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Echocardiographic Assessment Using Subxiphoid-Only Examination for Hypotensive Patients

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Assessing Clinical Integration of Point-of-Care Ultrasound With an Objective Structured Clinical Examination.

N Caroline Srisarajivakul-Klein¹, Jennifer Dong¹, Aron Mednick²

¹Department of Medicine, New York University Grossman School of Medicine, NYC Health & Hospitals/Bellevue, New York City, NY, USA.

Journal of Medical Education and Curricular Development

|December 30, 2025

Summary

Internal medicine residents demonstrated proficiency in selecting and interpreting point-of-care ultrasound (POCUS) exams, but opportunities exist to enhance comprehensive scanning techniques and clinical reasoning integration in their POCUS curriculum.

Keywords:

OSCE POCUS clinical reasoning graduate medical education point-of-care ultrasound simulation

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Area of Science:

Medical Education
Point-of-Care Ultrasound
Internal Medicine

Background:

Point-of-care ultrasound (POCUS) is a crucial skill in internal medicine (IM), endorsed by national societies.
Current POCUS competence evaluations often neglect clinical decision-making, focusing only on image acquisition and interpretation.

Purpose of the Study:

To develop and assess an objective structured clinical examination (OSCE) for IM residents.
To evaluate residents' ability in selecting POCUS exams, interpreting images, and integrating findings into clinical decisions.

Main Methods:

A longitudinal POCUS curriculum was implemented for 110 PGY-2 IM residents over two academic years.
An OSCE case involving systemic lupus erythematosus and respiratory distress was administered to 81 residents, assessing image quality, interpretation, and clinical reasoning via a 50-question rubric.

Main Results:

Most residents successfully selected appropriate POCUS examinations (91% lung, 96% cardiac) and interpreted images.
Gaps were identified in comprehensive lung exam performance and acquisition of certain cardiac views.
Despite technical challenges, the majority formulated appropriate differential diagnoses and management plans.

Conclusions:

The developed OSCE effectively evaluated residents' scanning patterns and application of findings to clinical scenarios.
The study identified areas for POCUS curriculum improvement, emphasizing comprehensive examination techniques and clinical reasoning integration.