Elliott Brian P, Berglund Andrew J, Markert Ronald J, Burtson Kathryn M
Wright Patterson Medical Center, Wright Patterson AFB, OH, USA.
Department of Internal Medicine and Neurology, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
J Med Educ Curric Dev. 2023 Aug 3;10:23821205231193284. doi: 10.1177/23821205231193284. eCollection 2023 Jan-Dec.
Point-of-care ultrasound (POCUS) has extensive clinical utility in internal medicine, but formal and uniform curricula in internal medicine are lacking.
To determine the effectiveness of a longitudinal, flipped-classroom, academic half-day curriculum on internal medicine resident confidence, utilization, and changes in clinical management.
We implemented an asynchronous, flipped-classroom, academic half-day curriculum from November 2020 to November 2021 and conducted an evaluation with a prospective, before-after cohort study. Curriculum included 4 rotating sessions comprised of 20 to 30 min of image interpretation followed by 1.5 to 2 h of image acquisition. Confidence was rated via Likert scale. Utilization was reported via indicating never, 1 to 2, 3 to 4, 5 to 6, or >6 times per month (recorded as 1-5, respectively). Image interpretation was assessed via a 6-question, multiple-choice video assessment.
Nineteen of 99 potential residents (19%) completed a pre- and post-curriculum evaluation. Residents attended a median of 4 sessions. Confidence improved from 2.47 to 3.53 ( = .002). Utilization did not improve overall (2.11-2.42, = .22), but utilization of left ventricular function assessment (1.53-2.00, = .046) and pulmonary assessment (1.53-2.00, = .039) increased. The percentage of residents that had ever changed their clinical management by POCUS increased from 47% to 84% after implementation of the curriculum. Cardiac, pulmonary/pleural, volume assessment, and abdominal free fluid exams were reported as the most clinically useful.
Implementation of a longitudinal, academic half-day curriculum for POCUS resulted in improved confidence, increased POCUS utilization for the cardiac and pulmonary examination, and changes in clinical management based on POCUS.
床旁超声（POCUS）在内科具有广泛的临床应用价值，但内科缺乏正式且统一的课程。
确定一项纵向、翻转课堂、学术半天课程对内科住院医师信心、应用情况及临床管理变化的有效性。
我们于2020年11月至2021年11月实施了一项异步、翻转课堂、学术半天课程，并通过前瞻性前后队列研究进行评估。课程包括4个轮转环节，每个环节包括20至30分钟的图像解读，随后是1.5至2小时的图像采集。信心通过李克特量表进行评分。应用情况通过每月从不、1至2次、3至4次、5至6次或>6次（分别记录为1 - 5）来报告。图像解读通过一个包含6个问题的多项选择题视频评估进行。
99名潜在住院医师中有19名（19%）完成了课程前后评估。住院医师参加课程的中位数为4次。信心从2.47提高到3.53（P = 0.002）。总体应用情况未改善（2.11 - 2.42，P = 0.22），但左心室功能评估的应用（1.53 - 2.00，P = 0.046）和肺部评估的应用（1.53 - 2.00，P = 0.039）增加。课程实施后，因POCUS改变临床管理的住院医师比例从47%增加到84%。心脏、肺部/胸膜、容量评估和腹部游离液体检查被报告为临床上最有用的检查。
实施一项针对POCUS的纵向学术半天课程可提高信心，增加心脏和肺部检查中POCUS的应用，并基于POCUS改变临床管理。
