“There’s been an explosion of interest in the use of point-of-ultrasound,” Nilam J. Soni, MD, MS, SFHM, FACP, explains. “It doesn’t take a lot to convince physicians that there’s a need for better technology at the bedside, and point-of-care ultrasound provides that. The question, then, is: We’ve established that this is a better way to provide care, and the technology is available, but why isn’t everyone using it?”
For a study published in the Journal of Hospital Medicine, Dr. Soni, Jason P. Williams, MD, and colleagues aimed to determine current point-of-care ultrasound (POCUS) use, as well as training needs, and barriers related to, POCUS use among chiefs of hospital medicine groups in Veterans Affairs medical centers.
“Uniquely in this study, we wanted to characterize the changes in POCUS use over time,” Dr. Williams notes. “We were able to do this by comparing the results of this study to a previous survey by our group from 2015.”
‘Huge Gap’ Between Current POCUS Use and Desire for Training
The study team reported a 90% response rate among the 117 hospital medicine groups surveyed and ongoing POCUS use in 64% of the groups. Between 2015 and 2020, procedural POCUS use declined by 19%, but diagnostic POCUS use rose by 8% for cardiac applications, 7% for pulmonary applications, and 8% for abdominal applications.
“I was very impressed to see that 64% of hospital medicine groups reported at least one person using POCUS,” says Dr. Soni. “However, the number of groups using POCUS didn’t grow substantially, as we had thought it would.”
Of the barriers to POCUS use reported by hospital medicine chiefs, lack of training was the most common (89%), and only 34% of hospital medicine groups had access to such training (Table). Access to ultrasound equipment was the most infrequent barrier to use, at 57%, and the proportion of hospital medicine groups with one or more ultrasound machines rose from 29% to 71% from 2015-2020.
According to Dr. Soni, “a huge gap exists” in current POCUS use compared with the desire for training. He cited multiple reasons for this gap, including the inability to use the technology without training, the inability to access training, and—at least initially—the inability to access equipment.
“We made progress from the perspective of equipment availability between 2015 and 2020,” Dr. Soni says. “Only about 30% of hospital medicine groups had a one or more ultrasound machines available in 2015, but that increased to about 70% in 2020. It’s the training gap that persists in 2020.”
Identifying, Then Addressing Barriers to Training
The results show that “there has to be an investment in training and infrastructure” for POCUS use to expand, Dr. Williams, notes.
“It isn’t just the actual training that physicians need access to,” Dr. Soni says. “It’s the factors related to training, including taking time off work to participate, finding a course that’s available, and traveling to the course, which is hard on clinicians’ families and partners. There is also the question of who pays for the training.”
The implications “are based on specific needs within a health system,” he continues, including whether training is available, whether clinicians can access training, and whether equipment is available for practice.
“There are many training models out there, and they vary quite a bit,” Dr. Soni says. “I haven’t seen much research about which training model is the most efficient or the most effective to allow learners to reach competency for POCUS independently. How long is the ideal course? How many scans does a clinician need to do before they’re considered competent? We don’t currently have a lot of evidence for educational outcomes in terms of how to efficiently reach competency.”
Finally, the researchers agree that it will likely take 10 to 20 years before all clinicians who want to use POCUS are fully trained in the technology.
“Certain specialty training programs, whether they are residences or fellowships, require ultrasound training, including critical care, emergency medicine, and endocrinology, but the general medicine programs—family medicine, internal medicine, pediatrics—currently do not,” Dr. Soni says. “Once it becomes a requirement, though, it will allow us to obtain the resources to put the training infrastructure in place for everyone.”