Creating a Novel Cardiac Limited Ultrasound Exam Curriculum for Internal Medical Residency: Four Unanticipated Tasks

Nardi, Melissa; Shaw, David; Amundson, Stanley; Phan, James N.; Kimura, Bruce J.

doi:10.4137/jmecd.s18932

Cited by 7 publications

(6 citation statements)

References 43 publications

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“…Few studies have examined residents’ skills and attitude towards POCUS training,28–38 but to the best of our knowledge, no prior study has compared POCUS image interpretation skills and self-reported confidence between residents with and without POCUS training in medical school. The goal of this study was to assess our residents’ attitude, basic needs, and prior knowledge about POCUS and whether POCUS training and exposure during medical school influences their POCUS image interpretation skills and confidence level.…”

Section: Introductionmentioning

confidence: 99%

<p>Internal medicine residents’ point-of-care ultrasound skills and need assessment and the role of medical school training</p>

Elhassan¹,

Gandhi²,

Sandhu³

et al. 2019

AMEP

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Introduction: Point-of-care-ultrasound (POCUS) as a useful bedside tool is growing. Few studies have examined residents’ attitude towards POCUS or compared POCUS image interpretation skills between residents with and without POCUS training in medical school. Material and Methods: We distributed an anonymous survey and image interpretation test to assess residents’ attitude towards POCUS, confidence, and skills in interpreting POCUS images and videos. Using independent samples t-tests, we compared mean confidence levels and test scores between residents with and without prior POCUS training. Results: Fifty-two residents responded to survey (response rate 68%) and 59 took the image interpretation test (77%). Most residents (90%) reported being interested in POCUS. Residents with prior POCUS training (n=13) were either PGY-1 (9) or PGY-2 (4). No PGY-3 resident had prior training. Most residents (83%) thought POCUS could be extremely useful in the inpatient setting compared to 29% for outpatient setting. PGY-1 residents with prior training had a higher mean confidence level than PGY-1 residents without prior training, but the difference was not statistically significant (3.26 vs 2.64; p =0.08). PGY-1 with prior training had a mean confidence level that was close to that of PGY-3 residents. PGY-1 residents with prior training scored significantly higher than PGY-1 residents without prior training in image interpretation test (10.25 vs 7; p =0.01). Residents felt most confident in interpreting inferior vena cava images (mean 3.7; max. 5), which also had the highest score in image interpretation test (correct response rate of 88%). Conclusion: Our residents seem very interested in POCUS. PGY-1 residents with prior POCUS training in medical school seem to have higher confidence in their POCUS skills than PGY-1 residents without prior training and outperformed them in image interpretation test. The study is very instructive in building our future POCUS curriculum for residents.

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Section: Introductionmentioning

confidence: 99%

<p>Internal medicine residents’ point-of-care ultrasound skills and need assessment and the role of medical school training</p>

Elhassan¹,

Gandhi²,

Sandhu³

et al. 2019

AMEP

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“…Similarly, the Society of Hospital Medicine is actively releasing position statements on certification in point‐of‐care ultrasonography and creating a certification program (https://www.hospitalmedicine.org/clinical-topics/ultrasonography-cert/). In response, some internal medicine residency programs have identified the need to train their residents and hence have preemptively developed formal curricula in point‐of‐care ultrasonography . How best to instruct and how often to retrain noncardiologists in FCU remains unclear.…”

mentioning

confidence: 99%

“…In response, some internal medicine residency programs have identified the need to train their residents and hence have preemptively developed formal curricula in point-of-care ultrasonography. [3][4][5][6] How best to instruct and how often to retrain noncardiologists in FCU remains unclear.…”

mentioning

confidence: 99%

Three‐Dimensional Printed Cardiac Models for Focused Cardiac Ultrasound Instruction

