Point-of-Care Ultrasound for Family Medicine Residents: Attitudes and Confidence

Background and Objectives: Point-of-care ultrasound (POCUS) is increasingly being incorporated into family medicine residency training. Attitudes towards POCUS among family medicine residents (FMRs) are largely unknown, and confidence levels with performing and interpreting POCUS exams are also unknown among this group of learners. Our aim was to evaluate FMRs’ attitudes and confidence levels before and after the implementation of a new POCUS curriculum. Methods: Study participants included FMRs in all postgraduate years (ie, PGY1-PGY3) at the University of New Mexico (UNM) Family Medicine Residency Program. Our intervention was a yearlong implementation of a new POCUS curriculum based on the American Academy of Family Physicians POCUS curriculum guidelines. Our interventions included hands-on training sessions for both FMRs and faculty along with a resource website. We assessed attitudes and confidence levels with various POCUS exams using a pre- and postintervention survey. Results: Overall, FMRs felt significantly more confident in their ability to perform and interpret a point-of-care ultrasound after the implementation of POCUS curriculum. There was no significant difference in participants’ expectations of their use of POCUS during or after residency. Conclusions: Overall, this study provides evidence that the implementation of a POCUS curriculum that includes hands-on and didactic training is associated with increased confidence in utilizing POCUS among FMRs.

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Considerations for Implementing Point-of-Care Ultrasound in a Community-Based Family Medicine Residency Program

Journal of Medical Education and Curricular Development ◽

10.1177/2382120519884329 ◽

2019 ◽

Vol 6 ◽

pp. 238212051988432

Author(s):

Megan Weemer ◽

Matt Hutchins ◽

Eric Beachy ◽

Nicole McGuire

Keyword(s):

Family Medicine ◽

Residency Program ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Family Medicine Residency ◽

Vein Thrombosis ◽

Recent Graduates ◽

Barriers To Implementation ◽

Procedural Guidance ◽

Deep Vein

Background: Prior to implementing Point-of-Care Ultrasound (POCUS) training into our Family Medicine Residency Program, we sought to determine opinions on the most relevant applications according to current Family Medicine residents and recent graduates. As there are so many POCUS applications relevant to Family Medicine, it would be efficient to teach only the most relevant scans. Objective: Examine current POCUS use and the perception of future use among current residents and recent graduates of a Family Medicine Residency Program. Methods: In 2017, an electronic survey was used to examine differences in perceptions regarding the value of POCUS applications, benefits of use, and potential barriers to implementation. Results: Of the 88 surveys sent, 21 of 21 current residents (100%) and 28 of 67 recent graduates (41.8%) completed the survey with a total completion rate of 55.7%. The POCUS practices differed between groups. Current residents were significantly more likely than recent graduates to use POCUS for vascular procedural guidance and other procedural guidance. Recent graduates were significantly more likely to report POCUS use for abdominal aortic aneurysm screening and lower extremity Doppler screening for deep vein thrombosis. All P values were significant at the .05 level. Conclusions: Point-of-Care Ultrasound training is generally desired by current residents. Some applications are perceived to be of sufficient utility by current residents and recent graduates. Findings would justify investment of time and effort required to implement POCUS training in Family Medicine Residency curriculums. Curriculum should focus on applications viewed as high priority based on usage rates.

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Design and evaluation of the I-SCAN faculty POCUS program

BMC Medical Education ◽

10.1186/s12909-020-02453-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Janjigian ◽

Anne Dembitzer ◽

Caroline Srisarajivakul-Klein ◽

Khemraj Hardower ◽

Deborah Cooke ◽

...

Keyword(s):

Training Programs ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Median Score ◽

