Results from an Implemented Longitudinal Ultrasound Curriculum for Internal Medicine Residents

Abstract

Point-of-care ultrasound (POCUS) is highly utilized in the critical care setting. There is also growing evidence supporting use of POCUS by internal medicine (IM) physicians as an extension of traditional physical diagnostic skills. As part of the newly formed curriculum at our residency program, we performed pre and post curriculum assessment of the residents' ability to acquire focused cardiac, lung, pleural, abdominal and vascular images. Methods: We integrated a POCUS curriculum which focused on teaching basic bedside ultrasonography. POCUS instruction was delivered by pre-workshop learning materials, short didactic sessions and handson scanning of healthy volunteers guided by faculty members, critical care fellows and chief residents. The residents' skills were assessed prior to initiation of the curriculum and at the end of the academic year. The residents were asked to identify the 3 basic cardiac views (parasternal long and short, and apical four chamber), inferior vena cava, pleural views (lung sliding and Alines), kidney (long axis and short axis), bladder and internal jugular vein. They were given a score of 1 for correct identification, 2 for incomplete views, and 3 for inability to identify the structure. All the scores were assessed by predetermined grading rubrics. Results: A total of 62 residents (23 PGY1, 24 PGY2, 15 PGY3) participated in the year-long curriculum. We calculated odds ratio for acquiring the correct image (1) vs partial / incorrect acquisition (2 or 3), significant differences were found in acquisition of most views including para-sternal short (OR 7.7, 95% CI 2.86 -20.74, p<0.001), IVC (OR 5.05, 95% CI 1.91 -13.35, p=0.001) and bladder (OR 5.06, p=0.003). Non-significant differences were found in acquisition of apical 4 chamber, A line and internal jugular vein. Conclusion: We found that the implementation of a longitudinal POCUS curriculum resulted in significant improvement in image acquisition for many common bedside ultrasound views. Future directions include advancing our bedside echocardiography curriculum for upper level residents to include objective left ventricle and right ventricle function analysis, and including more case based pathologic image review