Handheld Ultrasound Device Usage and Image Acquisition Ability Among Internal Medicine Trainees: A Randomized Trial

Abstract

Background: There is insufficient knowledge about how personal access to handheld ultrasound devices (HUDs) improves trainee learning with point-of-care ultrasound (POCUS).

Objective: To assess whether HUDs, alongside a yearlong lecture series, improved trainee POCUS usage and ability to acquire images.

Methods: Internal medicine intern physicians (n = 47) at a single institution from 2017 to 2018 were randomized 1:1 to receive personal HUDs (n = 24) for patient care/self-directed learning vs no-HUDs (n = 23). All interns received a repeated lecture series on cardiac, thoracic, and abdominal POCUS. Main outcome measures included self-reported HUD usage rates and post-intervention assessment scores using the Rapid Assessment of Competency in Echocardiography (RACE) scale between HUD and no-HUD groups.

Results: HUD interns reported performing POCUS assessments on patients a mean 6.8 (SD 2.2) times per week vs 6.4 (SD 2.9) times per week in non-HUD arm (P = .66). There was no relationship between the number of self-reported examinations per week and a trainee's post-intervention RACE score (rho = 0.022, P = .95). HUD interns did not have significantly higher post-intervention RACE scores (median HUD score 17.0 vs no-HUD score 17.8; P = .72). Trainee confidence with cardiac POCUS did not correlate with RACE scores.

Conclusions: Personal HUDs without direct supervision did not increase the amount of POCUS usage or improve interns' acquisition abilities. Interns who reported performing more examinations per week did not have higher RACE scores. Improved HUD access and lectures without additional feedback may not improve POCUS mastery.

Figure

Overview of Study Note: In period 1, assessments were performed on incoming 2017 interns (pre-intervention/baseline measurement) who were at the beginning of their year. No point-of-care ultrasound (POCUS)–related didactics were administered prior to the pre-intervention measurement. In period 2, they all received weekly didactics in POCUS while rotating on the inpatient wards service. In addition, they were randomized 1:1 to have personal access to a handheld ultrasound device (HUD; n = 24) or no such device (non-HUD; n = 23). In period 3, post-intervention assessments were performed after completing their year of ultrasound training. We compared image acquisition performance between pre- and post-intervention groups, as well as HUD vs no HUD groups. Due to scheduling constraints, 25 interns completed the post-intervention measurement (HUD, n = 11; no-HUD, n = 14).