Beyond the Echo Chamber: A Train The Trainer (T3) approach to Point of Care Ultrasound Education for Duke IM residents
Title: Beyond the Echo Chamber: a train the trainer (T3) collaborative approach to POCUS education for Duke Internal Medicine Residents Authors: Madeline Watson MD, John Demis MD, Amber Bowman, MD, PhD, Lindsey Wu, MD, Brice Lefler MD. Background/Purpose: Point of care ultrasonography refers to ultrasonography performed at the bedside by the treating clinician in real time. Studies have shown POCUS can increase clinician diagnostic performance compared with traditional clinical examinations without hazards of radiation nor patient transport (Gartlehner, et al). As such, POCUS is used widely, and IM resident physicians are interested in learning this valuable skill. However, learning image acquisition, interpretation and integration is time and labor-intensive. To meet this educational need the Durham VA invested in a small group of VA hospitalists to become POCUS champions. These experts in turn created a 2.5 day ‘Intro to POCUS’ Workshop and taught this curriculum to all VA hospitalists and Duke IM residents from 2021-2024. 91.6% of interns completed this workshop ‘very interested’ to participate in JAR workshop with advanced topics. However, POCUS education is complex; learners require regular supervised practice to develop skills to integrate ultrasound into clinical management and avoid pitfalls associated with incorrect use (Olgers et al., 2020). Objective and Methods: To meet this educational need, a ‘train the trainer’ T3 model (Butki et al.) approach was used with funding support from the Duke IM residency council to create the POCUS Champions Pathway. This specific track educates 12 residents annually. These six JARs and six SARs are pursuing a variety of career paths yet share a strong interest in POCUS and commitment to peer education. The pathway offers advanced POCUS didactics, dedicated scanning time on ‘gel rounds’, teaching opportunities in workshops, access to a POCUS qbank, as well as supervision and feedback on a personal ultrasound portfolio. Investing so heavily into these champions empowers and prepares them to teach POCUS to their peers throughout their residency rotations, shifting the culture toward POCUS use. Outcomes and Improvements: Since its inception, 18 residents have participated in the POCUS Pathway. In 2025, the first set of POCUS Champions from the full two-year program will graduate. Residents have noted the pathway to be helpful in increasing their ultrasound knowledge, use and confidence. The majority of interns cited using POCUS about once per month prior to the Intro to POCUS course, while the majority of champions cite using POCUS multiple times per week as a result of their education and teaching their peers. Significance: Didactics and trainings have increased POCUS use dramatically. The medical adage of ‘see one, do one, teach one’ echoes true for POCUS education. Uniquely, the Durham VA Hospital Medicine Program and Duke Internal Medicine have partnered and used the T3 model in three iterations, initially training VA hospitalist champions, then training VA attending hospitalists, and finally training resident champions. This model and the POCUS Champion Pathway create ripple effects to improving education to all internal medicine trainees and serves as a model for education where there is not a substitute for 1:1 supervised training. References: Reaume, M., Siuba, M., Wagner, M., Woodwyk, A., Melgar, T.A., 2019. Prevalence and Scope of Point-of-Care Ultrasound Education in Internal Medicine, Pediatric, and Medicine-Pediatric Residency Programs in the United States. J. Ultrasound Med. 38, 1433–1439. https://doi.org/10.1002/jum.14821 Olgers, T.J., Azizi, N., Bouma, H.R., ter Maaten, J.C., 2020. Life after a point-of-care ultrasound course: setting up the right conditions! Ultrasound J. 12, 43. https://doi.org/10.1186/s13089-020-00190-7 Butki N, Long J, Butki A, Corser W. A Novel 'Train the Trainer' Emergency Medicine Resident Point-of-Care Ultrasound Course: A Feasibility Study. Spartan Med Res J. 2020 Jan 30;4(2):11650. doi: 10.51894/001c.11650. PMID: 33655171; PMCID: PMC7746134. Gerald Gartlehner, Gernot Wagner, Lisa Affengruber, et al.Point-of-Care Ultrasonography in Patients With Acute Dyspnea: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med.2021;174:967-976. [Epub 27 April 2021]. doi:10.7326/M20-5504 Kobal SL, Trento L, Baharami S, et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005;96:1002-6.
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