Introductory Course ◽

Hands On ◽

Before And After ◽

Online Feedback ◽

Passing Score ◽

Longitudinal Phase

Abstract Background Point-of-care ultrasound (POCUS) is becoming widely adopted with increasing accessibility of courses. Little is known about the optimal design of the introductory course or longitudinal training programs targeting hospitalists that are critical to success. Methods Hospitalists at four academic sites participated in a two-day introductory course and a longitudinal phase comprising clinical POCUS practice, clip uploading with online feedback, hands-on teaching, and monthly ultrasound conferences. Assessments were performed immediately before and after the two-day course and after 1 year. Results Knowledge increased from baseline to post two-day course (median score 58 and 85%, respectively, p < 0.001) and decreased slightly at 1 year (median score 81%, p = 0.012). After the two-day introductory course, the median score for hands-on image acquisition skills, the principal metric of participant success, was 75%. After 1 year, scores were similar (median score 74%). Confidence increased from baseline to post two-day course (1.5 to 3.1 on a 4 point Likert scale from Not at all confident (1) to Very confident (4), p < 0.001), and remained unchanged after 1 year (2.73). Course elements correlating with a passing score on the final hands-on test included number of clip uploads (r = 0.85, p,0.001), attendance at hands-on sessions (r = 0.7, p = 0.001), and attendance at monthly conferences (r = 0.50, p = 0.03). Conclusions The I-ScaN POCUS training program increased hospitalist knowledge, skill and confidence with maintained skill and confidence after 1 year. Uploading clips and attending hands-on teaching sessions were most correlative with participant success.

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A structured curriculum and procedure clinic to help family medicine residents diagnose and treat skin cancer

Canadian Medical Education Journal ◽

10.36834/cmej.69825 ◽

2021 ◽

Author(s):

Christine Rivet ◽

Farhad Motamedi ◽

Joseph Burns ◽

Douglas Archibald

Keyword(s):

Skin Cancer ◽

Family Medicine ◽

Family Physicians ◽

Residency Programs ◽

Family Medicine Residency ◽

Diagnosis And Management ◽

Skin Cancers ◽

Ideal Situation ◽

Hands On ◽

Family Medicine Residents

Implication Statement Melanoma is a potentially deadly type of skin cancer that has been increasing in incidence but is curable if found in the early stages. Family physicians are in an ideal situation to examine the skin during routine visits, but studies indicate they are not well trained to detect or treat skin cancers. We piloted a structured, longitudinal, hands-on procedural curriculum to improve family medicine residents’ ability to identify and manage skin cancers. Family medicine residency programs wishing to improve the diagnosis and management of skin cancer by family physicians might consider trialing our structured curriculum and procedure clinic.

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Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study

Family Medicine ◽

10.22454/fammed.2020.223648 ◽

2020 ◽

Vol 52 (7) ◽

pp. 505-511

Author(s):

Jeffrey W. W. Hall ◽

Harland Holman ◽

Tyler W. Barreto ◽

Paul Bornemann ◽

Andrew Vaughan ◽

...

Keyword(s):

Family Medicine ◽

Core Curriculum ◽

Point Of Care ◽

Program Directors ◽

Point Of Care Ultrasound ◽

Residency Programs ◽

Family Medicine Residency ◽

Survey Results ◽

Research Alliance ◽

Residency Program Directors

Background and Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. Methods: Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. Results: POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Only 27% of programs use six of the eight surveyed POCUS modalities more than once per year. The top three barriers to including POCUS in residency training in 2019 have not changed since 2014, and are (1) a lack of trained faculty, (2) limited access to equipment, and (3) discomfort with interpreting images without radiologist review. Conclusions: Training in POCUS has increased in family medicine residencies over the last 5 years, although practical use of this technology in the clinical setting may be lagging behind. Further research should explore how POCUS can improve outcomes and reduce costs in the primary care setting to better inform training for this technology.

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LO092: The educational impact of a formalized RUSH (Rapid Ultrasound in Shock) protocol in emergency medicine residency ultrasound training

CJEM ◽

10.1017/cem.2016.129 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S61-S62

Author(s):

C. Hrymak ◽

E. Weldon ◽

C. Pham

Keyword(s):

