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A6789 - A Novel Clinician-Performed Ultrasound Curriculum for Internal Medicine Residents
Author Block: C. Baston1, E. Harmon2, W. Chan3, N. Panebianco3, L. Bellini1; 1Internal Medicine, University of Pennsylvania, Philadelphia, PA, United States, 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, 3Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
Rationale: The evidence base for clinician performed ultrasound (CPU) in the diagnostic workup of certain conditions has grown considerably. Specific competencies have been incorporated into the Accreditation Council of Graduate Medical Education (ACGME) program requirements for emergency medicine (EM) and critical care. Internal medicine (IM) has not yet developed recommendations for implementing CPU as a core competency. Recognizing that faculty would need to supervise residents who use CPU for diagnostic purposes, we sought to understand the ultrasound knowledge among our faculty and to subsequently create a curriculum.
Methods: An online scenario-based knowledge assessment was developed in conjunction with the EM Ultrasound Division at our institution. The survey was sent to faculty identified as educators by the school of medicine. Using a Likert score from 0-4, respondents were asked their comfort levels in using and interpreting ultrasound. They then responded to 12 scenarios asking if they could use ultrasound to assess 9 true (cardiac tamponade, gallstones, intraperitoneal bleed, abscess, abdominal aortic aneurysm, kidney stone, pneumothorax, pulmonary edema, and elevated intracranial pressure) and 3 false (acute otitis media, stroke, and urinary tract infection) indications for CPU.
Results: The survey had 88 responses from 192 faculty, with 22 IM and 16 EM faculty responded. 96% of IM faculty self-assessed as “not comfortable” using or interpreting ultrasound, vs 6% of EM faculty. IM faculty correctly identified the indications for CPU in 75% (sd 22%) of scenarios, compared to 85% (sd 10%) for EM faculty. Based on these results, we developed a curriculum for the IM residency using the framework of Entrustable Professional Activities (EPA’s), with discrete milestones reflecting a gradual progression of independence. Learners start by understanding the indications for ultrasound and subsequently progress to acquire, interpret, and incorporate images into clinical decision-making, and finally to mastery of CPU. The curriculum embraced spaced learning and includes a 1 day annual intensive, access to a sonographer educator during rounds, a flipped classroom model of online modules, rotation-specific ultrasound competencies, and asynchronous quality assurance and feedback (QPATH).
Conclusions: IM faculty at our institution were uncomfortable with the use of CPU compared to EM faculty, suggesting they could not be CPU educators for residents. In order to embed CPU into our program, we generated a phased, competency based curriculum for residents whom we expect to model the value and skill of CPU for our faculty.