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Browsing by Subject "POCUS"

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    Development of a Musculoskeletal Ultrasound Curriculum for Internal Medicine Residents
    (2025-04-25) Chaudhari, Rachna; Wilson, Reid; Chaudhari, Sonia; Ventura, Meredith
    Introduction/Background: As the utilization of point of care ultrasound (POCUS) increases in internal medicine, residency programs have begun to implement aspects of training within the curriculum. Most residency programs focus on cardiac and lung, but few have strong outpatient curriculums as evidenced by literature search. Study objective/hypothesis: Our hypothesis is that by implementing a musculoskeletal (MSK) ultrasound lecture and basic skills workshop among the first-year residents at our program, knowledge of MSK POCUS in the outpatient setting will increase. Methods: This study includes internal medicine residents from Indiana University. Likert scale surveys were provided to participants to assess current knowledge, perceptions, and current utilization of diagnostic musculoskeletal ultrasound in practice. Residents then participate in a mandatory lecture session which is followed by a simulation session. A post survey utilizing a Likert scale survey will be provided to assess resident’s knowledge acquisition and utility of the session. Chi square analysis was done on pre and post survey questions. Results: 74% of PGY-1 residents had not been trained on MSK POCUS prior to residency. Prior to residency, 44% of PGY-1’s were extremely uncomfortable obtaining and interpreting MSK POCUS images, and 39% and 27% of PGY-1s were somewhat uncomfortable. Following the session, knowledge and skills improved (p<0.05). Prior to the session, 61% of respondents were uncomfortable with performing physical exam maneuvers to identify common orthopedic pathologies of the knee. After the session, 83% of respondents stated they were more comfortable (p<0.05). Conclusions: MSK POCUS can be easily incorporated into the residency curriculum. Though the power of this study was low due to low sample size, there was improvement in knowledge and skills before and after the session. In the future, this curriculum could be replicated with more residents to better assess efficacy of this pilot program.
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    Leveraging Advanced Cardiac POCUS in the Diagnosis of Infective Endocarditis with Negative Conventional Imaging: A Case Report
    (2025-04) Sanjuan, Adriano; Andrade, Heather; Bundy, Alyson; Clapham, Philip; Markus, Nathan; Brenner, Daniel; Hariri, Irina; Jackson, Edwin
    Introduction. Infective endocarditis (IE) is a life-threatening condition that includes bacteremia and echocardiographic findings. However, many cases yield inconclusive results with transthoracic (TTE) or transesophageal echocardiography (TEE), creating diagnostic challenges. This report highlights the role of advanced cardiac point-of-care ultrasound (POCUS) in addressing these limitations, using daily POCUS exams to address these limitations. Case report. A 68-year-old male with methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and recurrent fevers underwent multiple conventional TTEs and a TEE, that failed to detect valvular vegetations. Advanced cardiac POCUS, including parasternal long-axis (PLAX), parasternal short-axis (PSAX), right ventricular (RV) inflow/outflow, and apical four-chamber views, was performed daily at the bedside. The PLAX view enabled visualization of new onset of aortic regurgitation, and Color Doppler imaging was applied to assess the severity of the valve disfunction. A vegetation in the aortic valve was identified, later confirmed by a consultative TTE and TEE, leading to a change in management. Discussion. This case highlights the utility of advanced cardiac POCUS in diagnosing IE when conventional imaging is inconclusive. Advanced cardiac POCUS offers immediate, bedside diagnostic insights, making it a valuable tool for critically ill patients. Compared to basic cardiac POCUS, the advanced cardiac POCUS includes the RV inflow/outflow (that can be achieved through tilting or fanning of the probe), and use of color Doppler. A study by Hellmann et al. demonstrated that medical residents could achieve significant proficiency with color Doppler, with minimal formal training, aligning with our experience. Despite limitations such as operator dependency and patient characteristics, the integration of advanced cardiac POCUS into diagnostic workflows has the potential to improve diagnostic accuracy and outcomes. Additionally, the case emphasizes the need for advanced cardiac POCUS education among trainees, expanding their ability to address complex clinical scenarios.