Emergency Medicine ◽

Point Of Care ◽

Image Acquisition ◽

Image Interpretation ◽

Comfort Level ◽

Point Of Care Ultrasound ◽

Educational Impact ◽

Hands On ◽

Before And After ◽

Junior Residents

Introduction: Point of care ultrasound for assessment of undifferentiated hypotension and shock is part of the clinical scope of Emergency Physicians in Canada. The RUSH Exam outlines a systematic approach to these patients. A RUSH Exam educational model using didactic and hands on practice was developed and implemented for Emergency Medicine (EM) residents. This study evaluated the effectiveness of the module in a simulated setting on the following endpoints: improvement in image acquisition, interpretation, speed, and subjective comfort level, among EM residents with basic ultrasound training. Methods: Approval was received from the institutional health research ethics board for this before and after simulation study. Residents in the -EM Program or CCFP-EM Program from July 2014 to July 2015 were eligible to consent. Participants were excluded if they were unable to complete all portions. All residents were educated to the same level of introductory ultrasound training based on the curriculum in place at our institution. The 8-hour intervention included RUSH didactic and hands on small group sessions. Testing before and after the intervention was performed with the SonoSim Livescan training platform. Two evaluators scored each resident on the accuracy of image acquisition, image interpretation, and time to scan completion. A before and after survey assessed resident comfort level with performing ultrasound on an emergency patient in shock, and basing decisions on ultrasound findings. Statistical analysis was performed using McNemar’s test for image acquisition and interpretation, a paired T test for time, and the Bahpkar test for the questionnaire. Results: 16 EM residents including 11 senior residents and 5 junior residents were enrolled. Improvement was achieved in the categories of IVC image acquisition and interpretation, as well as interpretation for B-lines, lung sliding, cardiac apical and parasternal long axis, and DVT (p<0.05). Subjective comfort level of performing ultrasound in shock and basing decisions on the findings was increased (p<0.0001). Among junior residents, there was an increased speed of image acquisition. Conclusion: With the introduction of the RUSH Exam educational module, EM residents showed improved image acquisition, image interpretation, speed, and comfort level when using ultrasound in critically ill patients.

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Comparison of in-person versus tele-ultrasound point-of-care ultrasound training during the COVID-19 pandemic

The Ultrasound Journal ◽

10.1186/s13089-021-00242-6 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Nilam J. Soni ◽

Jeremy S. Boyd ◽

Gregory Mints ◽

Kevin C. Proud ◽

Trevor P. Jensen ◽

...

Keyword(s):

Test Scores ◽

Point Of Care ◽

Course Evaluations ◽

Point Of Care Ultrasound ◽

Knowledge Test ◽

Significant Difference ◽

Hands On ◽

Travel Restrictions ◽

Ultrasound Technology ◽

Training Courses

Abstract Background Lack of training is currently the most common barrier to implementation of point-of-care ultrasound (POCUS) use in clinical practice, and in-person POCUS continuing medical education (CME) courses have been paramount in improving this training gap. Due to travel restrictions and physical distancing requirements during the COVID-19 pandemic, most in-person POCUS training courses were cancelled. Though tele-ultrasound technology has existed for several years, use of tele-ultrasound technology to deliver hands-on training during a POCUS CME course has not been previously described. Methods We conducted a retrospective observational study comparing educational outcomes, course evaluations, and learner and faculty feedback from in-person versus tele-ultrasound POCUS courses. The same POCUS educational curriculum was delivered to learners by the two course formats. Data from the most recent pre-pandemic in-person course were compared to tele-ultrasound courses during the COVID-19 pandemic. Results Pre- and post-course knowledge test scores of learners from the in-person (n = 88) and tele-ultrasound course (n = 52) were compared. Though mean pre-course knowledge test scores were higher among learners of the tele-ultrasound versus in-person course (78% vs. 71%; p = 0.001), there was no significant difference in the post-course test scores between learners of the two course formats (89% vs. 87%; p = 0.069). Both learners and faculty rated the tele-ultrasound course highly (4.6–5.0 on a 5-point scale) for effectiveness of virtual lectures, tele-ultrasound hands-on scanning sessions, and course administration. Faculty generally expressed less satisfaction with their ability to engage with learners, troubleshoot image acquisition, and provide feedback during the tele-ultrasound course but felt learners completed the tele-ultrasound course with a better basic POCUS skillset. Conclusions Compared to a traditional in-person course, tele-ultrasound POCUS CME courses appeared to be as effective for improving POCUS knowledge post-course and fulfilling learning objectives. Our findings can serve as a roadmap for educators seeking guidance on development of a tele-ultrasound POCUS training course whose demand will likely persist beyond the COVID-19 pandemic.

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Pilot Project: Does formal bedside training of medical students with a FAST exam increase their knowledge and comfort level with ultrasound use in a community family medicine practice setting?

