Not just hocus POCUS: Implementation of a point of care ultrasound curriculum for internal medicine trainees at a large residency program

Introduction: In 2018, the American College of Physicians formally acknowledged the importance ofPoint of Care Ultrasound (POCUS) to the practice of internal medicine (IM). For the military internist, POCUS trainingis critical for care of the trauma patient in austere environments, mass casualty events and natural disasters. Whileemergency medicine and critical care training programs have adopted POCUS education, few IM programs have integrated POCUS into their core curricula. We designed and implemented an iterative POCUS curriculum for trainees at alarge military IM residency program over a two-year period. Methods: In collaboration with our critical care and simulation departments, we developed a pilot curriculum consisting of five, 60-minute courses offered on a voluntary basisat monthly intervals throughout 2017. Based on the pilot's success we incorporated a POCUS curriculum into the coreacademics received by all IM trainees during the 2017-2018 academic year. Trainees attended seven, 3-hour sessionsduring their scheduled academic time taught by subspecialists with POCUS expertise in an on-site simulation center.Baseline surveys and knowledge assessment examinations were administered during orientation and repeated at theend of the academic year. Comparison of results before and after the POCUS curriculum was the primary outcomeevaluated. Results: Intervention #1: Pilot, 2016-2017 Academic Year 45 trainees attended at least one course with anaverage of 1.8 sessions per trainee. Baseline survey data showed 91% of trainees believe POCUS is quite or extremelybeneficial for their patients, but 73% feel slightly or not at all confident in POCUS knowledge. The pre-test mean andmedian scores were 71% and 77% respectively, which both increased to a post-test mean and median of 81%. Post-testmean percentage correct for trainees attending 1, 2, or 3 courses was 74%, 82%, and 91% respectively. Intervention#2: Incorporation of POCUS into Core Academics, 2017-2018 Academic Year All 75 trainees participated in trainingwith an average of 3.77 sessions attended per trainee. Survey analysis revealed significant improvement in confidenceof performing ultrasound-guided procedures (p = 0.0139), and a 37% absolute increase in respondents who anticipateusing ultrasound in their clinical practice (p = 0.0003). The mean pre-test score was 67.8% with median of 63.6%while mean and median post-test scores were 82.1% and 81.8%, with an absolute improvement of 14.3% and 18.2%respectively (p = 0.0004). Conclusion: A structured POCUS curriculum was successfully incorporated at a large multiservice military IM residency program, with demonstrated retention of knowledge, improved confidence in performance of ultrasound guided invasive procedures, and increased interest in the use of POCUS in future clinical practice.Similar programs should be implemented across all IM programs in military graduate medical education to enhanceoperational readiness and battlefield care.