Making waves at a community-based program by initiating a diagnostic Pocus curriculum

BACKGROUND: Point-of-care Ultrasound training (POCUS) is becoming standard in Internal Medicine (IM) training programs across the country. However, a 2020 survey conducted by the Association of Program Directors in Internal Medicine reported university-based programs were more likely to implement a POCUS curriculum than other programs (82% vs. 46%, P < 0.001). The aim of this study was to develop, describe, and report out the results of a simple, scalable, and replicable diagnostic POCUS curriculum with definable goals and objectives in a community-based, POCUS Naïve, and limited faculty and resource IM setting. DESIGN: This curriculum was implemented in a 314-bed, community-based hospital system as a component of the IM residency program. Over a 36-month period (July, 2022 – June, 2025), we incorporated three separate iterations of a diagnostic POCUS curriculum. Two Plan, Do, Study, Act (PDSA) cycles were implemented at the end of year one and year two respectively. An online pre and post-test assessed knowledge of POCUS and its applications and a final skills-based image acquisition assessment using live models was performed at the end of each academic year. Residents were separated into cohorts defined as cohort 1 (PGY-1 and PGY-2s during initial curricular implementation), cohort 2 (PGY-1s of the following year), and the advanced cohort (Tier 2 and tier 3 residents during the final iteration). Performance improvement in both knowledge-based assessments and image acquisition were the main outcome measures of this study. RESULTS: Cohort 1 (n = 18/20) had mean knowledge scores that improved from a pretest score of 60.2% (SD 7.8) to a post-test score of 73.3% (SD 9.0), a mean gain of 13.1% (95% CI 8.81–17.42); paired t = 6.43, p < 0.001, Cohen’s dz = 1.51. Post-test data (cohort 1 and 2; n = 11/30) from the following year averaged 83.9% (SD 8.9), a mean difference of 23.3% (95% CI 12.6–34.0) from the year prior. Overall, mean image‐quality scores, using a 0–3 scale, increased across cohorts (cohort 1 = 1.33; cohort 1 and 2 = 1.62; advanced cohort = 2.65), reflecting progressive program maturation and greater engagement among advanced tiers. In the advanced cohort, 10/10 residents were successfully assessed. Proficiency rose to 90.5% (95% CI 80.7%–95.6%) with 74.6% at gold standard quality (95% CI 62.7%–83.7%). CONCLUSION: Having an advanced POCUS curriculum in place with defined goals and objectives can be achievable and have a positive impact in smaller, community-based IM programs. CLINICAL TRIAL NUMBER: Not applicable.

Cohort · Cohort study · Curriculum · Dreyfus model of skill acquisition · Educational measurement · MEDLINE · Cardiac Arrest and Resuscitation · Radiology practices and education · Ultrasound in Clinical Applications