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

Abstract

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.

Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments

“…Authors from other medical specialties, such as surgery, internal medicine, family medicine, and anesthesiology, have advocated that POCUS be taught to trainees and incorporated into their milestones for training evaluation. [17][18][19][20][21] The Liaison Committee on Medical Education (LCME) has not yet released requirements for POCUS training in undergraduate medical education, although some have advocated for this requirement. 22 While investigations continue to demonstrate that we can teach our trainees POCUS, 2-7 a central question remains: how do we evaluate their competency?…”

Point-of-care ultrasonography in Canadian anesthesiology residency programs: a national survey of program directors

“…Survey content was generated following a literature review of relevant publications on POCUS education amongst postgraduate training programs of various specialties. [1][2][3][4][5][6]14,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] We additionally looked at published [34][35][36] and unpublished A curricula of several anesthesiology-oriented POCUS courses to identify other possible perioperative POCUS applications relevant to our study. Survey content was further refined and simplified following review of the questions with six faculty anesthesiologists at the authors' institution.…”

Introduction of an academic medical center’s point-of-care ultrasound curriculum to internal medicine residents at a community-based teaching hospital

“…In contrast, reports of POCUS training courses at community-based teaching hospitals tend to focus on a single POCUS application such as renal sonography [ 9 ], musculoskeletal ultrasound [ 10 ], and cardiovascular ultrasound [ 11 ]. As articulated by Sabath and Singh in their call to add educational objectives specific to POCUS to the ACGME’s milestones for IM training [ 12 ], community hospitals face distinct challenges in adding POCUS curricula to IM residency education. Smaller numbers of housestaff and fewer faculty members can present logistical challenges to introduction of a POCUS training program, as local faculty expertise may not be available to deliver content material and supervise resident learning.…”