ISN POCUS: https://academy.theisn.org/products/pocus-curriculum
Welcome to the POCUS Curriculum. On this page you will see the following:
1. Structure: Goals, Educational Strategies, Curriculum Outline
2. Core Didactic Sections
3. POCUS Checklist and Image Atlas
4. POCUS Resources
Structure
Goals
The goal of the POCUS curriculum is to create a longitudinal learning platform, as part of a competency based medical education for the Internal Medicine residents to gain the clinical skills and knowledge to confidently integrate POCUS generated images into their clinical reasoning across multiple clinical learning environments. The POCUS curriculum will focus on learner skills development in Basic US, Lung, Cardiac, Abdominal, Vascular, eFAST, MSK Joints (optional) image acquisition and integration into the medical decision-making process. Procedurally, the residents will utilize the POCUS curriculum to obtain proficiency in paracentesis, thoracentesis, arterial lines, central venous access, and joint aspiration as part of the parallel simulation curriculum.
Overall Competency Based Goals: (by the end of the POCUS training Curriculum)
- Recognize the indications, contraindications, and limits of POCUS (Patient Care)
- Identify anatomical structures and pathophysiology processes with POCUS (Medical Knowledge)
- Develop and expand POCUS knowledge through learning and teaching assignments and utilization of online resources (Practice-based Learning and Improvement)
- Communicate POCUS image findings to the patient care team(s) and document/store the image results properly (Interpersonal and Communication Skills)
- Discuss the risks and benefits of POCUS and alternatives to POCUS with the patient and patient care team(s), and obtain verbal consent prior to a POCUS utilization (Professionalism)
- Utilize POCUS with an aim to increase patient care and safety by improving diagnostic speed and accuracy, reduce procedure complications, and patient care treatment plans (Systems-based Practice)
The following Five (5) direct observation behaviors will be used to determine a standard evaluation means for Basic IM POCUS training certification (modified from Bahner et al “I AIM” Model(1):
- Identify clinical question(s) to be answered, Indications, Contraindications, Limitations
- Demonstrate acquisition of the image
- Interpret the image at the point of care
- Integrate the image with other clinical data for patient care improvement
- Store the acquired image appropriately (used to justify certification)
Educational Strategies
The resident learner will attend targeted anatomical dedicated didactics and conferences, faculty and resident driven workshops, simulation, and small group problem-based learning to develop the skills necessary to utilize POCUS to its maximum benefit. These learning sessions will be scheduled annually with review and updates periodically as needed based on PGY training year, proficiency, and maintenance of proficiency. At the closing of each didactic session the resident will complete a hands-on synchronous workshop either immediately post-lecture or within a set time period. The resident is expected to come to all didactic and hands-on learning sessions with the basic knowledge/understanding of the lecture topic specific anatomy, physiology, pathophysiology, and related procedure. The resident learner will be expected to know how to perform a complete physical exam as it related to the didactic and workshop, respectively. Audio & Visual review resources specific to the upcoming didactic and hands-on session are available for the resident to read/review prior to attending any session. These are for the resident learner’s benefit, should the resident feel they need to brush up on their physical exam skill and understanding of the human anatomy.
Curriculum Outline
- Didactic Sessions
– A combination of in-person and online didactics (all are available online).
– Core 5 sessions (Basics, Pulmonary, Cardiac, Abdominal, Vascular) will demonstrate basic skills and understanding of highlighted area. A rapid integration approach will be used with all 5 sessions covered during orientation for incoming residents.
– Pre and Post-Test questions - Hands on Practice
– During the R1 Research and QI block, you will take 1 week for hands on practice with live patients and walk through the Checklist (listed below).
– This will provide kinesthetic practice to help optimize image orientation and quality.
– Allow for image collection and ability to review post-collection. - Implementation and Longitudinal Learning
– Didactic sessions will be used throughout the year ranging from basic understanding, workshops, and to integration/implementation into physical exam and diagnostic reasoning.
– Simulation Curriculum and manikin practice (separate).
Core Didactic Sessions
*Click on image to go to designated didactic session.
POCUS Checklist and Image Atlas
Listed below is the POCUS Checklist required to go through during the R1 Research and QI block. Do NOT forget to log in New-Innovations as a procedure.
Curriculum Resources
Applications (Phone and Tablet)
- Ohio State POC U/S
- 1 minute US
- SonoSupport
- SonoAccess
Books
- Point of Care Ultrasound Book, Nilam Soni et al
- Most med schools have access to clinicalkey.com where anyone can access the book.
