Anu Taylor, MD; Abhilash Koratala, MD; Pinky Jha, MD
WMJ. 2023;122(1):3.
Dear Editor:
Point-of-care ultrasonography (POCUS), especially that of heart, lungs, deep vein thrombosis, volume status, and free fluid assessments, is a great adjunct to bedside clinical examination for inpatient medical care. Its diagnostic accuracy, reduced time to diagnosis, prognostic significance, and favorable impact on physician-patient interactions is reverberating in our industry.1 In recent studies, emergency department POCUS led to a change of diagnosis in 30% of cases and change in management in 89% of life-threatening situations.2 In critical care and anesthesia cases, it changed diagnosis and management in 41% to 51% and 43% to 82%, respectively.3 Although established in the specialties of emergency, critical care, and anesthesia, internal medicine is relatively new to POCUS.4 And now there seems to be a widening knowledge gap between faculty and trainees, as undergraduate and graduate medical education programs incorporate POCUS training into their curricula.
In November 2022, we conducted a cross sectional survey to assess the level of exposure, perceptions, and interest towards POCUS training. An anonymous 13-question Qualtrics survey was sent to all Medical College of Wisconsin faculty and advanced practice professionals (APP) in the divisions of Hospital and Perioperative Medicine.
A total of 59 faculty and APPs completed the survey, with a response rate of 41% (60% were hospitalists; 40% were APPs). Thirty-three percent of respondents had more than 3 years of experience in their field. Around 24% of respondents had completed a POCUS training course: the majority had in-person hands-on training, and 2 had full certification. Sixty-six percent of the POCUS-trained faculty had less than 3 years’ experience performing POCUS, whereas 33% had more than 3 years’ experience. Seventeen percent reported using POCUS in routine clinical practice; 77% perceived benefit to diagnostic POCUS in clinical practice and teaching learners. Most respondents highlighted the importance of POCUS as a bedside tool, especially in volume status assessment. Eighty percent of respondents were interested and willing to commit time up to 40 hours for a longitudinal training program with an online precourse, a hands-on workshop, and then a longitudinal mentored portfolio creation for practice.
This survey highlights the glaring knowledge gap among faculty and the need for a well-structured longitudinal training program. A focused curriculum, Faculty for longitudinal assessment, image archiving, quality assessment, and devices are key for its success.4,5 Our future efforts will be to secure support from leadership and funding and partnering with local physician organizations.
REFERENCES
- Koratala A, Kazory A. An introduction to point of care ultrasound: Laennec to Lichtenstein. Adv Chronic Kidney Dis. 2021;28(3):193-199. doi:10.1053/j.ackd.2021.07.002
- Breitkreutz R, Price S, Steiger HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81(11):1527-1533. doi:10.1016/j.resuscitation.2010.07.013
- Heiberg J, El-Ansary D, Canty DJ, Royse AG, Royse CF. Focused echocardiography: A systematic review of diagnostic and clinical decision-making in anesthesia and critical care. Anesthesia. 2016; 71(9):1091-1100. doi:10.1111/anae.13525
- Janjigian M, Dembitzer A, Srisarajivakul-Klein C, et al. Design and evaluation of the I- Scan faculty POCUS program. BMC Med Ed. 2021;21(1):22. doi:10.1186/s12909-020-02453-2.
- Soni NJ, Schnobrich D, Mathews BK, et al. Point of care ultrasound for hospitalists: A position statement of the Society of Hospital Medicine. J Hosp Med. 2019;14:E1-E6. doi:10.12788/jhm.3079.