Internal Medicine Residency Point-of-Care Ultrasound (POCUS) Consensus Recommendations for Core Indications and Applications

Abstract

Background: Bedside point-of-care ultrasound (POCUS) is quickly becoming a routine part of internal medicine practice and training. The optimal POCUS training venue for internists is at the graduate medical education or residency stage of their career. Despite increased training, clinical use, and broad internal medicine society endorsement in the United States, no internal medicine POCUS consensus curricula exist. The goal of this consensus process was to guide the core elements for inclusion within internal medicine residency POCUS curricula in the United States.

Methods: A 4-step modified Delphi methodology was used to establish consensus (75% agreement) recommendations for core indications and applications among a panel of 14 inpatient- and outpatient-based, residency-affiliated, internal medicine POCUS experts in the United States.

Results: The consensus process identified 12 core diagnostic and 6 procedural POCUS indications (eg, dyspnea, shock, chest pain, thoracentesis, etc.), with an associated 15 diagnostic POCUS applications (eg, focused cardiac, gallbladder, urinary bladder, etc.) and 52 specific skill components (eg, identification of pericardial effusion, cholelithiasis, bladder volume, etc.) that reached consensus for inclusion in core curricula.

Conclusions: This consensus process represents the first expert and evidence-based recommendation for what POCUS elements should fall into a core internal medicine residency-based curriculum in the United States. Many areas not meeting consensus for inclusion still fall within the broader internal medicine POCUS scope and can be clinically impactful for specific subgroups of internists, such as advanced internal medicine POCUS users, and specific inpatient and outpatient clinical environments.

Keywords: Internal medicine; Medical education; Physical exam; Point-of-care ultrasound; Residency.