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    The State of Point-of-Care Ultrasound Training in Undergraduate Medical Education: Findings From a National Survey
    (Wolters Kluwer, 2021-11) Russell, Frances M.; Zakeri, Bita; Herbert, Audrey; Ferre, Robinson M.; Leiser, Abraham; Wallach, Paul M.; Emergency Medicine, School of Medicine
    Purpose: The primary aim of this study was to evaluate the current state of point-of-care ultrasound (POCUS) integration in undergraduate medical education (UME) at MD-granting medical schools in the United States. Method: In 2020, 154 clinical ultrasound directors and curricular deans at MD-granting medical schools were surveyed. The 25-question survey collected data about school characteristics, barriers to POCUS training implementation, and POCUS curriculum details. Descriptive analysis was conducted using frequency and percentage distributions. Results: One hundred and twenty-two (79%) of 154 schools responded to the survey, of which 36 were multi-campus. Sixty-nine (57%) schools had an approved POCUS curriculum, with 10 (8%) offering a longitudinal 4-year curriculum. For a majority of schools POCUS instruction was required during the first (86%) and second year (68%). Forty-two (61%) schools were teaching fundamentals, diagnostic, and procedural ultrasound. One-hundred and fifteen (94%) schools identified barriers to implementing POCUS training in UME, which included lack of trained faculty (63%), lack of time in current curricula (54%), and lack of equipment (44%). Seven (6%) schools identified no barriers. Conclusions: Over half of the responding medical schools in the United States had integrated POCUS instruction into their UME curricula. Despite this, a very small portion had a longitudinal curriculum and multiple barriers existed for implementation, with the most common being lack of trained faculty. The data from this study can be used by schools planning to add or expand POCUS instruction within their current curricula.
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    Two-week intensive medical student point-of-care ultrasound training impact on long term utilization
    (Springer Nature, 2024-08-16) Herbert, Audrey; Russell, Frances M.; Ferre, Robinson M.; Wilcox, James; Peterson, Dina; Davis, Jean; Zakeri, Bita; Hays, Matthew; Wallach, Paul M.; Emergency Medicine, School of Medicine
    Background: There is little to no data evaluating long term usage of point of care ultrasound (POCUS) after a training intervention for medical students. The purpose of this study was to examine the impact of an intensive POCUS training program on medical student's usage at 9-months post-program. Methods: This was a prospective cross-sectional study of rising second year medical students who participated in a 2-week summer POCUS training program. Instruction consisted of 8 h of asynchronous online didactic material, 2-4 h of daily hands-on instructor-led and independent scanning, and instruction on how to teach POCUS. Students were assessed pre- and post-program, and again at 9 months post-program to evaluate POCUS usage. Results: A total of 56 students participated in the program over 2 summers; 52 (92.9%) responded to the 9-month post-program survey. At 9 months, 49 (94.2%) of students taught POCUS after the program to peers or faculty. Students reported serving as a POCUS instructor in 283 subsequent teaching sessions accounting for 849 h of POCUS instruction time. Six (11.5%) students were involved in the creation of a POCUS interest group on their regional campus, 7 (13%) created a POCUS curriculum for their student interest group, and 4 (7.7%) created an opt-in co-curricular POCUS program for students at their regional campus. Three (5.8%) students did not serve as educators after the program and only one student reported not using POCUS again after the program. Conclusion: After a 2-week intensive POCUS training program for medical students, the majority of students demonstrated continued involvement in POCUS learning and education at 9-month follow-up including serving as peer instructors and assisting with limitations in financial resources and trained faculty.
