Integrating Point-of-Care Ultrasonography (POCUS) into Residency Curriculum

Background: Interest in Point-of-care ultrasound (POCUS) is increasing throughout medical education. The Alliance of Academic Internal Medicine (AAIM) advocates for its integration into internal medicine (IM) training, though challenges remain including lack of trained faculty. Leveraging specialties like critical care (CC) and nephrology can help overcome these obstacles. We present a comprehensive POCUS curriculum for IM residents, incorporating expertise from CC and nephrology. Methods: The curriculum comprised formal lectures, hands-on training, and objective structured clinical exams. A two-fold approach was employed: CC faculty and fellows conducted a week-long bootcamp, while nephrology faculty extended the curriculum over a year. Residents were expected to follow-up with independently performed POCUS sessions every three months. Results: In the pilot phase, 6 IM residents completed the year-long nephrology-led curriculum. The second group was expanded to 12 residents, with both groups successfully finishing the course. CC faculty guided four cohorts of 6-8 residents through the bootcamp, with full completion. Follow-up POCUS sessions were limited but showed similar participation rates between nephrology and cricital care. Each curriculum presented unique benefits and challenges. The year-long nephrology course offered flexibility to complete the curriculum despite residency scheduling conflicts. However, it delayed the use of POCUS for clinical decision-making, which may have led to missed early training opportunities. The week-long CC bootcamp provided intensive exposure, enabling swift POCUS competency but like Ebbinghaus’s forgetting curve, this approach risked skill attrition without regular follow-up. Conclusion: Utilization of multiple specialties helps integrate POCUS into IM curriculum. CC and nephrology faculty are experienced with POCUS and are able to provide instruction. Additionally, offering varied scheduling options boosts resident participation. As seen by the limited follow-up, POCUS exposure was a limiting variable. Going forward, chief IM residents at our institution will start to supervise admissions. This provides increased opportunities to increase POCUS during the admission process. We additionally plan to incorporate POCUS into the outpatient setting. Faculty at the resident run clinic have undergone POCUS training and will begin to supervise POCUS in the clinic.