Ochoa

Segal

Garcia

et al. 2018

J of Ultrasound Medicine

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Background Focused cardiac ultrasonography (FCU) is an increasingly integral component of routine medical training and practice. While various instructional methods have been described, few attempts have been made to incorporate a physical 3‐dimensional (3D) instructional aid. Objective The aim of this study was to determine if a 3D printed heart model workshop for FCU instruction leads to equivalent structure recognition and scanning ability compared to traditional didactic FCU instruction. Intervention Twenty first‐year medical students with no point‐of‐care ultrasonography experience were randomly assigned to a traditional lecture (n = 10) or a 3D printed heart model workshop (n = 10). Written examinations at 0 and 3 months as well as image acquisition at 3 months were compared. Results The median scores from the initial written structure identification in the traditional and 3D heart groups were 74% and 90%, respectively (P = 0.7). The second written exam at 3 months yielded median scores of 56% and 58% in the traditional and 3D heart groups, respectively (P = 0.8). The average scores on the image acquisition practical at 3 months were 3.3 of 5 and 2.7 of 5 (P = 0.1) in the traditional and 3D heart groups, respectively. Conclusions Utilizing 3D heart models in an FCU workshop format results in similar skill acquisition and knowledge retention as traditional didactics. The 3D heart models are relatively inexpensive, portable, and reusable, enabling learners to practice repeatedly and at flexible intervals. The reduction in ongoing expenses and the ability to teach large groups may decrease training costs as well as the need for local faculty expertise.

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“…This study advances older and smaller observations showing the feasibility of newly trained resident physicians in internal medicine to learn and perform US examinations and demonstrates, in particular, the successful clinical use of pocket‐sized devices . The CLUE used in the study has been well established as a required curriculum of a medical residency for greater than a decade, and the residents performing POCUS examinations in this study were not hand‐selected or motivated volunteers but random senior residents demonstrating their routine behaviors while admitting patients during a required rotation. The considerable but lesser accuracy (79%) of resident examinations may be explained by the inability to obtain a single view, the interobserver variability on subjective, borderline findings, or the evanescent nature of some initial CLUE findings, such as lung B‐lines and IVC plethora, which may have been altered by treatments in the emergency department and later absent during reference standard imaging.…”

Section: Discussionmentioning

confidence: 77%

“…This study was conducted at a 300‐bed community teaching hospital in which all 36 residents in the 3‐year internal medicine residency program were trained in CLUE and had been routinely scheduled for a “night float” rotation in their second or third year. In the 2‐week rotation, the resident independently admitted up to 6 patients to the ward and intermediate‐care units primarily from the emergency department and subsequently signed over patient care to a medical team in the morning, henceforth having no further coverage or effect on the management, treatment, or discharge of the patient.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission

Kimura

Lou

Dahms

et al. 2019

J of Ultrasound Medicine

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Objectives Few data exist regarding the use of ultrasound (US) to risk stratify ward admissions. Therefore, we evaluated associations between a cardiopulmonary limited ultrasound examination (CLUE) on admission and subsequent hospital outcomes. Methods Over a 22‐month period in a 300‐bed hospital, CLUE data reviewed from a series of nonelective ward admissions were correlated with the composite outcome of a hospital stay of longer than 2 days, disposition to hospice, or death. The CLUE included 5 quick‐look signs of left ventricular dysfunction, left atrial enlargement, lung B‐lines, pleural effusions, and inferior vena cava plethora and had been performed as warranted by 1 of 31 US‐trained admitting residents and then repeated by a cardiologist as the reference standard. The admitting condition, medical history, results of routine admission testing, and CLUE were assessed for an association with the outcome in univariate and multivariable models. Results Of 547 patients, the mean age ± SD was 62.9 ± 15.5 years; 59% were male; and the mean stay was 5.6 ± 8.1 days, with 355 (65%) lasting longer than 2 days and 21 (4%) having hospice disposition or death. An abnormal CLUE exam was found in 368 (67%) of patients, was related to the outcome (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.23–2.68; P = .001) when obtained by a resident or cardiologist, and was included in a best‐fit multivariable model with renal failure (OR, 2.44; 95% CI, 1.44–4.14; P < .001), infection/sepsis (OR, 2.25; 95% CI, 1.17–4.32; P = .02), and chest pain (OR, 0.36; 95% CI, 0.21–0.61; P < .001). Conclusions An abnormal admission point of care ultrasound exam was related to complex hospitalization, specifically a longer length of stay.

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Creating a Novel Cardiac Limited Ultrasound Exam Curriculum for Internal Medical Residency: Four Unanticipated Tasks

Cited by 7 publications

References 43 publications

<p>Internal medicine residents’ point-of-care ultrasound skills and need assessment and the role of medical school training</p>

<p>Internal medicine residents’ point-of-care ultrasound skills and need assessment and the role of medical school training</p>

Three‐Dimensional Printed Cardiac Models for Focused Cardiac Ultrasound Instruction

Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission

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