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    Use of Artificial Intelligence Program to Increase Resident Confidence and POCUS Use at the Bedside
    (2024-04-26) Wilcox, James; Lobo, Daniela; Hernandez, Reuben; Holley, Matthew; Renshaw, Scott
    Introduction: Point of Care Ultrasound (POCUS) education continues to increase in undergraduate and graduate medical education, mostly fueled by clinical usefulness and increasing graduate medical education requirements. Many schools are now teaching POCUS as a core part of the curriculum. However, with the sudden rush of POCUS education, one barrier often identified in the literature is a lack of trained faculty to educate residents and medical students. Study Objective: Our team at the Family Medicine Department recruited an artificial intelligence program developed by Global Ultrasound Institute to assist POCUS instructors with resident ultrasound education. The research project would use AI programming and learning to allow residents to access timely answers to questions at the bedside while on rounds, when a trained POCUS instructor might not always be present. Since POCUS instructors cannot be available for every bedside patient examination in the hospital or residency clinic, this AI program would provide answers to needed bedside questions to give residents more confidence with performing more POCUS evaluations. Methods: We would deploy the AI program for interns who have completed at least 6 months of POCUS training and residents who had completed prior intern POCUS training. This program would be available on smart phone devices for when rounding in adult medicine, pediatrics, OBGYN, and in the outpatient residency clinic. Residents will have 24/7 access to a smart AI who will answer questions about POCUS technique, indications for use, interpretation questions, and many more. The program will give residents a quick and focused answer, as well as access to resources for further study if needed. Resident POCUS use will be tracked with the Butterfly IQ academy, as well as with resident procedure logging. Results: Since this is a very new program and relationship with Global Ultrasound Institute, no results are currently available. We anticipate preliminary results will be available by the presentation date in April. Conclusions: Artificial Intelligence is changing the way medical education is approached in the United States and the world. This particular program will allow residents to have access to timely answers to their POCUS practice questions at the bedside, while on rounds. We anticipate this will allow residents the opportunity to use the ultrasound devices for more cases and scenarios, as well as have improved confidence in their ultrasound acquisition abilities, with the support of the AI Education Assistant.
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    Use of Ultrasound in the Prehospital Setting: A Scoping Review
    (Elsevier, 2025-03-01) Warren, Jonathan; Tamhankar, Omkar; Toy, Jake; Schlesinger, Shira A.; Liu, Yiju Teresa; Medicine, School of Medicine
    Objectives: With the advent of portable devices, prehospital ultrasound is increasingly available and has the potential to provide clinical and procedural decision support. This scoping review seeks to examine current literature on prehospital ultrasound, including study indications, the level of the health care professionals performing prehospital ultrasound, and reported research outcomes. Methods: We searched PubMed, Embase, Web of Science, CINAHL, and Cochrane databases for research articles and conference abstracts focused on prehospital ultrasound with scans performed in the field. After title/abstract screening by 2 independent reviewers, a full-text review was performed. We excluded reviews, case reports, letters to the editor, and research published in nonEnglish language. Descriptive statistics were reported. Results: We identified 9718 unique articles, and 109 were included after title/abstract review (Kappa 0.68) and full-text analysis. Annual publications increased yearly (P < .01). Nineteen countries were represented, with the United States having the highest number of publications (n = 34, 31.2%). Most studies were prospective (n = 74, 67.9%) with few randomized control trials (n = 6, 5.5%). Feasibility studies comprised 45.9% (n = 50) of the included publications, while clinical outcomes were the primary interest in 18 studies (16.5%). Physicians (n = 58, 53.2%) and paramedics (n = 38, 34.9%) were the most studied prehospital clinicians. The most common indication was trauma (n = 49, 45%) followed by dyspnea (n = 13, 11.9%) and cardiac emergencies (n = 10, 9.2%). Conclusion: There is a growing, heterogeneous body of literature describing the use of prehospital ultrasound. Published literature was primarily prospective and described feasibility trials. Identified gaps include a lack of studies in pediatric patients and research identifying clinical outcomes.
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