Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group

Irene W Y Ma,Shane Arishenkoff,Marcus Blouw,Jonathan Ailon,Jeffrey Wiseman,Samantha Halman,Janeve Desy,Leslie Martin,Patrick Willemot,Mirek Otremba

doi:10.1007/s11606-017-4071-5

Abstract

Bedside point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. At present, no consensus exists for what POCUS curriculum is appropriate for internal medicine residency training programs. This document details the consensus-based recommendations by the Canadian Internal Medicine Ultrasound (CIMUS) group, comprising 39 members, representing 14 institutions across Canada. Guiding principles for selecting curricular content were determined a priori. Consensus was defined as agreement by at least 80% of the members on POCUS applications deemed appropriate for teaching and assessment of trainees in the core (internal medicine postgraduate years [PGY] 1–3) and expanded (general internal medicine PGY 4–5) training programs. We recommend four POCUS applications for the core PGY 1–3 curriculum (inferior vena cava, lung B lines, pleural effusion, and abdominal free fluid) and three ultrasound-guided procedures (central venous catheterization, thoracentesis, and paracentesis). For the expanded PGY 4–5 curriculum, we recommend an additional seven applications (internal jugular vein, lung consolidation, pneumothorax, knee effusion, gross left ventricular systolic function, pericardial effusion, and right ventricular strain) and four ultrasound-guided procedures (knee arthrocentesis, arterial line insertion, arterial blood gas sampling, and peripheral venous catheterization). These recommendations will provide a framework for training programs at a national level.

Highlights

The use of point-of-care ultrasound (POCUS) has increased significantly over the last decade. This is likely the result of accumulating evidence demonstrating that effective POCUS skills can be acquired with minimal training[1,2,3] and that POCUS may improve diagnostic performance when used with the traditional physical examination,[4,5,6] especially in situations where patient characteristics limit the accuracy of the physical examination.[7,8]
Each identified lead was invited to participate in a 4-h consensus meeting, using a modified nominal group technique (NGT),[22] held during the Canadian Society of Internal Medicine (CSIM) Annual Meeting in Montréal, QC, on October 29, 2016
We recommend that four applications and three procedures be included in the core Internal Medicine PGY 1–3 curriculum

Summary

Introduction

The use of point-of-care ultrasound (POCUS) has increased significantly over the last decade. This is likely the result of accumulating evidence demonstrating that effective POCUS skills can be acquired with minimal training[1,2,3] and that POCUS may improve diagnostic performance when used with the traditional physical examination,[4,5,6] especially in situations where patient characteristics limit the accuracy of the physical examination.[7,8]. POCUS has significant utility in assessing patients seen by internists. POCUS guidance of some bedside procedures reduces errors and complications.[11,12,13] Lastly, POCUS use in internal medicine may result in reduced expenditures.[14]

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