MSK PoCUS Training for Rural Clinics

Abstract

INTRODUCTION: Point of care ultrasound (PoCUS) is a portable diagnostic technology with broad applicability, no radiation, and is less expensive than alternative imaging methods. PoCUS is emerging as high utility technology to expand bedside physical exams for primary care practitioners. Access to medical care in rural areas is an ongoing issue, especially for specialty care. By using PoCUS, rural providers may be able to more completely screen for conditions and determine if patients will need to seek specialty care, such as orthopedic intervention, which is often more time consuming for rural patients. OBJECTIVES: This study is to identify barriers to learning and using point of care ultrasound technology for rural primary care practitioners for expanded examination, including for orthopedic applications. The secondary objective of this pilot study is to evaluate the best practices of expanding rural PoCUS training. METHODS: The team identified six rural primary care practitioners at outpatient clinics around Indiana. Grant funding was used to equip these clinics with portable ultrasound probes with PoCUS-software-equipped iPads. Training consisted of approximately one hour of independent didactic material and two hours of in-person hands-on training with our investigators and students. Initial surveys were collected before and after the in-person training session. After a few months of individual practice, teleguidence training sessions were offered to the participants. Post-training surveys will be collected approximately six months after the initial training session. At this time, the first and second surveys for the six physicians have been analyzed and provide preliminary results. RESULTS: The pre-training survey from the six physicians before the in-person training session found that previous PoCUS experience of these physicians varies greatly, and nearly all of these practitioners have not used ultrasound in their clinic within the last year. This survey also showed unanimously that these physicians make orthopedic diagnoses in their practice but do not feel comfortable using ultrasound in supporting these diagnoses, showing the potential for PoCUS in their clinical practice. The second survey results have shown that even after just two hours of training, the physicians are comfortable with using ultrasound to support their orthopedic diagnoses, to the point that the majority are also somewhat comfortable teaching this material to others. All of the physicians agreed that the independent didactic material supplemented the in-person training, which supports both the quality and platforms provided for this material. The enthusiasm and improved confidence after the training sessions also support the quality of our investigators’ in-person training sessions. Though it was not difficult to recruit physician participants, one of the biggest obstacles this study faced was scheduling the in-person training session. CONCLUSION: Implementation of PoCUS in rural clinics for the evaluation of orthopedic diagnosis was met with enthusiasm and has shown potential for streamlining evaluation at specialty clinics. Major barriers to adopting this technology include finding adequate time for medical practitioners to learn and practice using the equipment and scheduling live, on-going training.