Implementation of a point-of-care ultrasound skills practicum for hospitalists

Abstract

Introduction: Point-of-care ultrasound is recognized as a safe and valuable diagnostic tool for patient evaluation. Hospitalists are prime candidates for advancing the point-of-care ultrasound field given their crucial role in inpatient medicine. Despite this, there is a notable lack of evidence-based ultrasound training for hospitalists. Most research focuses on diagnostic accuracy rather than the training required to achieve it. This study aims to improve hospitalists' point-of-care ultrasound knowledge and skills through a hands-on skills practicum. Methods: Four skill practicums were conducted with pre-course, post-course, and six-month evaluations and knowledge assessments. Results: The mean pre-vs. post-course knowledge assessment scores significantly improved, 41.7% vs. 75.9% (SD 16.1% and 12.7%, respectively, p < 0.0001). The mean ultrasound skills confidence ratings on a 10-point Likert scale significantly increased post-course (2.60 AE 1.66 vs. 6.33 AE 1.63, p < 0.0001), but decreased at six months (6.33 AE 1.63 vs. 4.10 AE 2.22, p < 0.0001). The greatest limitations to usage precourse and at six months were knowledge/skills and lack of machine access. While knowledge/skills decreased from pre-course (82.0%) as compared to six-months (64.3%), lack of machine access increased from pre-course (15.8%) to six-months (28.6%) (p ¼ 0.28). Conclusion: Hospitalists agree that point-of-care ultrasound has utility in the diagnostic and therapeutic management of patients, though the lack of training is a significant limitation. Our study demonstrated that a brief skills practicum significantly improves hospitalists' confidence and knowledge regarding ultrasound image acquisition and interpretation in the short term. Long-term confidence and usage wanes, which appears to be due to the lack of machine access.

Design and Evaluation of the I-SCAN Faculty POCUS Program

“…Cochard and others described a hospitalist POCUS training program where, of the 35 completing a survey out of 58 total who took the course, con dence waned at six months and 26% reported never using POCUS in their hospitalist practice. 17 Mathews, reporting on the CHAMP Ultrasound Program, found that of the learners participating in a voluntary 1-day refresher course following the initial 3-day introductory course, skill retention was most effectively maintained by those who attended any monthly scanning session or who had started an image portfolio. 14 I-ScaN was designed to maximize the effectiveness of the longitudinal phase while shortening the introductory course to 2 days.…”

“…2,13−15 Published reports of comprehensive faculty POCUS training programs demonstrate immediate short-term gains as would be expected, however, there is limited data on durability of these gains. [14][15][16][17] The CHAMP program reported that skills learned in the introductory course tended to wane over time, with participation in monthly scanning sessions/and or portfolio completion being associated with skill retention. 14 The recent position statement issued by SHM advocates for attendance at a local or national hands-on training program, which should be followed by a longitudinal study phase with hands-on instruction.…”

Design and evaluation of the I-SCAN faculty POCUS program

“…Successful completion of the I-ScaN program required three components: 1) Achieving a score of ≥80% on the final knowledge test 2) Receiving a score of ≥80% on the hands-on test and 3) Submitting an image portfolio based on SHM guidance [ 19 ]. Passing scores were established at these values through author consensus of clinical relevance and review of published data [ 14 ].…”

“…However, the training of faculty has emerged as a key barrier to adoption into hospitalist groups [ 2 , 13 – 15 ]. Published reports of comprehensive faculty POCUS training programs demonstrate immediate short-term gains as would be expected, however, there is limited data on durability of these gains [ 14 – 17 ]. The CHAMP program reported that skills learned in the introductory course tended to wane over time, with participation in monthly scanning sessions/and or portfolio completion being associated with skill retention [ 14 ].…”

“…Published reports of comprehensive faculty POCUS training programs demonstrate immediate short-term gains as would be expected, however, there is limited data on durability of these gains [ 14 – 17 ]. The CHAMP program reported that skills learned in the introductory course tended to wane over time, with participation in monthly scanning sessions/and or portfolio completion being associated with skill retention [ 14 ]. The recent position statement issued by the Society of Hospital Medicine (SHM) advocates for attendance at a local or national hands-on training program, which should be followed by a longitudinal study phase with hands-on instruction [ 2 ].…”