- Atlas of Handheld Ultrasound: problem driven ultrasound, like “anuria” with algorithms
- Introduction to Bedside Ultrasound iBook, Volume 1: Volume 1 & 2 are great resources assembled by the well-know EM docs behind US podcast
- Introduction to Bedside Ultrasound iBook, Volume 2: Volume 1 & 2 are great resources assembled by the well-know EM docs behind US podcast
Podcasts
Ultrasound Podcast: Podcasts
University of California Irvine iTunes U: 21 Video/Audio Podcasts
Modules and Websites
123 Sonography: ECHO (only a few are free)
ACEP: SonoGuide
ACP: POCUS Learning Center
AIUM: US in Medical Education Portal
American Medical Society for Sports Medicine’s Sports: Online Didactics (sign up for free)
Cascades East Family Medicine: US Curriculum site
Core Ultrasound:
– Home Page
– 5 Minutes Sono: video review
– Ultrasound of the Week
Echocardia: Home Page
Emergency Ultrasound: Home Page
Evidence and POCUS Atlas: Compilation of Evidence and Articles
IM Bedside US Site: Abbott NW residency program US page IMBUS Home
IMRESPDX: Home Page
NorthWestern IM US: Home Page
NYSORA: Regional Anesthesia Techniques
OHSU IM Residency Site Ultrasound: Resource Page
POCUS 101: Home Page
Society of Hospital Medicine: US Home Page (there is a member cost)
Society of Ultrasound in Medical Education: Comprehensive modules covering basics
SonoInternest: Home Page
SonoMojo: Guide to Bedside Ultrasound
SPOCUS: FOAM-ED POCUS Resource Page
Standford: ECHO Basics
UBC IM POCUS: Home Page
Ultrasound Training Solutions: DIY US Phantom Compilation
University of South Carolina: Anatomy and Physiology (Youtube)
Twitter (not all inclusive)
- @DRsonosRD
- @Sonointernist
- @pdxfutbal
- @benjikmathews
- @NsquaredPOCUS
- @IMUS_Spokane
- @AIUMultrasound
- #IMpocus
- #POCUS
- #FOAMus
- #FOAMed
Journal Articles (IM US Focus)
Kimura BJ, Shaw DJ, Amundson SA, Phan JN, Blanchard DG, DeMaria AN. Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination. J Ultrasound Med. 2015;34(9):1683-1690. doi:10.7863/ultra.15.14.09002.
Kimura BJ, Amundson SA, Phan JN, Agan DL, Shaw DJ. Observations during development of an internal medicine residency training program in cardiovascular limited ultrasound examination. J Hosp Med. 2012;7(7):537-542. doi:10.1002/jhm.1944.
Dulohery MM, Stoven S, Kurklinsky AK, et al. Ultrasound for internal medicine physicians: the future of the physical examination. J Ultrasound Med. 2014;33(6):1005-1011. doi:10.7863/ultra.33.6.1005.
Skalski JH, Elrashidi M, Reed DA, McDonald FS, Bhagra A. Using Standardized Patients to Teach Point-of-Care Ultrasound-Guided Physical Examination Skills to Internal Medicine Residents. J Grad Med Educ. 2015;7(1):95-97. doi:10.4300/JGME-D-14-00178.1.
Schnobrich DJ, Olson APJ, Broccard A, Duran-Nelson A. Feasibility and acceptability of a structured curriculum in teaching procedural and basic diagnostic ultrasound skills to internal medicine residents. J Grad Med Educ. 2013;5(3):493-497. doi:10.4300/JGME-D-12-00214.1.
Galen BT, Schnobrich DJ. Pocket-sized Ultrasound for Physical Diagnosis. J Gen Intern Med. 2015;30(7):883. doi:10.1007/s11606-015-3318-2.
Schnobrich DJ, Gladding S, Olson APJ, Duran-Nelson A. Point-of-Care Ultrasound in Internal Medicine: A National Survey of Educational Leadership. J Grad Med Educ. 2013;5(3):498-502. doi:10.4300/JGME-D-12-00215.1.
Soni NJ, Lucas BP. Diagnostic point-of-care ultrasound for hospitalists. J Hosp Med. 2014;10(2):120-124. doi:10.1002/jhm.2285.
Lucas, B. P., Tierney, D. M., Jensen, T. P., Dancel, R., Cho, J., El-Barbary, M., … Lucas, B. P. (2018). Credentialing of Hospitalists in Ultrasound-Guided Bedside Procedures: A Position Statement of the Society of Hospital Medicine. Journal of Hospital Medicine. http://doi.org/10.12788/jhm.2917
Ma, I. W. Y., Arishenkoff, S., Wiseman, J., Desy, J., Ailon, J., Martin, L., … Canadian Internal Medicine Ultrasound (CIMUS) Group*. (2017). Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. Journal of General Internal Medicine, 32(9), 1052–1057. http://doi.org/10.1007/s11606-017-4071-5
Mathews, B. K., Reierson, K., Vuong, K., Mehta, A., Miller, P., Koenig, S., & Narasimhan, M. (2018). The Design and Evaluation of the Comprehensive Hospitalist Assessment and Mentorship with Portfolios (CHAMP) Ultrasound Program. Journal of Hospital Medicine, (February), 1–7. http://doi.org/10.12788/jhm.2938
Platz, E., Merz, A. A., Jhund, P. S., Vazir, A., Campbell, R., & McMurray, J. J. (2017). Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review. European Journal of Heart Failure, 19(9), 1154–1163. http://doi.org/10.1002/ejhf.839
Thank you to Dr. Renee Dversdal (Twitter: DRsonosRD) for the helpful resources