Barriers to learning and using point-of-care ultrasound: a survey of practicing internists in six North American institutions

Abstract

Background: Point-of-care ultrasound (POCUS) is increasingly used in internal medicine, but a lack of trained faculty continues to limit the spread of POCUS education. Using a framework based on organizational change theories, this study sought to identify barriers and enablers for hospital-based practicing internists to learn and use POCUS in clinical practice. Methods: We invited practicing internists at six North American institutions to participate in an electronic survey on their opinions regarding 39 barriers and enablers. Results: Of the 342 participants invited, 170 participated (response rate 49.3%). The top barriers were lack of training (79%), lack of handheld ultrasound devices (78%), lack of direct supervision (65%), lack of time to perform POCUS during rounds (65%), and lack of quality assurance processes (53%). The majority of participants (55%) disagreed or strongly disagreed with the statement "My institution provides funding for POCUS training." In general, participants' attitudes towards POCUS were favourable, and future career opportunities and the potential for billing were not considered significant factors by our participants in the decision to learn or use POCUS. Conclusions: This survey confirms the perceived importance of POCUS to practicing internists. To assist in closing faculty development gap, interventions should address training, supervision, quality assurance processes, availability of handheld devices, as well as dedicated time to perform POCUS during clinical care.

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

“…Unfortunately, our data revealed that opportunities to perform procedures were missed because supervisors were not available. This observation is consistent with previous data highlighting that few general internists are able to teach procedural skills [ 29 ] and that many programmes lack trained faculty [ 30 ].…”

“…Institutional support for faculty training and the infrastructure for ongoing quality assurance processes with a secure system for archiving images must be prioritized [ 30 ]. This will require the support of the radiology department and fully certified interventional radiologists.…”

Point-of-Care Ultrasound and Modernization of the Bedside Assessment

“…For this reason, faculty expertise is critical for effective integration of POCUS into GME. 25,34,35 Residency leadership interested in developing competency-based POCUS curricula must consider investing in the development of POCUS expertise in their clinical educators as a foundational strategy.…”

Internal Medicine Point of Care Ultrasound in the 21st century: A ‘FoCUS’ on the Middle East

“…This phenomenon of using ultrasound without training is true not only of learners in Saudi Arabia. In a multi-center survey of practicing internists in North America, the number of practitioners who reported using ultrasound exceeded those who reported prior training [ 10 ].…”

“…In addition, to provide quality control and maintain standards, infrastructure support with a secure imaging archiving system is also needed. One key barrier encountered in many programs is the lack of trained faculty [ 10 ]. Thus, providing institutional support for faculty to be trained and infrastructure for ongoing quality assurance processes should be a priority [ 10 ].…”