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Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial
Jason C Ojeda1, James A Colbert, Xinyi Lin
1Department of Medicine, Jefferson University, Philadelphia, PA, USA.
Background:
Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded.
Objective:
We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice.
Design:
This was a randomized parallel group controlled trial.
Participants:
Forty internal medicine residents in a single program at an academic medical center participated in the study.
Intervention:
Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice.
Main Measures:
The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound.
Key Results:
Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023).
Conclusions:
The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice.
Trial Registration:
clinicaltrials.gov: number NCT01948076; URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2.
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