ABSTRACT #60

ABDOMINAL POINT-OF-CARE ULTRASOUND: A MULTIMODAL APPROACH

Suraj Shah, James Salonia, Adam Rothman

PURPOSE AND GOALS: Point-of-care ultrasound (POCUS) is an increasingly prevalent modality in the assessment of acutely ill patients. Few Internal Medicine programs have integrated POCUS into the core curricula, with most education being self-directed. This often leads to a wide discrepancy in competency and confidence level amongst residents. We therefore hypothesize that the incorporation of a multimodal approach to teaching abdominal POCUS will increase comfort, confidence, and knowledge in diagnostic image interpretation and acquisition, as well as in performing therapeutic interventions such as paracentesis.

METHODS: Internal Medicine residents were exposed to three different modalities of education: 30-minute interactive lecture, 30-minute hands-on training with task trainers, and a 45-minute high-fidelity simulation case with debriefing. The lectures were primarily focused on ultrasound image acquisition and interpretation to diagnose common pathologies. The task trainer utilized a Zone 1 skills checklist to increase proficiency and confidence in performing paracentesis. The high-fidelity simulation case summated primary objectives of demonstrating proper technique inabdominal ultrasound, as well as identifying ascites to diagnose and subsequently manage a patient.

EVALUATION PLAN: A pretest and posttest survey were given to measure confidence, comfortability, and knowledge in image interpretation/identification and therapeutic intervention (i.e., paracentesis). All questionnaires were administered immediately before and after training. Data was collected from March to April 2022, and analysis of variance (ANOVA) was performed across each PGY (postgraduate year) level.

SUMMARY OF RESULTS: Of the 108 participants included in the study, 95 completed the training modalities and surveys: PGY1 35 (36.8%), PGY2 30 (31.5%), and PGY3 30 (31.5%). Of all participants included, 36.8% had completed an ultrasound elective, rotation, or course in the past, the majority being PGY3. When compared to the pretest across all PGY levels, there was no statistically significant improvement in the participant’s knowledge after the post-lecture evaluation (P-values 0.535, 0.573, 1.000). There was, however, a statistically significant improvement across all PGY levels when analyzing confidence and comfortability with image interpretation and therapeutic intervention (P-value < 0.05).

REFLECTIVE CRITIQUE: This study evaluated the effectiveness of a novel multimodal POCUS curriculum, and showed a statistically significant increase in confidence and comfortability with ultrasound. A blend of interactive didactics, hands-on task training, and high-fidelity simulation can be an effective approach to teaching POCUS. Several limitations are recognized in this study, such as a single center study, its translation directly to clinical care, and assessing retention over a lengthened period.