Performance of the Cardiovascular Point of Care Ultrasound (POCUS) Exam by Internal Medicine Residents

Few studies have examined internal medicine residents' performance using cardiovascular point of care ultrasound (POCUS).

From 2019 to 2022, first-year residents from two academic medical centers in Baltimore participated in the Assessment of Examination and Communication Skills (APECS). Interns examined a single patient with aortic insufficiency and were assessed on physical exam and POCUS technique, identifying physical exam and POCUS findings, generating a differential diagnosis, clinical judgment, and maintaining patient welfare. Spearman's correlation test was used to describe associations between clinical domains. Preceptor comments were examined to identify common errors in physical exam and POCUS exam technique and in identifying correct findings.

Fifty-three first-year residents (interns) performed a cardiovascular POCUS exam. Of these, 44 (83%) scored either "unsatisfactory" or "borderline" on their POCUS technique with a mean score of 29.5 (out of 100). Seventeen (32%) interns were able to correctly obtain a parasternal-long axis (PLAX) view with only 26 (52%) attempting an apical four-chamber (AP4) or subcostal (SUBC) view. Of the 11 participants who correctly obtained both PLAX and parasternal-short views (PSAX), 10 were able to properly identify a normal ejection fraction and the absence of a pericardial effusion. POCUS technique was statistically significantly associated with physical exam technique, identifying the correct POCUS findings, and generating a correct differential diagnosis (r=0.46, p<0.01; r=0.41, p=<0.01; r=0.60, p=<0.01, respectively).

Internal medicine interns showed variable skill in performing and interpreting a cardiovascular POCUS exam. Further emphasis on teaching cardiovascular POCUS skills would likely increase ability to identify relevant cardiovascular findings and improve patient care.