A survey demonstrating that the procedural experience of residents in internal medicine, critical care and emergency medicine is poor: training in ultrasound is required to rectify this

Abstract

Background Training in procedural skills is often suboptimal. The aim of this study was to quantify the needs of residents in internal medicine (IM), critical care (CC), and emergency medicine (EM) for instruction in ultrasound-guided procedures. Methods All IM, EM and CC residents (n = 200) at King Abdulaziz Medical City, Riyadh, Saudi Arabia, were invited to participate in a questionnaire-based survey to identify skill and experience gaps. The contribution of procedural skills to patient care (i.e. applicability) and proficiency in the sterile technique required to perform ultrasound-guided procedures were rated on Likert scales. Data on training, accreditation, and experience with and without ultrasound were collected. Results The overall response rate was 72% (IM 91%, CC 100%, EM 40%). Although the sample reported that procedural skills were very applicable, 19% (IM n = 25, EM n = 2) had not performed any procedures. However, five residents were accredited in point-of-care ultrasound, 61% of the sample had performed ultrasound-guided procedures and 65% had used landmark techniques. Whilst more internists had performed procedures using landmark techniques, CC and EM residents had performed more ultrasound-guided procedures. Whilst CC residents had not missed any opportunities to perform procedures because supervisors were less available, EM (6) and IM (89) residents had. Whilst skill gaps were only identified in the IM residency programme, experience gaps were present in all three residency programmes. The IM residency programme had larger experience gaps than the CC and EM programmes for all procedural skills. Discussion Residents in IM, CC and EM perceive that ultrasound-guided procedures are relevant to their practice. However, the IM residents performed fewer procedures than CC residents and EM residents at least partly because internists also lack skills in ultrasound. Training in ultrasound-guided procedures may reduce the use of landmark techniques and improve patient safety. Residents in IM, CC and EM therefore require training in ultrasound-guided procedures.

First year internal medicine residents’ self-report point-of-care ultrasound knowledge and skills: what (Little) difference three years make

“…Our findings argue against an attempt to eliminate basic POCUS concepts and skills from the internal medicine residency POCUS curriculum. These high learning POCUS needs in our participants are similar to those of other learners in internal medicine [ 16 – 22 ]. However, to our knowledge, there are currently no follow-up studies that evaluate changes in learning needs over time, thus it remains unknown whether the lack of improvement in reported baseline POCUS knowledge and skills is a finding unique to our three Canadian centers or that this finding is also present elsewhere.…”

“…In our needs assessment survey in 2016, PGY-1 learners in internal medicine were largely novices, with minimal baseline POCUS knowledge and skills [ 15 ]. These learning needs are similar to needs expressed by internal medicine learners in other countries, including the United States [ 16 – 19 ], the Netherlands [ 20 ], and Saudi Arabia [ 21 , 22 ].…”

Training medical students in physical examination and point-of-care ultrasound: An assessment of the needs and barriers to acquiring skills in point-of-care ultrasound

“…While there are suggestions, competencies, and curricula for undergraduate training in PoCUS,[ 16 17 ] they must be tailored to the specific needs of each context using essential guidelines for the process:[ 21 31 ]…”

“…[ 21 31 ] Skills must be examined to guarantee competency and progress across each level of proficiency in the learning process The use of PoCUS requires clear indications (e.g., to accomplish a distinct objective, such as determining whether a pleural effusion is the cause of opacification on a chest X-ray) It is necessary to establish the scope of practice and institutional privileges. [ 21 31 ] Students need to be taught their limitations. [ 21 31 ] When performing PoCUS, it is critical to know when help from a professional (such as a radiologist) is necessary.…”

“…Because medical education has limited resources, any proposal deemed necessary has to be validated. [ 13 21 ] Indeed, a recent study in Saudi Arabia suggested that the internship year was not the best period to begin PoCUS training for physicians. [ 13 ] Besides, a needs assessment is essential to establish the necessity and appropriateness of the PoCUS training given to Saudi medical students.…”