Heart and lung point-of-care ultrasonography tutoring in internal medicine: a randomized controlled trial.

Abstract

In recent years, point-of-care ultrasonography (POCUS) has been integrated into internal medicine practice with most curricula composed of a single course. Despite competency acquisition during the course, a significant decline in proficiency occurs in the subsequent weeks due to a lack of regular practice and training. This study aims to evaluate the impact of a structured POCUS tutoring, on POCUS use and skills retention at 6months. In this randomized controlled trial, internal medicine residents were enrolled after completing a practical course focused on heart and lung ultrasonography. Residents assigned to the intervention group were paired with a tutor, and time slots were scheduled for bedside direct supervision over the following 6months. The primary outcome was the proportion of residents who successfully completed at least 25 POCUS examinations six months after inclusion. Secondary outcomes included self- and blinded-expert-assessed POCUS competency skills. Between January and May 2022, 23 residents were included in the study. The intervention significantly increased the proportion of participants reaching the primary outcome (70% versus 0%; p < 0.001) with a median of 27 (interquartile range, IQR, 6 to 44) supervised examinations performed versus 0 (IQR 0 to 0) in intervention and control arm respectively; p < 0.001. After 6months, proficiency was higher for most heart imaging but not for lung imaging, as assessed through self-assessment by participants or independently by blinded experts. Structured POCUS supervision significantly enhances the number of POCUS examinations and proficiency at 6-months, particularly in applications requiring greater visuospatial skills.