Anstey James E, Jensen Trevor P, Afshar Nima
From the Department of Medicine, University of California, San Francisco.
South Med J. 2018 Jul;111(7):444-448. doi: 10.14423/SMJ.0000000000000831.
Internal medicine (IM) residency point-of-care ultrasound (POCUS) curricula are being developed but often are limited in scope or components. In this article, we discuss the demonstration of a need for POCUS training in our large academic IM residency program; the development of a longitudinal curriculum; and the impact of the curriculum on POCUS knowledge, use, and confidence.
In 2014, we designed a cross-sectional POCUS survey and knowledge test for all IM residents at the University of California, San Francisco. The results of this assessment drove the design of a longitudinal POCUS curriculum that included a 2-hour workshop for all IM interns and a 1-month elective offered to all IM residents. Residents were tested on their POCUS knowledge and image interpretation before the elective and were given the same test 6 months after the elective. The posttest included a survey of self-reported POCUS use and confidence.
In the needs assessment, residents scored a mean of 27% on the knowledge test, and across all applications the percentage of residents reporting confidence in their POCUS skills was lower than the percentage reporting use of the application in clinical practice. Residents scored a mean of 37% on the elective pretest and 74% on the posttest, an increase of 37% (95% confidence interval 31.6-42.8, < 0.001), with improvements seen across all applications. After the elective, self-reported use of POCUS and confidence in POCUS skills were increased for the applications, using the needs assessment as an approximate baseline. For core cardiac and pulmonary applications, 76% to 95% of residents, depending on application, reported "high" or "very high" use and 79% to 100% reported "high" or "very high" confidence in their POCUS skills.
We used a needs assessment to guide the development of a longitudinal, multidisciplinary POCUS curriculum. Residents who completed all components showed substantial long-term gains in knowledge in all major applications and high use of and confidence in cardiac and pulmonary applications.
内科住院医师即时超声（POCUS）课程正在不断发展，但范围或内容往往有限。在本文中，我们讨论了在我们大型学术性内科住院医师培训项目中对POCUS培训需求的论证；纵向课程的开发；以及该课程对POCUS知识、应用和信心的影响。
2014年，我们为加州大学旧金山分校的所有内科住院医师设计了一项横断面POCUS调查和知识测试。该评估结果推动了纵向POCUS课程的设计，该课程包括为所有内科实习医生举办的为期2小时的研讨会，以及为所有内科住院医师提供的为期1个月的选修课。在选修课之前对住院医师的POCUS知识和图像解读能力进行测试，并在选修课6个月后进行相同的测试。后测包括对自我报告的POCUS使用情况和信心的调查。
在需求评估中，住院医师在知识测试中的平均得分为27%，在所有应用中，报告对自己的POCUS技能有信心的住院医师百分比低于报告在临床实践中使用该应用的百分比。住院医师在选修课预测试中的平均得分为37%，后测试中的平均得分为74%，提高了37%（95%置信区间31.6 - 42.8，P < 0.001），所有应用均有改善。选修课之后，以需求评估为大致基线，自我报告的POCUS应用情况和对POCUS技能的信心在各项应用中均有所增加。对于核心心脏和肺部应用，76%至95%的住院医师（取决于应用）报告“高”或“非常高”的使用频率，79%至100%的住院医师报告对自己的POCUS技能有“高”或“非常高”的信心。
我们利用需求评估来指导纵向、多学科POCUS课程的开发。完成所有课程内容的住院医师在所有主要应用的知识方面取得了显著的长期进步，并且在心脏和肺部应用中的使用率很高，信心也很强。
