cameron M. Baston ◽  
Paul Wallace ◽  
Wilma Chan ◽  
Anthony J. Dean ◽  
Nova Panebianco
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound

Entrusting internal medicine residents to use point of care ultrasound: Towards improved assessment and supervision

2018 ◽  
Vol 40 (11) ◽  
pp. 1130-1135 ◽  
Author(s):  
Daniel J. Schnobrich ◽  
Benji K. Mathews ◽  
Bernard E. Trappey ◽  
Brian K. Muthyala ◽  
Andrew P. J. Olson
Keyword(s):  
Internal Medicine ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Internal Medicine Residents

Response to Letter to the editor: Acute Medicine Journal

2020 ◽  
Vol 19 (1) ◽  
pp. 57-57
Author(s):  
Ben Chadwick ◽  
◽  
Nick Murch ◽  
Anika Wijewardane ◽  
◽  
...  
Keyword(s):  
Internal Medicine ◽  
Acute Care ◽  
Working Group ◽  
Point Of Care ◽  
Early Years ◽  
Point Of Care Ultrasound ◽  
Acute Medicine ◽  
Front Door ◽  
Medicine Journal ◽  
Wide Range

Editor- Thank you for giving us the opportunity to respond to the letter received regarding the Joint Royal College of Physicians Training Board (JRCPTB) curriculum for Acute Internal Medicine (AIM) that has previously been circulated for comment and consideration of implementation in August 2022. Dr Williamson is correct in asserting that the proposed curriculum hopes to produce doctors with generic professional and specialty specific capabilities needed to manage patients presenting with a wide range of medical symptoms and conditions. It does aim to produce a workforce that reflects the current trends of increasing patient attendances to both primary care and emergency departments- one that has a high level of diagnostic reasoning, the ability to manage uncertainty, deal with co-morbidities and recognise when specialty input is required in a variety of settings, including ambulatory and critical care. Contrary to the situation described in the correspondence, the new curriculum does not move away from each trainee being required to develop a specialist skill, such as medical education, management, stroke medicine or focused echocardiography. Trainees will still need to acquire competency in a specialist skill for their final 36 months of their training programme, usually after they have completed their Point of Care Ultrasound (POCUS) certification. The thinking behind introducing mandatory POCUS in the curriculum is that: POCUS is in the proposed curricula for intensive care medicine, respiratory medicine and emergency medicine, therefore we feel that in order to recruit the best trainees it is imperative POCUS training is offered as standard As evidenced by the trainee surveys, they often do not get allocated time to develop their specialist skill, especially in the early years of Higher Specialty Training before they often have decided on a particular skill. The introduction of mandatory POCUS training should legtimise time off the ward to obtain this skill early in training. POCUS is becoming more and more standardised in 21st Century acute care alongside the reducing costs of Ultrasound probe e.g. Philips Lumify and Butterfly iQ which are compatible with smart phones POCUS has been heralded as the fifth pillar of examination (observation, palpation, percussion, auscultation, insonation)1 The proposed curriculum therefore facilitates trainees to have regular dedicated time to develop interests inside or outside acute medicine to supplement their professional experience and training. This will also enable trainees to have time away from the ‘front door’ high intensity acute care. Mandatory POCUS will continue to set AIM training apart from other physician training programmes and continue to attract high quality trainees to apply to the specialty. Formal feedback seen at the SAC meeting in October 2019 to the draft curriculum (personal correspondence from JRCPTB) showed a positive response from nine individuals, an ambivalent one from two people, and only two against the introduction of formal POCUS training in the curriculum. Point of Care Ultrasound will likely be a welcome addition to the curriculum and will benefit patients, trainees and front door services up and down the country. Concerns regarding supervision are being addressed by the POCUS working group, in anticipation of the lead in period of well over two years. It is anticipated that most trainees can achieve POCUS sign off (e.g. Focused Acute Medical Ultrasound) in 6 to 12 months (personal correspondence Nick Smallwood from POCUS working group). With ongoing concerns regarding recruitment and retention in Acute Internal Medicine we agree strongly that with POCUS inclusion, we have a further selling point for AIM training.

scholarly journals MP035: Point-of-care-ultrasound to diagnose appendicitis in a Canadian emergency department

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S78-S78
Author(s):  
S. Sharif ◽  
S. Skitch ◽  
D. Vlahaki ◽  
A. Healey
Keyword(s):  
Imaging Modality ◽  
Point Of Care ◽  
Retrospective Chart Review ◽  
Fellowship Training ◽  
Point Of Care Ultrasound ◽  
Suspected Appendicitis ◽  
Test Characteristics ◽  
Resident Physicians ◽  
Definitive Management ◽  
Surgical Condition

Introduction: Appendicitis is a common surgical condition that frequently requires patients to undergo diagnostic imaging. Abdominal computed tomography is the gold standard imaging technique for the diagnosis of appendicitis, but exposes patients to radiation. Ultrasound offers an alternate radiation-free imaging modality for appendicitis. However, the availability of ultrasound during off-hours is limited in many Emergency departments (EDs). Clinician performed point-of-care ultrasound (POCUS) is increasingly used by emergency physicians as a bedside tool to evaluate suspected appendicitis. The purpose of this study is to evaluate the test characteristics of emergency physician performed POCUS to diagnose appendicitis in a Canadian ED. Methods: A pragmatic, retrospective chart review was performed on all patients for whom a POCUS was performed to diagnose appendicitis at St. Joseph’s Healthcare Hamilton in Ontario from December 1, 2010 to December 4, 2015. All POCUS scans were performed by physicians with Registered Diagnostic Medical Sonographer (RDMS) credentials or resident physicians undergoing POCUS fellowship training. All scans were over-read by RDMS credentialed faculty and subject to a rigorous quality assurance (QA) process. POCUS findings and patient outcomes were reported. Results: A total of 90 patients were included in the study. 24 patients were diagnosed with appendicitis on POCUS. Ultimately, 18 were diagnosed with appendicitis through formal imaging, laparoscopy, and pathology. The sensitivity and specificity for POCUS to diagnose appendicitis was found to be 69.2% (95% CI, 48.1%-84.9%) and 90.6% (95% CI, 80.0%-96.1%) respectively. Conclusion: Bedside ultrasound is a reliable imaging modality for ruling in acute appendicitis. In cases where POCUS is negative or indeterminate for appendicitis, further imaging should be obtained as clinical suspicion warrants. The use of POCUS has the potential to reduce patient exposure to ionizing radiation and decrease the costs of obtaining CT scans, while hastening the process of achieving definitive management through earlier surgical consultation.

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