An Interdisciplinary Approach to the Introduction of Point-of-Care Ultrasound in an Urban Academic Primary Care Center

Abstract

Introduction Limited guidance exists for primary and urgent care ultrasound applications. This study sought to identify the most useful applications for providers in these clinical settings, to create and implement a structured interdisciplinary point-of-care ultrasound (POCUS) curriculum, and to assess the effectiveness of the course. Methods This prospective cohort study took place at an urban academic medical center. After a needs-based assessment of ultrasound applications in primary and urgent care, the Emergency Medicine ultrasound faculty and fellows were paired with a primary or urgent care provider (N = 6). The pairings met for scanning sessions in the emergency department to practice image acquisition, documentation, and incorporation of ultrasound into the workflow. Participants were given POCUS pre-work to review before each session. The final bedside session included a formal Objective Standard Clinical Examination (OSCE) to assess learner proficiency to be cleared for independent imaging. The program was assessed using pre- and post-training surveys. Results The survey results demonstrated that renal, gallbladder, and soft tissue scans were the most interesting and useful to primary and urgent care providers after completion of the training course. Conclusion The course was effective, and efficient, simple, high-yield POCUS applications should be included in future programs and organizational guidelines for primary and urgent care POCUS education.

Keywords: faculty development; medical education; point-of-care ultrasonography; primary health care; urgent health care.

Figure 1. Responses for pre-training provider familiarity with selected POCUS applications (N = 6)

POCUS application: AAA = Abdominal aortic aneurysm, MSK = Musculoskeletal, IUP = intrauterine pregnancy

Figure 2. Responses for post-training provider familiarity with selected POCUS applications (N = 5)

POCUS application: AAA = Abdominal aortic aneurysm, MSK = Musculoskeletal, IUP = Intrauterine pregnancy

Figure 3. Responses for pre-training (N=6) and post-training (N=5) provider interest in POCUS applications

POCUS application: MSK = Musculoskeletal, IUP = Intrauterine pregnancy, AAA = Abdominal aortic aneurysm, FAST = Focused assessment with sonography for trauma

Figure 4. Responses for post-training provider expected frequency of use for POCUS applications (N = 5)

POCUS application: MSK = Musculoskeletal, IUP = Intrauterine pregnancy, AAA = Abdominal aortic aneurysm, FAST = Focused assessment with sonography for trauma

Figure 5. Responses for perceived barriers to POCUS use in the clinic (N=6)

Figure 6. Reported Use of POCUS Applications in Clinic (N = 7)

POCUS application: MSK = Musculoskeletal, IUP = Intrauterine pregnancy, AAA = Abdominal aortic aneurysm, FAST = Focused assessment with sonography for trauma