Point-of-Care Ultrasound in Internal Medicine: A National Survey of Educational Leadership

Abstract

Background: Ultrasound is a valuable tool in the safe performance of an increasing number of procedures. It has additionally emerged as a powerful instrument for point-of-care assessment by offering internists an opportunity to extend their traditional physical examination.

Objective: This study explored how internal medicine (IM) educators perceive the use of ultrasound for procedures and point-of-care assessments, the extent to which curricula for teaching IM residents ultrasound skills exist, and perceived barriers to teaching its use.

Methods: In February 2012, we administered a 27-question survey to all members of the Association of Program Directors in Internal Medicine, eliciting their opinions about the use of point-of-care ultrasound.

Results: Of 2200 surveys distributed electronically, 234 were returned (a 11% response rate), including 167 by program directors or assistant program directors. Respondents highly rated the usefulness of ultrasound for central-line placement, thoracentesis, paracentesis, and diagnosis of pleural effusions. Evaluation of vena cava and heart, and placement of radial artery catheters received somewhat lower usefulness scores. Forty-five respondents (25%) reported having formal curricula to teach point-of-care ultrasound, and 46 respondents without current ultrasound programs were planning to initiate them in the next 12 months. Potential barriers to teaching and use of ultrasound included the time and cost to train faculty, the cost of ultrasound machines, and the time required to train residents.

Conclusions: Educational leaders in IM view point-of-care ultrasound as a valuable tool in diagnosis and procedures, and many residency programs are teaching these skills to their learners.

FIGURE 1

Perceived Usefulness of Point-of-Care Ultrasound Performed by Internists The graph depicts average usefulness scores (based on a 5-point Likert scale in which 1  =  not at all useful and 5  =  very useful) for survey respondents. The number of responses ranged from 231 to 234 for each item. Abbreviations: IVC, inferior vena cava; FAST, Focused Assessment with Sonography for Trauma; DVT, deep venous thrombosis.

FIGURE 2

Current Usage of Point-of-Care Ultrasound by Internal Medicine Residents The graph depicts the proportion of survey respondents who indicated that residents in their setting currently use ultrasound for a particular application (n  =  161 for all questions). Procedural uses of ultrasound are the most common, with a substantially smaller fraction of residents using point-of-care ultrasound for diagnostic applications. Programs were asked the indication(s) for which residents perform bedside ultrasound; data is the percentage of programs reporting use for the given indication. Abbreviations: IVC, inferior vena cava; FAST, Focused Assessment with Sonography for Trauma; DVT, deep venous thrombosis.