The Master Clinician's Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine.

Cason Pierce Md,Joseph Walker Keach Md,Rebecca Allyn Md,Maria Gabriela Frank Md,Gerard Salame Md,Noelle Northcutt Md

doi:10.24908/pocus.v5i1.14225

Abstract

Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program's aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents' knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.

Highlights

Many internal medicine residency programs have incorporated ultrasonography into their curriculum; its integration with physical examination skills teaching at a graduate medical level is scarce
Our data clearly shows a marked improvement of learners in both their physical exam and point-of-care ultrasound (POCUS) skills
While our elective is a collaboration of four physical exam -focused providers and two POCUS providers, it could feasibly be run with as few as 1 of each with enrollment limited to four participants

Summary

Introduction

Many internal medicine residency programs have incorporated ultrasonography into their curriculum; its integration with physical examination skills teaching at a graduate medical level is scarce. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In its Choosing Wisely® campaign, the American Board of Internal Medicine highlights the downstream effects of blind reliance on technological innovation in the practice of medicine: increased healthcare expenditures, medically unnecessary interventions, and adverse patient outcomes [6,7] Within this context, our elective provides learners with a more tempered integration of a new imaging modality—Point of Care Ultrasonography (POCUS)—into clinical practice with specific goals: to answer a focused clinical question, improve procedural safety, minimize complications, and augment the accuracy of the physical examination

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Results

Discussion

Conclusion