What learners want: Qualitative analysis of learner interviews in developing a longitudinal point-of-care ultrasound curriculum for internal medicine faculty

Background: Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound technology to make diagnostic and therapeutic decisions in real-time at the patient’s bedside. In recent years, the use of POCUS by... [ view full abstract ]

Background:
Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound technology to make diagnostic and therapeutic decisions in real-time at the patient’s bedside. In recent years, the use of POCUS by hospitalist and primary care physicians has increased greatly. POCUS training is also expanding in medical schools and internal medicine residency programs. Numerous studies have attempted to determine if brief POCUS training sessions result in improved skills, with mixed results. These training programs are typically one-time events with limited follow-up support. There is relatively little data examining the feasibility, structure, and educational outcomes of longitudinal POCUS curricula. In developing a POCUS training program for general internal medicine clinician-educators, we conducted qualitative interviews with participants with responses being used to inform curricular design and maximize participant engagement.

Methods:
We conducted semi-structured, key-informant interviews with the participants (n=10) of a POCUS curriculum at a large Midwestern academic institution. Participants included volunteer general internal medicine faculty and chief residents who regularly work with residents and students. Interviewees discussed their perceptions regarding various aspects of POCUS training, including facilitators/barriers, clinical applications, and impact on their teaching. Interviews were recorded, transcribed verbatim, and coded for themes. Thematic analysis was conducted to look for similarities between provider perceptions and was used to code, organize, and describe patterns and concepts in the data. The constant comparison method was used to organize themes into categories using inductive category coding to concurrent comparison of relationships as they appear throughout the analysis.

Results:
Demographics: The interview response rate was 100% (10/10), with 40% females (4/10). The median interval since participants completed medical school was 5.5 years (range 3-16). Nine of ten participants had no prior POCUS training.

Themes: Faculty participants were motivated to learn POCUS to improve their clinical and teaching skills. Most felt that a workshop was a good method to introduce key concepts, but that longitudinal support was necessary to achieve competence. Interviewees felt that practicing in peer groups and structured image review sessions would be the most helpful curricular components. Time limitations was the biggest perceived barrier to learning and teaching POCUS. Participants also expressed concerns about becoming confident enough to apply these skills to real-world patients and to teach others. Perceived facilitating factors included the development of multi-facetted and comprehensive longitudinal training, accountability to peers, and the ongoing support of instructors and administrative leaders.

Discussion:
Our study identified learner perceptions that will help inform the development of a POCUS faculty development program. Many training programs rely on one-time workshops, but our data suggests that novice learners feel ongoing longitudinal support is necessary if they are to develop competence. Interviewees felt peer mentoring groups would be particularly helpful, as a means to create accountability and avoid practice attrition and skills decay. They also supported the creation of regular didactic and image review sessions. Unsurprisingly, time limitations was the biggest perceived barrier, suggesting that curriculum designers need to consider ways to optimize training efficiency (e.g. reliable access to machines), allow for flexibility in the training schedule (e.g. online didactic content, real-time supervision at the bedside), and garner support from administrative leadership to support dedicated time for learning and teaching this skill set. As the demand for POCUS training for students, residents, hospitalists, and primary care physicians continues to grow, this information can help guide curriculum development in other programs and institutions.