INTRODUCTION
With increasing evidence and support in using point-of-care ultrasound (POCUS) at the bedside,
1‐4 its application in internal medicine is gaining traction in North America and internationally.
4‐7 In 2018, the American College of Physicians issued an official statement in support of POCUS use for internal medicine.
4 Similarly, for the practice of hospital medicine, the Society of Hospital Medicine has issued a position statement providing guidance for hospitalists and administrators regarding application, training, assessment, and program management for POCUS.
8 Internal medicine residency training programs have only recently begun to incorporate POCUS in their curricula. A national survey in 2013 revealed that only 25% of internal medicine residency programs in the USA offered a formal POCUS curriculum.
9 Since then, a number of programs across the USA have described successful efforts at introducing POCUS to their internal medicine training programs, both in a workshop format
10,11 and longitudinal curricula.
12‐14
Despite these advances, internal medicine point-of-care ultrasound (IM POCUS) curriculum development and implementation continues to be a challenge globally for many residency training programs. For example, a survey study in Chicago suggests that learners continue to feel incompetent in the use of ultrasound,
15 and learners in Canada similarly reported low level of IM POCUS skills.
16 Barriers to IM POCUS education consistently cited in the literature include lack of access to equipment, lack of established curricula, limited availability of educational time, and lack of trained faculty.
9,17‐20 Introducing a novel technology such as POCUS into clinical practice requires significant resources and new infrastructure (e.g., ultrasound machines, image archiving systems), and relies on a limited supply of professionals with expertise. As such, integrating POCUS is expected to be formidable.
21 Potential solutions to integrate POCUS, therefore, must be engineered to anticipate and overcome these obstacles—a multifaceted approach is necessary.
On a global scale, education is diverse and heterogeneous. To allow for the comparisons of the state of education worldwide, the Organization for Economic Co-operation and Development (OECD) publishes annual results on education indicators.
22 These indicators characterize education outputs, financial and human resources invested, access to education, and learning environments.
22 These process, structure, and outcome measures provide timely and quantifiable key information metrics for policy decision-makers and can assist in ensuring quality across programs.
23
Education indicators are rarely utilized in medical education, given the relative stability in medical education over the past decades.
24 The introduction of POCUS has, in many ways, produced a technological disruption that is challenging in the current era of stability
25 and is raising new issues in the geographically diverse landscape of Canada. Establishing standards to define program processes, structure, and outcomes is a crucial step to ensure that POCUS program development is deployed in a thoughtful manner and with broad support. Education indicators provide policy makers and educators such as hospital administrators, program directors, and POCUS faculty with a clear and instructive framework to guide curriculum development, implementation, evaluation, and monitoring efforts. Establishing standardized measures of quality can help advance POCUS education in a number of ways.
26 First, POCUS educators can improve the design and delivery of their POCUS curriculum by adhering to quality metrics espoused by the education indicators. Second, education indicators can assist policy makers such as hospital administrators and program directors in where to direct necessary resources. Third, by adhering to education indicators, greater uniformity in quality can be achieved across programs. This study seeks to establish consensus-based recommendations for education program indicators for internal medicine POCUS training in Canada.
Acknowledgments
We wish to thank the Canadian Society of Internal Medicine Council and Education Committee for their support of our work. The following are members of the 2017 Canadian Internal Medicine Ultrasound (CIMUS) Group:
Anshula Ambasta, MD, MPH, FRCPC: Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada;
Shane Arishenkoff, MD, FRCPC: Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; shanearish@hotmail.com
Marko Balan, MD, FRCPC: Division of General Internal Medicine, Department of Critical Care, Dalhousie University, Halifax, NS, Canada; Marko.Balan@Dal.ca
Marcus Blouw, MD, MHA, FRCPC: Department of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada; mblouw@hsc.mb.ca
Brian Buchanan, MD, FRCPC: Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada; bmb@ualberta.ca
Sharon E. Card, MD, MSc, FRCPC: Division of General Internal Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; sharon.card@usask.ca
Barry Chan, MB, BCh, BAO, MD, FRCPC: Division of General Internal Medicine, Department of Medicine, Queen’s University, Kingston, ON, Canada; barrytschan@gmail.com
Janeve Desy, MD, MEHP, FRCPC, RDMS: Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada; janeve.desy@albertahealthservices.ca
Gabriel Demchuk, MD: General Internal Medicine, Université Laval, Québec, QC, Canada;
Colin R. Gebhardt, MD, FRCPC: Division of General Medicine, Department of Medicine, Department of Critical Care, University of Saskatchewan, Saskatoon, SK, Canada; icurg@gmail.com
Alberto Goffi, MD: Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; alberto.goffi@uh.ca
Samantha Halman, MD, MMED, FRCPC: Division of General Internal Medicine, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; shalman@toh.ca
Brendan Kerr, MD, RDMS, FRCPC: Clinical Assistant Professor, Division of General Internal Medicine, Department of Medicine, University of Calgary, AB, Canada; kerr.brendan@gmail.com
Irene W. Y. Ma, MD, PhD, RDMS, RDCS, FRCPC: Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada; ima@ucalgary.ca
Leslie Martin, MD, FRCPC, MHPE: Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton ON, Canada; leslie.martin@medportal.ca
Michael Mayette, MD, FRCPC: Internal Medicine and Critical Care Medicine Division, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada; michael.mayette@usherbrooke.ca
Steven J. Montague, MD, FRCPC: Division of General Internal Medicine, Department of Medicine, Queen’s University, Kingston, ON, Canada; StevenJMontague@gmail.com
Sharon Mulvagh, MD, FRCPC, FASE, FACC, FAHA: Professor of Medicine, Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, NS, Canada; Professor Emeritus, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA; sharon.mulvagh@nshealth.ca
Jennifer Ringrose, MD, MSc: Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada; jringros@ualberta.ca
Shannon Ruzycki, MD, FRCPC: Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada: sarro@ualberta.ca
Jeffrey P. Schaefer, MD, MSc. FRCPC: Division of General Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB, Canada; jpschaef@ucalgary.ca
Jeffrey Yu, MD, FRCPC: Division of General Internal Medicine, Department of Medicine, Western University, London, ON, Canada; jeffrey.yu@lhsc.on.ca