The intensive care unit functions as a near-constant routine protocol disconnected from solar time. Behavioural interventions to promote entrainment should be supported by objective measurements of light and sound.

Objectives: To identify the time at which point of care ultrasound static image recognition and image acquisition skills decay in novice learners. Setting: The University of Iowa Hospitals and Clinics. Subjects: Twenty-four subjects (23 first-year medical students and one first-year physician assistant student). Design: The subjects completed an initial didactic and hands-on session with immediate testing of learned image acquisition and static image identification skills. Interventions: Retesting occurred at 1, 4, and 8 weeks after the initial training session with no retraining in between. Image acquisition skills were obtained on the same healthy male volunteers, and the students were given no immediate feedback on their performance. The image identification skills were assessed with a 10 question test at each follow-up session. Measurements and Main Results: For pleural ultrasound by 4 weeks, there was a significant decline of the ability to identify A-lines (p = 0.0065). For pleural image acquisition, there was no significant decline in the ability to demonstrate lung sliding. Conversely, cardiac image recognition did not significantly decline throughout the study, while the ability to demonstrate cardiac images at 4 weeks (parasternal short axis view) did (p = 0.0008). Conclusions: Motor and cognitive skills decay at different times for pleural and cardiac images. Future ultrasound curricula should retrain skills at a maximum of 8 weeks from initial training. They should focus more on didactic sessions related to image identification for pleural images, and more hands-on image acquisition training for cardiac images, which represents a novel finding.

Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. Methods: We integrated a POCUS curriculum which focused on teaching basic bedside ultrasonography. POCUS instruction was delivered by pre-workshop learning materials, short didactic sessions and handson scanning of healthy volunteers guided by faculty members, critical care fellows and chief residents. The residents' skills were assessed prior to initiation of the curriculum and at the end of the academic year. The residents were asked to identify the 3 basic cardiac views (parasternal long and short, and apical four chamber), inferior vena cava, pleural views (lung sliding and Alines), kidney (long axis and short axis), bladder and internal jugular vein. They were given a score of 1 for correct identification, 2 for incomplete views, and 3 for inability to identify the structure. All the scores were assessed by predetermined grading rubrics. Results: A total of 62 residents (23 PGY1, 24 PGY2, 15 PGY3) participated in the year-long curriculum. We calculated odds ratio for acquiring the correct image (1) vs partial / incorrect acquisition (2 or 3), significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86 -20.74, p<0.001), IVC (OR 5.05, 95% CI 1.91 -13.35, p=0.001) and bladder (OR 5.06, p=0.003). Non-significant differences were found in acquisition of apical 4 chamber, A line and internal jugular vein. Conclusion: We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper level residents to include objective left ventricle and right ventricle function analysis, and including more case based pathologic image review

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