Diagnostic Influence of Routine Point‐of‐Care Pocket‐size Ultrasound Examinations Performed by Medical Residents

Andersen, Garrett Newton; Graven, Torbjørn; Skjetne, Kyrre; Mjølstad, Ole Christian; Kleinau, Jens Olaf; Olsen, Øystein E.; Haugen, Bjørn Olav; Dalen, Håvard

doi:10.7863/ultra.34.4.627

Cited by 88 publications

(50 citation statements)

References 38 publications

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“…Among the studies reporting on the effects of training attending clinicians to perform POCUS, the application of POCUS was considered to contribute to changes in management in 16–37% of cases in different clinical contexts . Studies reported similar findings after training residents or fellows, with POCUS contributing to management changes in 16–40% of clinical applications . Only one study evaluated any impact on patient‐relevant outcomes of training medical students to perform POCUS, demonstrating improved safety of simulated central venous catheter placement using ultrasound …”

Section: Resultsmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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IntroductionPoint-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications. MethodsThis research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA. ResultsWe identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students' understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent, and rests on minimal evidence. With POCUS, students' diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate. DiscussionOur analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

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Section: Resultsmentioning

confidence: 99%

Ultrasound in undergraduate medical education: a systematic and critical review

et al. 2017

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“…Novice point‐of‐care US users can diagnose life‐threatening conditions such as deep venous thrombosis and abdominal aortic aneurysms; in addition, medical students using point‐of‐care US are able to outperform experienced cardiologists performing a traditional physical examination . When medical residents with limited US training routinely examined patients with point‐of‐care US, it changed, verified, or added additional diagnoses in 35% of cases . Data continue to emerge demonstrating that point‐of‐care US can be used to answer focused, clinically relevant questions at the bedside.…”

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confidence: 99%

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Reaume

Siuba

Wagner

et al. 2018

J of Ultrasound Medicine

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Objectives The purpose of this study was to determine the prevalence and scope of point‐of‐care ultrasound (US) education in internal medicine, pediatric, and medicine‐pediatric residency programs nationwide. Methods Program directors were surveyed between January and June 2016 with a 15‐item online questionnaire to assess the state of point‐of‐care US training in their programs. The survey aimed to identify whether programs had an established point‐of‐care US curriculum and, if not, what reasons may have existed for a lack of point‐of‐care US training in their programs. Results The survey was distributed to 685 program directors, and the response rate was 19.2%. Only 31.5% of respondents reported having a formal point‐of‐care US curriculum in their program, and in 12.4% of programs, there was no US training at all. The presence of point‐of‐care US training as reported by internal medicine (n = 64) and medicine‐pediatric (n = 24) respondents showed formal point‐of‐care US curriculum rates of 37.5% and 43.5%, respectively. Pediatric programs (n = 24) reported limited point‐of‐care US training, with formal curriculum in only 12.4% of programs and 27.3% having no point‐of‐care US training at all. The most common reasons for lack of a point‐of‐care US curriculum among program directors were lack of trained faculty/instructors (70.4%), lack of guidelines/standards by governing societies (44.4%), and lack of the necessary technology (33.3%). Conclusions Less than half of residents with internal medicine training will have trained at a program with a point‐of‐care US curriculum, and point‐of‐care US training in pediatrics is even more limited. The major reason for the lack of point‐of‐care US education is a lack of trained faculty or instructors.

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“…In nearly 200 patients undergoing cardiac and abdominal sonography, Andersen et al (32) showed that approximately one-third had an additional diagnosis uncovered or the primary diagnosis changed completely. In the pulmonary realm, Filopei et al (33) demonstrated how ultrasound increased residents’ diagnostic accuracy compared to clinical assessment alone – particularly for chronic obstructive pulmonary disease (COPD), pneumonia, pleural effusion, and pulmonary edema.…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now

Sabath

Singh

2016

Journal of Community Hospital Internal Medicine Perspectives

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Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution – a community hospital – in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

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Diagnostic Influence of Routine Point‐of‐Care Pocket‐size Ultrasound Examinations Performed by Medical Residents

Cited by 88 publications

References 38 publications

Ultrasound in undergraduate medical education: a systematic and critical review

Ultrasound in undergraduate medical education: a systematic and critical review

Prevalence and Scope of Point‐of‐Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine‐Pediatric Residency Programs in the United States

Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now

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