Point of care ultrasound training for internists in Singapore; A need for structured training and competency assessment

Abstract

In recent years, there have been increasing interest in point of care ultrasonography (POCUS) in General Internal Medicine in Singapore. Internal Medicine Physicians have found it to be a useful adjunct to diagnostics and procedures. Yet a lack of a formal training program has been identified previously as a major barrier in acquiring POCUS skills. This has resulted in a wide variation in skills amongst senior residents and practising internal medicine physicians With the aim of introducing POCUS to Singhealth Advanced Internal Medicine Residency Program, the Department of Internal Medicine in Singapore General Hospital organized our first pilot POCUS course in January 2019. The course was targeted at Advanced Internal Medicine senior residents and focused on image acquisition of the heart, lungs, pleura, genitourinary and lower limb venous systems. A survey was conducted before and after the course, exploring the knowledge, confidence level and skills amongst our senior residents. Our survey revealed that most of our 12 participants had prior experience in POCUS, and their knowledge was picked up mainly during previous clinical rotations (8 of 12), while some had also attended courses (5 of 12), or learnt from their peers (5 of 12). Ultrasound was most commonly used for procedures like central line insertion (10 of 12), thoracocentesis (8 of 12) and abdominal paracentesis (6 of 12). 7 participants had utilized POCUS to evaluate hypotension, 3 for deep vein thrombosis, 2 for dyspnea and 2 for acute kidney injury. All participants agreed that POCUS is an important skill for Internists. While knowledge and confidence in image acquisition for the various systems amongst participants were generally varied and low before the course, there was a marked improvement in all components being surveyed after the course. The participants were more confident and familiar with the required views, landmarks and structures to identify when performing ultrasonography of the various systems. This survey highlights the fact that POCUS is already utilized in an ad-hoc manner in our Internal Medicine service. There is a need to develop a structured training program with a rigorous assessment to standardize the competency of POCUS users in order to ensure patient safety and improve quality of care.