POCUS Journal ◽

10.24908/pocus.v2i2.13279 ◽

2017 ◽

Vol 2 (2) ◽

pp. 15-17

Author(s):

Rimi Sambi, MD ◽

Heather Sawula, MD ◽

Brent Wolfrom, MD ◽

Joseph Newbigging, MD

Keyword(s):

Medical Students ◽

Family Medicine ◽

Point Of Care ◽

Training Session ◽

Undergraduate Curriculum ◽

Knowledge Retention ◽

Comfort Level ◽

Point Of Care Ultrasound ◽

Medical Undergraduate ◽

Fast Exam

As point of care ultrasound (PoCUS) becomes increasingly popular and a standard of care in many clinical settings, the interest for integration in medical undergraduate curriculum is also growing [1]. This project aims to assess whether formal bedside Focused Abdominal Scan for Trauma (FAST) exam training of medical students increases their knowledge and comfort with the use of bedside ultrasound in a family medicine setting at Queen’s University. Third year medical students (n=18) were recruited to participate in a training session involving a 1-hour online video and 2-hour hands-on session. Knowledge based surveys were completed before and after the training. A survey was completed 4 months after the teaching session evaluating knowledge retention, comfort, and application of skills. Student knowledge of PoCUS and FAST increased and was maintained (pre-training 56%±20%, post-training 82%±10%, p<0.001). Self-evaluation of comfort performing a FAST examination (5-point Likert scale) similarly increased post-training session (pre-training 1.4±0.8, post-training 3.8±0.9, p<0.005), but decreased 4 months later (3±1.2, p<0.005). Students in this study were unanimously interested in ultrasound training and the methods used effectively increased theoretical knowledge and comfort with use. Students did not retain their comfort levels with FAST exam 4 months after the training session, nor did they have the opportunity to utilize the skills learned. Further evidence is required to identify the applicability of these results to undergraduate curriculum development.

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Teaching Tools to Teach Geriatric Medicine to Family Medicine Residents

Gerontology & Geriatrics: Research ◽

10.26420/gerontolgeriatrres.2021.1050 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jaqua EE ◽

◽

Nguyen V ◽

Jubran A ◽

Park S ◽

...

Keyword(s):

Family Medicine ◽

Geriatric Medicine ◽

Relevant Information ◽

Beers Criteria ◽

San Bernardino County ◽

Teaching Tools ◽

Family Medicine Residency ◽

San Bernardino ◽

Loma Linda University ◽

Family Medicine Residents

Objective: To determine if pocket-sized, reference guides are helpful tools for teaching geriatric medicine to family medicine residents. Setting: Loma Linda University Healthcare Education Consortium, a family medicine residency in San Bernardino County, California. Participants: Family medicine residents that successfully completed the required geriatrics rotation between July 2019 and June 2020. Results: From the twelve family medicine residents, 100% believed their geriatric medicine rotation helped them to be successful in residency. The preferred study tool was the pocket guides, mainly the “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”. For a more comprehensive reading, the study tool most used was search engines such as Up-to-date and Dynamed. Geriatrics at Your Fingertips (Reuben et al., 2016) and the “Guiding Principles for the Care of Older Adults with Multimorbidity Pocket Card” were not as helpful due to the perceived increased efforts to rapidly find clinically relevant information. Conclusion: Pocket guides, especially “Geriatric Medicine Pocket Guide” and “2019 AGS Beers Criteria”, are helpful teaching tools that can be used to augment geriatric medicine education in a family medicine residency.

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P025: Checking the pulse in the 21st century: inter-observer reliability of carotid pulse detection by point-of-care ultrasound

CJEM ◽

10.1017/cem.2020.233 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S73-S74

Author(s):

D. Smith ◽

J. Chenkin ◽

R. Simard

Keyword(s):

