Minding the Gap(s): Hospitalists Experience Aspirational, Safety, and Knowledge Deficits That Prevent Them From Practicing POCUS

Abstract

Point-of-care ultrasound (POCUS) has been a mainstay of clinical decision-making in the intensive care unit and emergency department for more than a decade, but adoption into hospital medicine has lagged behind. Recently, internal medicine residency programs have started to develop POCUS curricula for trainees, though concurrent hospitalist training programs have been limited to date, with little consensus on what hospitalist-oriented curricula should entail. As such, there is wide variability amongst hospitalists with respect to utilization of, training in, and proficiency in POCUS. We conducted a two-part survey of internal medicine hospitalists at our institution: (1) needs assessment that focused on prior training, attitudes and perspectives, current practices, desired use, and barriers to clinical integration; and (2) knowledge test of exam indications, image interpretation, medical decision-making, and understanding of limitations. Our results demonstrate that a majority of hospitalists felt that POCUS was important for diagnostic purposes and that they would benefit from POCUS-specific education. Inadequate training was the most cited barrier to POCUS use. Hospitalist knowledge was lacking in all domains, particularly image interpretation and clinical integration. As a result, we created a three-tiered training program meant to engage: (1) All hospitalists in basic knowledge and appropriate use of POCUS, (2) Some hospitalists in hands-on skill acquisition and image interpretation, and (3) Few hospitalists in mastery of POCUS with resultant formal credentialing. A tiered approach to POCUS training for hospitalists ensures a fundamental cognitive understanding of POCUS for all, but also facilitates hands-on training for those who are committed to further skillset development.