Title

Barriers to POCUS Use for Medical Students in the Internal Medicine Core Clerkship

Author

Mohit Bandla MS, BS

Area of Concentration (Petal)

Medical Education & Leadership 

Specialty 

Internal Medicine

Keywords: Internal Medicine clerkship, barriers to POCUS use, POCUS 

Background: The use of POCUS has risen in recent times as providers have embraced this portable and non-invasive diagnostic imaging tool. The David Geffen School of Medicine at UCLA (DGSOM) in particular has implemented a longitudinal POCUS curriculum for medical students that includes integration of clerkship-specific POCUS training. In IM, this includes focused echocardiography, and inferior vena cava (IVC) assessments for volume status. For students, there have been several barriers to regular use of POCUS in this population identified in previous studies including lack of trained faculty, lack of protected time for curricular development, and lack of infrastructure to support saving studies. Many specialties have fully integrated POCUS in graduate medical education training, including Emergency Medicine, but it has only recently been incorporated into IM training. This survey study focuses on the utilization and perceptions of barriers to POCUS use on a 6-week IM inpatient clerkship for second and third-year medical students at DGSOM. 

Objective: Our objective is to better understand medical students’ main barriers to utilization of point-of-care ultrasound (POCUS) while on the Internal Medicine (IM) clerkship. 

Methods: We conducted a mixed methods study incorporating multiple rounds of random sampling of all currently listed second and third-year medical students at six core DGSOM clinical sites. Participants were asked via an online questionnaire about their use of POCUS during the IM clerkship, and barriers in three domains: 1) knowledge / skills performing POCUS (eg, performing POCUS), 2) attitudes about POCUS (eg, perceived relevance of POCUS), and 3) team/workflow issues (eg, presence of supervisors) while using POCUS. Surveys will then be followed up with semi-structured interviews to gain insight into student experiences with POCUS and its barriers to use. 

Results: Response rate was 22/72 (30.6%). Results (n = 22) indicate that a mean of 2.3 (median of 2.0) ultrasound scans were conducted among all sites, with a mean of 2.2 scans being used for clinical diagnosis/management. Types of scans include volume status (eg, IVC) and other assessments. Results indicated that within the skills domain, students felt comfortable with turning a POCUS machine on/off (mean = 3.9/5 on Likert scale), but did not feel as comfortable saving studies (mean = 2.3/5). Within the attitudes and team domains, 55% of respondents felt that potential uses of POCUS did not occur due to the team not deeming POCUS necessary, while a similar percentage of respondents felt a lack of personal knowledge with the POCUS exam (55%). Preliminary interview results suggest that lack of use of POCUS by the primary team was a consistent barrier, despite students’ desire to use it. Of note, a majority of students indicated visual aids (eg, reference cards) would be helpful. 

Conclusions: A low number of scans have been performed over the course of the average inpatient rotation across multiple sites. Given the average respondents' perception ratings, the difficulty of POCUS use and its integration into clinical decision-making are important to consider for first-time learners.  Further interviews are pending to obtain qualitative information from this study.