Cardiac Arrest ◽

Healthcare Provider ◽

Point Of Care ◽

Rank Test ◽

Point Of Care Ultrasound ◽

Current Standard ◽

Observer Reliability ◽

Pulse Palpation ◽

Before And After ◽

The Impact

Introduction: Detection of a pulse is crucial to decision-making in the care of patients who are in cardiac arrest, however, the current standard of manual pulse palpation is unreliable. An emerging alternative is the use of point-of-care ultrasound (POCUS) for direct assessment of the carotid pulse. The primary objective of this study is to determine the inter-observer reliability for healthcare provider interpretation of the carotid pulse by POCUS in patients who are peri-arrest or in cardiac arrest. Methods: We conducted a web-based survey of healthcare providers. Participants were shown a tutorial demonstrating POCUS detection of the carotid pulse and then asked to interpret 15 carotid pulse ultrasound clips from patients who were peri-arrest or in cardiac arrest. The primary outcome was inter-observer reliability for carotid pulse assessment. Secondary outcomes included inter-observer reliability stratified by healthcare provider role and POCUS experience, mean tutorial duration, mean pulse assessment duration, rate of pulse assessments < 10 seconds, and change in participant confidence before and after the study. Inter-observer reliability was determined by Krippendorff's α. Change in participant confidence was determined by Wilcoxon signed-rank test. Results: 68 participants completed our study, with a response rate of 75% (68/91). There was near perfect inter-observer reliability for pulse assessment amongst all study participants (α=0.874, 95% CI 0.869, 0.879). Senior residents (n = 24) and POCUS experts (n = 6) demonstrated the highest rates of inter-observer reliability, α=0.902 (95% CI 0.888, 0.914) and α=0.925 (95% CI 0.869, 0.972), respectively. All sub-groups had α greater than 0.8. Mean tutorial duration was 31 seconds (SD = 17.5) with maximum duration of 55 seconds. Mean pulse assessment duration was 7.7 seconds (SD = 5.2) with 76% of assessments completed within 10 seconds. Participant confidence before and after the study significantly increased from a median of 2 to a median of 4 on a 5-point Likert-type scale (z = 6.3, p < .001). Conclusion: Interpretation of the carotid pulse by POCUS showed near perfect inter-observer reliability for patients who were peri-arrest or in cardiac arrest. Participants required minimal training and indicated improved POCUS pulse assessment confidence after the study. Further work must be done to determine the impact of POCUS pulse assessment on the resuscitation of patients in cardiac arrest.

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LO22: Does point-of-care ultrasonography improve diagnostic accuracy in emergency department patients with undifferentiated hypotension? An international randomized controlled trial from the SHoC-ED investigators

CJEM ◽

10.1017/cem.2019.65 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S15

Author(s):

P. Atkinson ◽

M. Peach ◽

S. Hunter ◽

A. Kanji ◽

L. Taylor ◽

...

Keyword(s):

Cardiogenic Shock ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Primary Outcome ◽

Point Of Care ◽

Statistical Tests ◽

Controlled Study ◽

Point Of Care Ultrasound ◽

Randomized Controlled ◽

Significant Difference

Introduction: Point of care ultrasound has been reported to improve diagnosis in non-traumatic hypotensive ED patients. We compared diagnostic performance of physicians with and without PoCUS in undifferentiated hypotensive patients as part of an international prospective randomized controlled study. The primary outcome was diagnostic performance of PoCUS for cardiogenic vs. non-cardiogenic shock. Methods: SHoC-ED recruited hypotensive patients (SBP < 100 mmHg or shock index > 1) in 6 centres in Canada and South Africa. We describe previously unreported secondary outcomes relating to diagnostic accuracy. Patients were randomized to standard clinical assessment (No PoCUS) or PoCUS groups. PoCUS-trained physicians performed scans after initial assessment. Demographics, clinical details and findings were collected prospectively. Initial and secondary diagnoses including shock category were recorded at 0 and 60 minutes. Final diagnosis was determined by independent blinded chart review. Standard statistical tests were employed. Sample size was powered at 0.80 (α:0.05) for a moderate difference. Results: 273 patients were enrolled with follow-up for primary outcome completed for 270. Baseline demographics and perceived category of shock were similar between groups. 11% of patients were determined to have cardiogenic shock. PoCUS had a sensitivity of 80.0% (95% CI 54.8 to 93.0%), specificity 95.5% (90.0 to 98.1%), LR+ve 17.9 (7.34 to 43.8), LR-ve 0.21 (0.08 to 0.58), Diagnostic OR 85.6 (18.2 to 403.6) and accuracy 93.7% (88.0 to 97.2%) for cardiogenic shock. Standard assessment without PoCUS had a sensitivity of 91.7% (64.6 to 98.5%), specificity 93.8% (87.8 to 97.0%), LR+ve 14.8 (7.1 to 30.9), LR- of 0.09 (0.01 to 0.58), Diagnostic OR 166.6 (18.7 to 1481) and accuracy of 93.6% (87.8 to 97.2%). There was no significant difference in sensitivity (-11.7% (-37.8 to 18.3%)) or specificity (1.73% (-4.67 to 8.29%)). Diagnostic performance was also similar between other shock subcategories. Conclusion: As reported in other studies, PoCUS based assessment performed well diagnostically in undifferentiated hypotensive patients, especially as a rule-in test. However performance was similar to standard (non-PoCUS) assessment, which was excellent in this study.

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