A Tale of Two Curriculums: Strategies for POCUS Instruction in the ICU

Abstract

Rationale: It is recommended that internal medicine residency programs incorporate point of care ultrasound (POCUS) training into the curriculum. However, the optimal approach to this training lacks recommendations or structural guidelines. We sought to compare an asynchronous video curriculum to a bedside hands-on/didactic curriculum. We used diagnostic accuracy as a surrogate for quality of ultrasound education. We hypothesize there is no difference in the accuracy of cardiac and lung POCUS comparing these two strategies. Methods: This pilot study was conducted in the Medical Intensive Care Unit at the University of Maryland Medical Center. Via block randomization, internal medicine trainees were assigned to a combined hands-on/didactic (further called “didactic”) ultrasound curriculum or a video-based curriculum. The didactic curriculum consisted of a 45-minute demonstration of cardiac and lung POCUS taught by a pulmonary/critical care fellow. Trainees assigned to the video curriculum were provided access to six short, topic-focused ultrasound videos. For both curricula, topics included introduction to the machine, parasternal long axis, parasternal short axis, apical four chamber, and subxiphoid views. Lung ultrasound focused on lung sliding, B lines, A lines, and pleural effusions. Participants were asked to perform ultrasounds while rotating in the MICU on patients who were scheduled to receive a gold-standard diagnostic test (CT chest, chest X-ray, formal transthoracic echocardiogram). Trainees were asked to comment on left and right ventricular function and pericardial effusion. Lung ultrasound evaluated for pneumothorax, pleural effusion, pulmonary edema, and ascites. Participants recorded the interpretations of their images in an online based form, prior to reviewing the formal gold-standard study. The results of the formal exams were retrospectively compared to the POCUS interpretations. The primary outcome of this study was diagnostic accuracy. Results: A total of 36 cardiac exams and 20 lung exams were performed. We utilized a Fisher's Exact Test to compare the diagnostic accuracy of those who receive the didactic curriculum to the video curriculum. There was no difference in interpretation accuracy between didactic and video curriculums in cardiac or lung ultrasound. Conclusion: Based on diagnostic accuracy, a video-based POCUS curriculum is non-inferior to a didactic curriculum. As the COVID pandemic continues, the medical education paradigm will need to shift from traditional strategies to ones that implore asynchronous learning to promote social distancing. However, this cannot come at the cost of inferior medical education. Our results suggest that instruction can continue safely using a video-based curriculum with no impact on ultrasound education. (Table Presented).