Entrusting internal medicine residents to use point of care ultrasound: Towards improved assessment and supervision

Abstract

Background: Internal medicine physicians and trainees are increasingly using, and seeking training in, diagnostic point of care ultrasound (POCUS). Numerous internal medicine training programs have described their curricula, but little has been written about how learners should be assessed, supervised, and allowed to progress toward independent practice, yet these practices are imperative for safe and effective use. Entrustable professional activities (EPAs) offer a practical method to assess observable units of professional work and make supervision decisions.

Methods: An EPA for POCUS is used as a framework to assess and determine appropriate levels of supervision in an internal medicine residency program.

Results: All learners have been able to advance to level 2 with a mandatory introductory boot camp course. Learners have been able to advance to higher levels of independence, often after taking formal elective programmatic coursework. However, not all learners taking the same coursework have been granted the same level of independence.

Conclusions: It is feasible to assess and supervise internal medicine residents’ ability to use diagnostic point of care ultrasound using an EPA.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Point of care ultrasound (POCUS): The use of portable ultrasonography at the bedside by the treating clinician for either diagnostic or procedural purposes. Diagnostic POCUS exams are typically focused on a single sign, symptom, or clinical question; and the results of the exam are immediately interpreted and integrated into management decisions by the treating clinician.

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Additional information

Notes on contributors

Daniel J. Schnobrich

Daniel J. Schnobrich, MD, is an internal medicine and pediatrics hospitalist at the University of Minnesota. He has served as a core faculty member of the internal medicine residency program, directed the teaching of POCUS and procedures, and co-directed the medicine procedural service.

Benji K. Mathews

Benji K. Matthews, MD, is the section head of Hospital Medicine at Regions Hospital (St. Paul, MN), the director of POCUS for Health Partners, and is a core faculty member of the internal medicine residency program at the University of Minnesota.

Bernard E. Trappey

Bernard E. Trappey, MD, is an internal medicine and pediatrics hospitalist at the University of Minnesota. He has served as an instructor in the ultrasound and procedures teaching to internal medicine residents, and is the co-director of the advanced ultrasound course, and serves on the procedural service.

Brian K. Muthyala

Brian K. Muthyala, MD, MPH, is an internal medicine and pediatrics hospitalist at the University of Minnesota. He has served as an instructor in the ultrasound and procedures teaching to internal medicine residents, and is the co-director of the advanced ultrasound course.

Andrew P. J. Olson

Andrew P. J. Olson, MD, is an internal medicine and pediatrics hospitalist at the University of Minnesota. He is an instructor in both the ultrasound and procedures teaching to internal medicine residents, co-directs the medical procedure service, and leads several initiatives to introduce POCUS skills to medical students.