479 - POCUS: What Exactly are Pediatric Residents Looking At?

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 479
Publication Number: 479.421

Trenton Rivera, Children's National Health System, Washington, DC, United States; Ernestina F. Gambrah, Children's National Health System, WASHINGTON, DC, United States; Piyawat Arichai, University of Southern California, Pasadena, CA, United States; April Slamowitz, Cohen Children's Medical Center, Island Park, NY, United States; Sonali Basu, Children's National Health System, Arlington, VA, United States; Jeremy Kern, Children's National Health System, Washington, DC, United States; Alyssa Abo, Children’s National Hospital, Washington, DC, United States; Angela Maxwell, Children's National Health System, Washington, DC, United States

Presenting Author(s)

Trenton Rivera, MD (he/him/his)

Resident Physician
Children's National Hospital
Washington, District of Columbia, United States

Background: Point-of-care ultrasound (POCUS) is a clinician-performed examination that can provide timely diagnostic information and procedural guidance in pediatrics. However, there is currently no standard curriculum or validated evaluation tool for POCUS training in pediatric residency programs. Our needs assessment in 2020 demonstrated a strong desire for a POCUS curriculum from both trainees and faculty, which led to the development and implementation of a two-week POCUS elective. Our curriculum evaluation in 2021 demonstrated that the elective improved resident POCUS knowledge and self-efficacy. However, higher-level learning goals such as image acquisition and interpretation skills remained a challenge to systematically evaluate.

Objective: Evaluate POCUS higher-level learning goals using standardized POCUS worksheets at our institution. Our novel worksheet is a combination of the standard POCUS reporting guidelines of the American College of Emergency Physicians and Butterfly iQ worksheets.

Design/Methods:
Residents participated in a 2-week POCUS elective consisting of online modules, hands-on sessions, and supplemental reading materials. Residents completed a POCUS worksheet documenting views, findings, interpretations, as well as confidence scoring for each study obtained, which were reviewed by POCUS trained Pediatric Emergency Medicine faculty. The view adequacy and completion of findings and interpretation documented in the POCUS worksheets were analyzed.

Results:
From July, 2020 to February, 2022, 24 residents completed the elective. Residents completed a total of 94 scans with accompanying worksheets. By system, this included 6 lung, 17 cardiac, 30 FAST, 5 renal/bladder, 20 soft tissue/MSK, 6 biliary, 5 pelvic and 5 others. Residents obtained 74% of the required views, 82% of the required findings and were able to make interpretations in 90% of the scans. (Table 1) Residents averaged moderate confidence in image acquisition, quality of views obtained and accuracy of interpretation. (Table 2)

Conclusion(s): Standardized POCUS worksheets can be used to systematically evaluate effectiveness of a POCUS curriculum. Residents demonstrated the ability to successfully obtain the required POCUS views and document relevant findings. Residents were most successful at lung and cardiac exams and least effective at MSK and FAST exam, which can guide the focus of curriculum changes. Further study is needed to determine the accuracy of POCUS interpretation and assess the utility of POCUS worksheets longitudinally in learning environments with varying degree of supervision.