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

Point-of-care ultrasound (POCUS) is endorsed by multiple national societies as an important skill in internal medicine (IM). Despite its growing importance, current evaluation methods for POCUS competence focus primarily on image acquisition and interpretation, overlooking clinical decision-making.

We developed and evaluated an objective structured clinical examination (OSCE) that assesses IM residents' ability to select appropriate ultrasound examinations, interpret pathological images, and integrate these findings into clinical decision-making.

Over both the 2022 and 2023 academic years, 110 postgraduate year-2 IM residents participated in a longitudinal POCUS curriculum. Eighty-one of these residents participated in a 40-min OSCE case 9 months later. In the OSCE, residents encountered a clinical case involving a patient with systemic lupus erythematosus and respiratory distress, requiring both lung and cardiac ultrasounds. Residents' performance was evaluated using a 50-question rubric that assessed image quality, interpretation, and clinical reasoning. This is a cross-sectional study.

Most residents successfully identified the appropriate examinations and interpreted pathological images, with 91% performing a lung ultrasound and 96% performing a cardiac ultrasound. However, many residents did not conduct a comprehensive lung exam, and many faced challenges obtaining certain cardiac views. Despite these gaps, most residents articulated appropriate differential diagnoses and management plans.

Our OSCE was able to evaluate the scanning patterns of the residents and test their ability to apply abnormal findings to a case, despite variability in the residents' scanning skills. This OSCE highlights opportunities to improve our POCUS curriculum in emphasizing comprehensive examination techniques and integration of clinical reasoning.