IMPROVING POINT-OF-CARE ULTRASOUND PROFICIENCY OF PRIMARY CARE RESIDENTS THROUGH A FORMAL, FACULTY-LED TRAINING COURSE
INTRODUCATION: Point-of-care ultrasound (POCUS) is gaining momentum as a tool with the capability to improve patient care. POCUS has been shown to enhance the information gathered by physicians during physical examinations, and also plays a major role in improving procedural outcomes. In addition, ultrasound is portable, cost-effective, non-invasive, and does not expose the patient to radiation as with other imaging modalities. Despite its utility, the vast majority of primary care residents in the United States receive little to no training in POCUS during their residency. The purpose of this study was to evaluate an ultrasound-training program for primary care residents and assess participants self-rated proficiency in POCUS before and after the course.
METHODS: Over a 6-month period, a 10-session ultrasound course took place, involving 45 residents in primary care specialties. The course was led by a medicine-pediatrics faculty member with a broad experience in multiple areas of ultrasound training. The course took place from September 2017 through February 2018. Each session lasted 2-hours and consisted of both a didactic lecture and hands-on supervised scanning time. Participants were expected to complete required readings and to view a variety of training videos demonstrating organ or exam specific ultrasounds prior to each session. Participants were surveyed prior to and following the course. The survey aimed to primarily assess participants self-rated proficiency in POCUS.
RESULTS: The pre-survey response rate was 53.3%. The majority of participants reported some degree of prior POCUS exposure, mainly for procedures (58.3%) or on patients for diagnostics (50%). Several residents involved in the course (25%) had no prior POCUS training. Participants were asked to rate their proficiency within 16 different POCUS categories on a 5-point Likert scale (1 = not at all proficient, 5 = expert). The areas where residents identified greatest proficiency were in using ultrasound for procedures (2.66), pulmonary exam (1.75) and cardiac echocardiography (1.65). The average score between all 16 categories was 1.42. The post-survey had a response rate 40%. Self-rated proficiency was highest for POCUS use for procedures (3.66), pulmonary exam (3.05) and examination of the kidneys (2.94) and bladder (2.94). The average score for all 16 categories 2.45.
DISCUSSION: Our study showed that a 10-session POCUS course consisting of self-study, didactic, and hands-on practical experience yielded significant improvement in self-rated proficiency with POCUS. Including all 16 categories assessed, respondents indicated an absolute increase in self-rated POCUS proficiency by 1.03 points on a 5-point Likert scale. This amounts to a relative 72.5% increase in self-rated proficiency. There was an increase in self-rated proficiency in every category included in the survey (16/16), even those where there was no formal teaching in the course (obstetrics, POCUS for procedures). This demonstrates a broader increase in comfort with performing POCUS from the course, including the mechanics of machine use, as well as obtaining and interpreting images, as opposed to simply enhanced exam-specific proficiency.
Overall, our study demonstrated the benefit of a 10-week POCUS course for primary care residents. These benefits included enhanced self-rated proficiency in using POCUS for a variety of examination categories and provided an avenue for residents to practice hands-on ultrasound scans on their colleagues to enhance familiarity with using POCUS in the clinical setting.